血清胃泌素释放肽前体和神经元烯醇化酶在小细胞肺癌的辅助诊断作用及影响因素

Diagnostic Value of Serum Pro-gastrin-releasing Peptide and Neuron-specific Enolase for Small Cell Lung Cancer and Its Influencing Factors

目的分析评价血清胃泌素释放肽前体（pro-gastrin-releasing peptide,ProGRP）和神经元烯醇化酶（neuronspecific enolase,NSE）在小细胞肺癌（small cell lung cancer,SCLC）患者临床辅助诊断中的作用及干扰因素。方法 2010年7月至2012年6月在北京协和医院住院的SCLC患者（SCLC组）93例、非小细胞肺癌（non-small cell lung cancer,NSCLC）患者（NSCLC组）120例、肺良性疾病患者（肺良性疾病组）120例及健康者（健康对照组）90名,分别采用ELISA法测定各组血清ProGRP和NSE浓度;化学发光免疫分析和电化学发光免疫分析方法评价标本溶血和患者肾功能损害对2项指标在SCLC诊断中的影响。结果 SCLC组的血清ProGRP和NSE浓度分别为90.61（11.75～20 020.90）ng/L和13.18（3.05～201.88）μg/L;NSCLC组为13.26（8.54～526.23）ng/L和5.86（1.80～100.90）μg/L;肺良性疾病组为24.65（1.32～802.93）ng/L和7.22（1.36～174.62）μg/L;健康对照组为14.74（4.59～100.86）ng/L和4.95（1.31～10.58）μg/L;SCLC组与其他组相比差异均具有统计学意义（P〈0.01）。血清ProGRP诊断SCLC的受试者工作特征曲线下面积为0.856±0.023（95%CI：0.811～0.901）;以46 ng/L为临界值时,其敏感度、特异度、阳性预测值、阴性预测值和约登指数分别为64.5%（60/93）、94.2%（311/330）、75.9%（60/79）、90.4%（311/344）和58.7%。标本溶血严重影响NSE的检测水平,导致NSE结果升高;患者肾功能损害则使ProGRP的检测结果升高。结论血清ProGRP和NSE均为辅助诊断SCLC较好的指标,ProGRP与NSE组合的临床诊断价值较高。标本溶血严重导致NSE的检测结果升高,患者肾功能损害则使ProGRP的检测结果升高。

Objective To investigate the clinical significance and influencing factors of serum levels of pro-gastrin-releasing peptide（ ProGRP） and neuron-specific enolase（ NSE） in the diagnosis of small cell lung cancer（ SCLC）. Methods The levels of serum ProGRP and NSE in 93 SCLC patients（ SCLC group）,120non-small cell lung cancer（ NSCLC） patients（ NSCLC group）,120 benign pulmonary disease patients（ benigndisease group）,and 90 healthy people（ healthy control group） were determined using enzyme-linked immunosorbent assay（ ELISA）. The potential impacts of the hemolysis in samples and impaired renal function on ProGRP and NSE were tested via electroluminescent and chemiluminescent immunoassay,respectively. Results The serum ProGRP and NSE concentrations were 90. 61（ 11. 75- 20 020. 90） ng /L and 13. 18（ 3. 05- 201. 88） μg /L,respectively,in SCLC group; 13. 26（ 8. 54- 526. 23） ng /L and 5. 86（ 1. 80- 100. 90） μg /L in NSCLC group;24. 65（ 1. 32- 802. 93） ng /L and 7. 22（ 1. 36- 174. 62） μg /L in benign disease group; and 14. 74（ 4. 59-100. 86） ng /L and 4. 95（ 1. 31-10. 58） μg /L in healthy control group. The levels in the SCLC group were significantly different from those in the other three groups（ all P〈0. 01）. The area under the receiver operating characteristic curve of ProGRP was（ 0. 856 ± 0. 023）（ 95% CI： 0. 811- 0. 901）. When the cutoff value of ProGRP was set at 46 ng /L,the diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and Youden＇s index were 64. 5%（ 60 /93）,94. 2%（ 311 /330）,75. 9%（ 60 /79）,90. 4%（ 311 /344）,and 58. 7%,respectively,showing good detection performance. Sample hemolysis seriously improved the detection results of NSE. Patients with impaired renal function had higher ProGRP levels. Conclusions The serum ProGRP and NSE levels are valuable tumor markers for the diagnosis of SCLC. Detection of both markers are particularly useful for the monitoring of SCLC. Sample hemolysis may seriously increase the detected NSE level,whereas impaired renal function may increase the detected ProGRP level.