促胃泌素释放肽前体对小细胞肺癌的诊断价值

Diagnosis value of pro-gastrin-releasing peptide precursor for small cell lung cancer

目的:探讨促胃泌素释放肽前体(ProGRPp)对小细胞肺癌(SCLC)的诊断价值。方法:检测4 251名初治原发肺癌患者外周血ProGRPp、神经元特异性烯醇酶(NSE)、鳞状细胞癌抗原(SCC)、细胞角蛋白19片段(CYFRA21-1)、癌胚抗原(CEA)、糖类抗原199(CA-199)水平,运用受试者工作曲线(ROC)对检测结果进行临床评价。结果:ProGRPp和NSE诊断SCLC灵敏度分别为86.1%、80.2%,特异度分别为96.6%、84.8%。并且在Ⅰ~Ⅱ、Ⅲ、Ⅳ期肺癌中ProGRPp诊断SCLC的临界值分别为56、72、99 ng/L,灵敏度分别为95.7%、84.6%、85.7%,特异度分别为93.0%、97.1%、98.5%。在Ⅰ~Ⅱ期肺癌患者中联合ProGRPp与CYFRA21-1/ProGRPp、CYFRA21-1/NSE未进一步提高灵敏度、特异度,而在Ⅲ、Ⅳ期,联合CYFRA21-1/NSE诊断SCLC灵敏度分别提高到93.8%、97.0%,在Ⅳ期联合CYFRA21-1/ProGRPp诊断SCLC特异度提高到99.0%。结论:ProGRPp诊断SCLC具有较高的灵敏度及特异度,建议不同分期采用不同的临界值,另外联合CYFRA21-1/ProGRPp、CYFRA21-1/NSE能进一步增强对肺癌病理类型鉴别的作用。

Objective: To investigate the values of progastrin-releasing peptide precursor(ProGRPp) in the diagnosis of small cell lung cancer(SCLC). Methods: In this study, ProGRPp, and neuron-specific enolase(NSE), squamous cell carcinoma antigen(SCC), cytokeratin19(CYFRA21-1), carcinoembryonic antigen(CEA), and cancer antigen 199(CA-199) were detected in peripheral blood of 4 251 patients who were diagnosed with primary lung cancer, and ROC curve was used to analyze the results. Results: The sensitivities of ProGRPp and NSE in the diagnosis of SCLC were 86.1% and 80.2%, and the specificities were 96.6% and 84.8%, respectively. In lung carcinoma, the cut-off values of ProGRPp in the diagnosis of SCLC in stage Ⅰ~Ⅱ,Ⅲ, and Ⅳ were 56, 72, 99 ng/L, the sensitivities were 95.7%, 84.6%, and85.7% respectively, and the specificities were 93.0%, 97.1% and 98.5%, respectively. Combination of ProGRPp with CYFRA21-1/ProGRPp, CYFRA21-1/NSE did not further increase sensitivity or specificity of diagnosis of SCLC in patients with stageⅠ~Ⅱ lung cancer,but with the combination of CYFRA21-1/NSE and ProGRPp in stages Ⅲ and Ⅳ, the sensitivities of diagnosis of SCLC increased to 93.8%and 97.0% respecitively, and the specificity increased to 99.0% with the combination of CYFRA21-1/ProGRPp and ProGRPp in the diagnosis of SCLC among stage Ⅳ lung cancer patients. Conclusion: ProGRPp shows significant higher sensitivity and specificity in the diagnosis of SCLC. Different cut-off values are recommended in different stages. In addition, the combination of CYFRA21-1/ProGRPp、CYFRA21-1/NSE could further improve the diagnosis of lung cancer pathological types.