伴神经内分泌分化肺腺癌血清癌胚抗原水平的分析

The analysis of serum carcinoembryonic in neuroendocrine differentiation of lung adenocarcinoma

目的探讨伴神经内分泌分化(neuroendocrine differentiation,ND)的肺腺癌血清癌胚抗原(carcinoembryonic,CEA)水平及其与ND的关系。方法对160例确诊肺腺癌肺组织标本(包括手术切除及经纤支镜活检取得)采用免疫组化S-P法检测神经内分泌标志物的表达。治疗前抽取患者静脉血,用化学发光法检测血清CEA水平。结果 160例肺腺癌中具有ND的共19例(10.61%),其中突触素(synaptophysin,Syn)阳性5例(26.32%)、嗜铬颗粒蛋白(chromogranin,Cg A)阳性7例(36.84%)、神经元特异性烯醇酶(neuron specific enolase,NSE)阳性1例(5.26%)、Syn和Cg A同时阳性6例(31.58%)。伴ND的及不伴ND的肺腺癌组血清CEA水平分别为[16.54(2.5-89.92)]ng/m L和[2.71(1.56-4.97)]ng/m L,两者比较有统计学差异(P<0.05)。在伴ND的肺腺癌中Syn阳性组、Cg A阳性组、Syn+Cg A阳性组血清CEA水平分别为[49.36(4.05-181.71)]ng/m L、[2.5(2.1-28.02)]ng/m L和[87.7(16.54-171.25)]ng/m L。Syn阳性组与Cg A阳性组、Syn阳性组与Syn+Cg A阳性组比较均无统计学差异(P分别为0.198和0.462)。Cg A阳性组与Syn+Cg A阳性组比较有统计学差异(P=0.044)。Syn与血清CEA水平有相关性。以不伴ND的肺腺癌为对照组,诊断伴ND的肺腺癌的血清CEA的最佳折点为15.89ng/m L,敏感性44.4%,特异性90.6%,曲线下面积为0.76。结论血清CEA可能是预测肺腺癌伴ND的一个简单有效的指标。

Objective To explore the levels of carcinoembryonic antigen（CEA） and the correlation between CEA and neuroendocrine differentiation（ND） in patients with lung adenocarcinoma of neuroendocrine. Methods 160 lung tissue samples with lung adenocarcinoma（including surgical resection and biopsy by bronchoscopy） were taken in. The levels of neuroendocrine markers were detected by immunohistochemical S-P method. And the levels of serum CEA were detected by chemiluminescence before treatment. Results There were 19 lung adenocarcinomas（10.61%） with neuroendocrine differentiation in the 160 cases of lung adenocarcinomas. Among the 19 cases, 5 cases（26.32%） were positive of synaptophysin（Syn）, 7 cases（36.84%） were positive of chromogranin（Cg A）, 1 case（5.26%） was positive of neuron specific enolase（NSE）, and 6 cases（31.58%） were positive of both Syn and Cg A. The levels of serum CEA in lung adenocarcinoma with ND and non-neuroendocrine differentiation were [16.54（2.5-89.92）] ng / m L and [2.71（1.56-4.97）] ng / m L, respectively. And there was a significant difference in the levels of serum CEA between the two groups（P 0.05）. In the lung adenocarcinoma with ND, the levels of serum CEA in group positive of Syn, group positive of Cg A and group positive of Syn and Cg A were[49.36（4.05-181.71）] ng / m L, [2.5（2.1-28.02）] ng / m L and [87.7（16.54-171.25）] ng / m L, respectively.There were no significant differences in the levels of serum CEA between the group positive of Cg A, either between the group positive of Syn and the group positive of both Syn and Cg A（P =0.198 and P =0.462,respectively） There was a significant difference in the levels of serum CEA（P =0.044） between the group positive of Cg A and the group positive of both Syn anf Cg A. And there was a correlation between Syn and the levels of serum CEA. Taking the lung adenocarcinoma with non-neuroendocrine differentiation as a control group, the cut-off of serum CEA to distinguish lung adenocarcinoma with ND was 15.89 ng / m L, while the sensitivity, specificity and the area under curve were 44.4%, 90.6% and 0.76, respectively. Conclusion The serum CEA is possibly a simple and effective marker to predict the lung adenocarcinoma with ND.