血清PCT及NSE对小细胞肺癌患者的诊断价值

Study on the diagnostic value of serum PCT and NSE on small cell lung cancer

目的探究神经元特异性烯醇化酶(NSE)及血清降钙素原(PCT)对小细胞肺癌诊断、疗效检测的临床价值。方法选取2015年1月至2016年12月于该院接受治疗的肺癌患者90例,其中小细胞肺癌患者33例,非小细胞肺癌患者57例(包括腺癌患者30例,鳞癌患者27例);再选取同期来该院进行体检的健康者35例作为对照组,测量患者血清中的NSE及PCT水平,对NSE及PCT水平进行比较。结果在肺癌患者中,鳞癌组共有4例(13.3%)患者PCT水平超过0.25ng/mL,腺癌组共有2例(7.4%)患者PCT水平超过0.25ng/mL,小细胞肺癌组共有13例(39.4%)患者PCT水平超过0.25ng/mL,对照组PCT水平均低于0.25ng/mL;组间比较差异均有统计学意义(P<0.05)。腺癌组、鳞癌组、小细胞肺癌组和对照组研究对象NSE水平分别为13.30(10.14,17.25)、14.17(10.50,21.40)、32.79(17.30,74.21)和13.19(8.69,16.31)ng/mL;腺癌组、鳞癌组和对照组PCT水平均为0.00,小细胞肺癌组患者PCT水平为0.12(0.00,0.42)ng/mL,与小细胞肺癌组比较,鳞癌组和腺癌组患者NSE水平和PCT水平均远远低于小细胞肺癌组,差异均有统计学意义(P<0.05)。鳞癌组和腺癌组患者NSE水平和PCT水平比较,差异均无统计学意义(P>0.05)。NSE、PCT和PCT联合NSE测定小癌细胞肺癌特异度、灵敏度、阳性似然比、阴性似然比、阳性预测值和阴性预测值均有差异,其中PCT+NSE联合测定可将特异度、阳性似然比、阴性似然比和阴性预测值提高,分别提高至98.1%、21.6%、0.6%和83.2%,差异均有统计学意义(P<0.05)。PCT曲线下面积、95%CI和最佳截断值分别为0.671、0.580~0.775和0.10ng/mL,NSE曲线下面积、95%CI和最佳截断值分别为0.805、0.725~0.871和23.91ng/mL。结论血清PCT对于小细胞肺癌的鉴定起着重大的作用;PCT联合NSE测定可提高诊断的特异度,对小细胞肺癌的诊断有一定价值。

Objective To investigate the clinical value of neuron-specific enolase(NSE)and serum procalcitonin(PCT)in the diagnosis and evaluation of small cell lung cancer.Methods Ninety patients with lung cancer treated in our hospital from January 2015 to December 2016 were selected(33 patients with small cell lung cancer and 57 patients with non-small cell lung cancer,including(30 patients with adenocarcinoma and 27 patients with squamous cell carcinoma).And then 35 healthy subjects were selected in our hospital for the same period as the control group,the serum NSE and PCT levels were measured,and the NSE and PCT levels were compared.Results In the lung cancer patients,there were 4 patients(13.3%)with PCT levels which were more than 0.25 ng/mL in the squamous cell carcinoma group and 2 patients(7.4%)in the adenocarcinoma group with PCT levels which were higher than 0.25 ng/mL and 13 patients with small cell lung cancer(39.4%)in patients with PCT levels of more than 0.25 ng/mL.PCT level of the control group was 0.25 ng/mL;for different levels of PCT levels,the difference was statistically significant(P<0.05).The levels of NSE in subjects with adenocarcinoma,squamous cell carcinoma,small cell lung cancer and control group were 13.30(10.14,17.25),14.17(10.50,21.40),32.79(17.30,74.21)and 13.19(8.69,16.31)ng/mL.Adenocarcinoma group,squamous cell carcinoma group and control group,the level of PCT was 0.00,the level of PCT in small cell lung cancer group was 0.12(0.00,0.4)ng/mL,compared with small cell lung cancer group,squamous cell carcinoma and adenocarcinoma group NSE level and PCT level were significantly lower than those of small cell lung cancer group,the difference was statistically significant(P<0.05).There was no significant difference in NSE level and PCT level between squamous cell carcinoma group and adenocarcinoma group.There was no significant difference between the two groups(P>0.05).The PCT+NSE combination assay′s specificity,positive likelihood ratio,negative likelihood ratio and negative predictive value were increased to 98.1%,21.6%,0.6% and 83.2%respectively,the difference was statistically significant(P<0.05).The area under the PCT curve,95%CIand the optimal cutoff points were 0.671,0.580-0.7752 and 0.10 ng/mL,respectively,the area under the NSE curve,95%CIand the optimal cutoff were 0.805,0.725-0.871,and 23.91 ng/mL.Conclusion PCT+NSE detection could improve the specificity of diagnosis,and it is of great value in the diagnosis of small cell lung cancer.