血清ProGRP和NSE在小细胞肺癌化疗疗效评价中的应用价值

The value of serum proGRP and NSE in the evaluation of the efficacy and prognosis of chemotherapy for small cell lung cancer patients

目的探讨血清胃泌素释放肽前体(Pro GRP)和神经源特异性烯醇化酶(NSE)在评价小细胞肺癌(SCLC)化疗疗效及其在判断预后方面的临床价值。方法采用回顾性研究方法,于2016年1月至2017年10月选取江苏省肿瘤医院和东南大学附属中大医院收治的90例接受标准化疗方案(依托泊苷+顺铂或依托泊苷+卡铂)治疗≥2个周期的SCLC患者作为研究对象,于化疗前及化疗2个周期后常规采集空腹静脉血,分别以酶联免疫吸附法(ELISA)、电化学发光法(ECLIA)检测血清ProGRP和NSE水平;评价化疗疗效并分析血清ProGRP和NSE水平与患者化疗疗效及其预后的关系。结果接受2个周期标准化疗方案治疗之后,完全缓解(CR)5例,部分缓解(PR)47例,稳定(SD)26例,进展(PD)12例;不同性别、不同年龄(<60岁、≥60岁)患者的血清ProGRP和NSE水平比较差异均无统计学意义(P>0.05),但肿瘤直径(<4 cm、≥4 cm)、分期(LD期、ED期)、是否远处转移患者的血清ProGRP和NSE水平比较差异均有统计学意义(P<0.05);治疗后CR组、PR组、SD组的血清ProGRP和NSE水平均较治疗前显著降低(P<0.05),但PD组血清ProGRP水平较治疗前升高(P<0.05),血清NSE较治疗前无显著变化(P>0.05);血清ProGRP高水平组(≥75.3 pg/ml)、低水平组(<75.3 pg/ml)与血清NSE高水平组(≥16.3 ng/ml)、低水平组(<16.3 ng/ml)的无进展生存期(PFS)差异有统计学意义(<0.05);经COX回归分析,血清NSE是有意义的预后影响因素(P<0.05)。结论血清ProGRP在监测SCLC患者化疗疗效方面敏感性高于血清NSE,而血清NSE在判断SCLC患者预后方面敏感性高于血清ProGRP;两种指标相互补充、综合参考,在判断SCLC患者病情进展、化疗疗效以及临床预后方面更有积极意义。

Objective To investigate the serum gastrin-releasing peptide precursor（ Pro GRP） and the source of neural specificity enolization enzyme（ NSE） in evaluating the effect of small cell lung cancer（ SCLC） chemotherapy and its clinical value in judging prognosis. Methods 90 SCLC patients who underwent standard chemotherapy regimens（ Etoposide ＋ Cisplatin and Etoposide ＋ Carboplatin） treatment were selected as the research objects. Before and after chemotherapy,routine fasting venous blood was collected after 2 cycles,and enzyme-linked immunosorbent（ ELISA） and electrochemical luminescence（ ECLIA） was used to detect serum Pro GRP and NSE level; The efficacy of chemotherapy and the relationship between serum Pro GRP and NSE levels in patients were analyzed. Results After treatment of 2 cycles standard chemotherapy regimen,there were CR 5 patients,PR 47 patients,SD 26 patients,and PD 12 patients. serum Pro GRP and NSE levels of patients with different gender,age（ 〈 60 years old,the age of 60 years old or higher） had no statistical significant difference（ P 〉 0. 05）,but those parameters with different tumor diameter（ 〈 4 cm,4 cm or higher） and staging（ LD）,ED period,whether patients with distant metastasis were statistically significantly different（ P 〈 0. 05）; after treatment,the Pro GRP and NSE serum levels of CR,PR group were significantly lower than before treatment（ P 〈 0. 05）,but the serum Pro GRP level in SD group was higher than before treatment（ P 〈 0. 05）,serum NSE without significant difference（ P 〉 0. 05）. Progression-free surial（ PFS） of serum Pro GRP high level group（ 〉 43 ng/L）,the low level group（ 〈 43 ng/L） and high levels of serum NSE group（ 〉 17 ng/ml）,the low level group（ 〈 17 ng/ml） was statistically significantly different（ P 〈 0. 05）. After COX regression analysis showed that serum NSE was a significant prognostic factor（ P 〈 0. 05）. Conclusion Serum Pro GRP was more sensitive than serum NSE in monitoring the efficacy of chemotherapy in patients with SCLC,and serum NSE is more sensitive in monitoring the prognosis of SCLC patients than serum. The combination of the two indexes has significant value in judging the efficacy of chemotherapy and the clinical prognosis.