胃泌素释放肽前体和神经元特异性烯醇化酶对小细胞肺癌的临床应用价值

目的探讨血清胃泌素释放肽前体(ProGRP)和神经元特异性烯醇化酶(NSE)在小细胞肺癌(SCLC)中的临床应用价值。方法采用ELISA法和电化学发光法检测34例SCLC,31例非小细胞肺癌(NSCLC),35例肺良性疾病,30例正常健康者血清ProGRP和NSE的值。采用ROC曲线比较两者的诊断水平。结果SCLC组血清ProGRP和NSE值显著高于其它对照组(P<0.01),广泛期(ED)NSE水平显著高于局限期(LD)(P<0.01),LD期ProGRP的升高幅度大于NSE,二者均值分别是正常人均值的10.3倍和3.1倍。ProGRP和NSE诊断SCLC的敏感性分别为73.5%和55.9%(P<0.01),特异性为94%和92%。ED期NSE的敏感性(75%)显著高于LD期(28.6%)(P<0.01)。血清ProGRP和NSE区分SCLC和NSCLC,LD和ED的ROC曲线下面积有显著性差异(P<0.01)。化疗前NSE水平正常的SCLC患者化疗后完全缓解的占66.67%,而NSE升高的化疗患者完全缓解的占21.1%(P<0.01)。结论ProGRP和NSE是有效的SCLC肿瘤标志物,ProGRP适用于SCLC的早期诊断,以及与NSCLC的鉴别诊断;NSE有助于SCLC的分期和评估化疗效果。将ProGRP和NSE联合检测,优势互补,在SCLC中有重要的临床应用价值。     

血清胃泌素前体释放肽片断31-98和神经元特异性烯醇化酶水平与肺癌不同病理组织学类型的关系及其临床意义

目的 探讨血清胃泌素前体释放肽片断31-98(ProGRP)、神经元特异性烯醇化酶(NSE)水平与肺癌不同病理组织学类型的关系及其临床应用价值.方法 将明确病理组织学分型的353例肺癌患者分为2组:小细胞肺癌(SCLC)组96例,非小细胞肺癌(NSCLC)组257例,并以90例肺部良性病变作为对照组,采用酶联免疫吸附实验对所有患者进行血清ProGRP及NSE检测,比较肺癌与肺部良性病变患者之间及不同病理组织学类型肺癌患者之间血清ProGRP、NSE水平其临床应用价值.结果 SCLC组、NSCLC组血清ProGRP、NSE水平均明显高于肺部良性病变组(P均<0.01);血清ProGRP单项检测诊断SCLC的敏感度、特异度、Youden指数和Kappa值,分别为0.7708、0.9444、0.7153和0.7111,血清NSE单项检测诊断SCILC的敏感度、特异度、Youden指数和Kappa值,分别为0.7604、0.8778、0.6382和0.6355;血清ProGRP+NSE联合检测(序列试验)诊断SCLC的敏感度、特异度、Youden指数和Kappa值,分别为0.7604、0.9667、0.7271和0.7221;血清ProGRP+NSE联合检测(平行试验)诊断SCLC的敏感度、特异度、Youden指数和Kappa值,分别为0.8229、0.9000、0.7229和0.7209.血清ProGRP、NSE单项及联合检测诊断NSCLC的敏感度、特异度、Youden指数和Kappa值均较低.结论 在SCLC的诊断中,血清ProGRP检测优于NSE,血清ProGRP+NSE联合检测(平行试验)及ProGRP+NSE联合检测(序列试验)优于血清ProGRP或NSE单项检测,血清Pro-GRP+NSE联合检测(平行试验)优于血清ProGRP+NSE联合检测(序列试验).血清ProGRP及NSE单项及联合检测对NSCLC的诊断价值不大.     

小细胞肺癌患者血清胃泌素释放肽前体检测的临床意义

目的探讨血清肿瘤标志物胃泌素释放肽前体(ProGRP)在小细胞肺癌(SCLC)与非小细胞肺癌(NSCLC)鉴别诊断以及化疗效评估中的临床意义。方法应用酶联免疫吸附试验(ELISA)检测210例健康人、200例肺部良性疾病患者、260例NSCLC患者和182例SCLC患者化疗前后血清中ProGRP水平。结果 SCLC患者血清中ProGRP水平明显高于NSCLC组、健康对照组和肺部良性疾病组(P0.01)。ProGRP对SCLC检测的敏感性为56.3%,特异性为92.6%;SCLC患者经过2个周期化疗后,ProGRP水平明显低于化疗前(P0.01)。结论肿瘤标志物ProGRP对于SCLC的辅助诊断、鉴别诊断以及化疗效评估有非常重要的临床指导意义。     

4项肿瘤标志物在肺癌诊断中的应用价值

目的探讨肿瘤标志物胃泌素释放肽前体(ProGRP)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19的可溶性片段(CYFRA21-1)和鳞状细胞癌抗原(SCC)在肺癌诊断中的临床价值。方法选择151例肺癌及肺部良性病变患者为研究对象,其中小细胞肺癌(SCLC)43例,非小细胞肺癌(NSCLC)68例(包括腺癌35例、鳞癌33例),肺部良性病变患者40例,另选取健康体检者40例纳入健康对照组。采用罗氏电化学发光仪E601检测所有研究对象血清中的ProGRP、NSE、CYFRA21-1和SCC水平。结果 SCLC组的ProGRP和NSE水平均明显高于NSCLC-腺癌组、NSCLC-鳞癌组及肺部良性病变组,而NSCLC-腺癌组和NSCLC-鳞癌组的CYFRA21-1和SCC水平均明显高于SCLC组及肺部良性病变组,差异均有统计学意义(P<0.05)。在单项指标中,ProGRP在SCLC中的灵敏度和特异度最高,分别为77.2%和91.1%;CYFRA21-1在NSCLC-腺癌和NSCLC-鳞癌中的灵敏度和特异度较高,分别为65.9%和90.1%,以及71.5%和91.2%;在联合检测中,ProGRP+NSE在SCLC中的灵敏度和特异度分别为92.5%和83.6%;CYFRA21-1+SCC对NSCLC-腺癌和NSCLC-鳞癌的灵敏度在83.0%以上,特异度在85.0%以上。结论 ProGRP与NSE联合检测诊断SCLC的价值优于单项肿瘤标志物的检测;CYFRA21-1与SCC联合检测对NSCLC-腺癌和NSCLC-鳞癌有较高的灵敏度和特异度,这些肿瘤标志物诊断和筛查肺癌的潜力值得进一步研究。     

血清ProGRP和NSE检测在小细胞肺癌诊断和放化疗监测中的价值

目的 探讨血清胃泌素释放肽前体(ProGRP)和神经元特异性烯醇化酶(NSE)在小细胞肺癌(SCLC)临床诊断和化放疗监测中的意义。方法 分别对2015年9月～2018年1月期间,厦门市第二医院就诊的84例SCLC患者、77例非小细胞肺癌(NSCLC)患者、80例肺良性疾病患者及80例健康体检者的血清ProGRP和NSE进行化学发光法检测; 同时监测84例SCLC患者连续3个周期放化疗后的血清ProGRP和NSE水平变化,采用SPSS17.0进行统计学分析。结果 SCLC组患者的血清ProGRP和NSE浓度显著高于其它组(P<0.05)。血清ProGRP单独检测诊断SCLC,LD-SCLC和ED-SCLC的敏感度和特异度均优于血清NSE,两者联合诊断的敏感度最高。连续3个周期的放化疗后,在治疗有效组中SCLC患者血清ProGRP和NSE水平均有显著下降(P<0.05); 治疗稳定组患者无明显变化(P>0.05); 治疗无效组患者血清NSE无明显增高(P>0.05),但血清ProGRP治疗后较治疗前有显著增高(P<0.05)。结论 血清ProGRP和NSE均可用于SCLC患者的诊断和放化疗的疗效监测,其中两者联合检测可有效提高SCLC患者的诊断率,血清ProGRP更能反映患者放化疗的疗效。     

血清胃泌素前体释放肽片断31—98和神经元特异性烯醇化酶水平与肺癌不同病理组织学类型的关系及其临床意义

目的探讨血清胃泌素前体释放肽片断31-98（ProGRP）、神经元特异性烯醇化酶（NSE）水平与肺癌不同病理组织学类型的关系及其临床应用价值。方法将明确病理组织学分型的353例肺癌患者分为2组：小细胞肺癌（SCLC）组96例,非小细胞肺癌（NSCLC）组257例,并以90例肺部良性病变作为对照组,采用酶联免疫吸附实验对所有患者进行血清ProGRP及NSE检测,比较肺癌与肺部良性病变患者之间及不同病理组织学类型肺癌患者之间血清ProGRP、NSE水平其临床应用价值。结果SCLC组、NSCLC组血清ProGRP、NSE水平均明显高于肺部良性病变组（P均〈0．01）;血清ProGRP单项检测诊断SCLC的敏感度、特异度、Youden指数和Kappa值,分别为0．7708、0．9444、0．7153和0．7111,血清NSE单项检测诊断SCLC的敏感度、特异度、Youden指数和Kappa值,分别为0．7604、0．8778、0．6382和0．6355;血清ProGRP＋NSE联合检测（序列试验）诊断SCLC的敏感度、特异度、Youden指数和Kappa值,分别为0．7604、0．9667、0．7271和0．7221;血清ProGRP＋NSE联合检测（平行试验）诊断SCLC的敏感度、特异度、Youden指数和Kappa值,分别为0．8229、0．9000、0．7229和0．7209。血清ProGRP、NSE单项及联合检测诊断NSCLC的敏感度、特异度、Youden指数和Kappa值均较低。结论在SCLC的诊断中,血清PmGRP检测优于NSE,血清ProGRP＋NSE联合检测（平行试验）及ProGRP＋NSE联合检测（序列试验）优于血清ProGRP或NSE单项检测,血清Pro—GRP＋NSE联合检测（平行试验）优于血清ProGRP＋NSE联合检测（序列试验）。血清ProGRP及NSE单项及联合检测对NSCLC的诊断价值不大。     

血清肿瘤标记物NSE、CEA、SCC、ProGRP及CYFRA21-1对肺癌病理类型的鉴别诊断价值

目的评估血清肿瘤标记物神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、鳞状细胞癌抗原(SCC)、胃泌素释放肽前体(ProGRP)及细胞角蛋白19片段(CYFRA21-1)对小细胞肺癌(SCLC)与非小细胞肺癌(NSCLC)、腺癌与鳞癌的鉴别诊断价值。方法选取于西安交通大学附属二一五医院就诊的患者96例,其中NSCLC 80例(腺癌58例,鳞癌22例),SCLC 16例,使用电化学发光法对所有患者行血清肿瘤标记物检测。统计SCLC与NSCLC、腺癌与鳞癌间各项血清肿瘤标记物是否存在差异,并采用受试者工作曲线(ROC)进行诊断效能评价。结果 ProGRP水平在SCLC与NSCLC两组间差异有统计学意义(P<0.05),SCC在腺癌及鳞癌两组间差异有统计学意义(P<0.05);ProGRP对SCLC与NSCLC鉴别诊断的ROC曲线下面积为0.926,灵敏度为97.7%,特异度为87.5%。SCC对腺癌及鳞癌鉴别诊断的ROC曲线下面积为0.690,灵敏度50.0%,特异度87.9%。结论可考虑将血清肿瘤标记物ProGRP用来鉴别SCLC与NSCLC;将SCC用来鉴别鳞癌与腺癌。     

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

  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(neuron-specific 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。     

血清CEA,ProGRP,NSE和CYFRA21-1联合检测在肺癌诊断中的应用研究

目的 研究血清癌胚抗原(CEA)、胃泌素释放前体(ProGRP)、神经元特异性烯醇化酶(NSE)和细胞角蛋白19片段(CYFRA21-1)联合检测在肺癌诊断中的应用。方法 空腹取诊断明确的133例肺癌患者、67例肺部良性病变患者及同期66例体检健康者(对照组)的静脉血,用化学发光法检测血清CYFRA21-1,CEA,NSE和ProGRP水平,并计算敏感度、准确度和特异度。结果 CYFRA21-1,CEA,NSE和ProGR水平,肺癌患者血清分别为6.31±1.04 ng/ml,20.58±2.41 ng/ml,32.74±3.24 ng/ml和125.78±15.32 pg/ml,肺良性病变患者血清分别为1.93±0.52 ng/ml,2.93±0.82 ng/ml,10.49±1.93 ng/ml和48.32±6.72 pg/ml,对照组血清分别为1.56±0.45 ng/ml,2.67±0.74 ng/ml,8.34±1.2 ng/ml和35.78±4.2 pg/ml,肺癌患者血清CEA,ProGRP,NSE,CYFRA21-1水平均高于肺良性病变患者(t=1.48～2.78,P=0.13～0.25)和对照组(t=1.981～2.371,P=0.21～0.41),差异均有统计学意义(P<0.05)。CYFRA21-1,NSE,CEA和ProGRP单项检测肺癌的敏感度分别为61.65%,45.86%,52.63%和63.91%,准确度为72.36%,63.81%,67.34%和74.87%。联合两项、三项检测肺癌,敏感度为72%～89%,准确度为78.89%～89.44%。四项联合检测肺癌的敏感度(92.48%)、准确度(90.45%)最高。结论 血清标志物能较好地诊断肺癌,联合多种血清学指标检测可提高肺癌诊断的敏感度、准确度。     

Triple test with tumor markers CYFRA 21.1, HE4, and ProGRP might contribute to diagnosis and subtyping of lung cancer

Background and aimEarly diagnosis and histological subtyping are important issues in the management of patients with lung cancer (LC). The aim of this study is to investigate the diagnostic value of a panel of serum tumor markers in newly diagnosed patients with LC.MethodsVenous blood samples were collected from 99 patients with LC (42 adenocarcinoma, 35 squamous, and 22 small cell carcinoma) and 30 patients with benign lung disease. Progastrin releasing peptide (ProGRP), squamous cell carcinoma antigen (SCCAg), cytokeratin 19-fragments (CYFRA 21.1), human epididymis protein 4 (HE4), Chromogranin A (CgA) and neuron specific enolase (NSE) levels were measured. The diagnostic value of the biomarkers was assessed with ROC curve analyses; the area under the curve (AUC) was calculated.ResultsSerum CYFRA 21.1, ProGRP, SCCAg, NSE levels were significantly higher in LC patients. While ProGRP levels were higher (p = 0.009) in SCLC; CYFRA 21.1 and SCCAg levels were higher in NSCLC (p = 0.019 and p = 0.001, respectively). The sensitivity and specificity of tumor markers were 72%, 83% for CYFRA 21.1; 70%, 57% for HE4; 18%, 93% for ProGRP; 43%, 77% for SCCAg; 54%, 53% for CgA; 73%, 50% for NSE. CYFRA 21.1 (p < 0.001, r = 0.394), HE4 (p = 0.014, r = 0.279) and CgA (p = 0.023, r = 0.259) levels were positively correlated with tumor stage in NSCLC. CgA levels were significantly higher in extensive stage SCLC (p = 0.004). CYFRA 21.1 had the highest diagnostic value for LC (AUC = 0.865). When it is combined with HE4, diagnostic value increased (AUC = 0.899). ProGRP had the highest diagnostic value (AUC = 0.875, p < 0.001) for discriminating SCLC from NSCLC.ConclusionA panel of three tumor markers CYFRA 21.1, HE4 and ProGRP may play a role for discriminating LC from benign lung disease and subtyping as SCLC.     

肺癌患者血清肿瘤标志物检测的临床意义

目的测定小细胞肺癌和晚期非小细胞肺癌患者化疗前后癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)的变化,并探讨该种变化的临床意义.方法用放射免疫分析的方法分别测定20例肺部良性疾病、20例广泛期小细胞肺癌(SCLC)以及45例初诊晚期非小细胞肺癌(NSCLC)患者化疗前后血清CEA、CYFRA21-1、NSE的水平,再分别作对比分析.结果肺癌组CEA、CYFRA21-1、NSE的水平高于良性疾病组,但CYFRA21-1在良性疾病和小细胞肺癌中、NSE在良性疾病和鳞癌以及良性疾病和腺癌中均未见统计学差异(P>0.05);化疗后小细胞肺癌患者NSE显著下降(P<0.01),鳞癌患者CYFRA21-1 水平显著下降(P<0.01),但在腺癌患者只有NSE水平较化疗前下降,另两种标志物未见统计学差异(P>0.05).结论三种肿瘤标志物在非小细胞肺癌晚期均升高,其中CEA在腺癌、CYFRA21-1在鳞癌、NSE在SCLC中尤为明显,化疗后显著下降,三种指标的测定有助于肺癌的病理分型,并且可以分别作为判定不同病理类型肺癌化疗疗效的指标.     

血清肿瘤标志物在肺癌不同病理分型中的应用价值

目的 探讨血清肿瘤标志物癌胚抗原(CEA)、癌抗原125(CA125)、鳞状细胞癌抗原(SCC-Ag)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段抗原(CYFRA21-1)和胃泌素释放肽前体(ProGRP)在肺癌不同病理分型中的应用价值.方法 选取2020年1—11月我院肺腺癌25例(肺腺癌组)、肺鳞癌25例(...     

Pro-gastrin-releasing peptide (ProGRP) and neuron specific enolase (NSE) in therapy control of patients with small-cell lung cancer

In small-cell lung cancer patients tumor markers were used for disease monitoring. The goal of this study was to identify diagnostic efficiency in the detection of tumor behavior in small-cell lung cancer patients by using a relatively new tumor marker, ProGRP, in comparison to the established marker NSE. 34 consecutive small-cell lung cancer (SCLC) patients were included in this prospective study. The changes of the blood levels of ProGRP and NSE were compared to the clinical evaluation. Clinical monitoring was evaluated according to the standard criteria of the WHO. 19 patients had remission, 8 stable disease and 7 tumor progression under therapy. NSE and ProGRP were measured in sera before and after treatment with polychemotherapy. After tumor remission the NSE but also the ProGRP levels decreased significantly under treatment (p=0.0001 resp. p=0.0180). As suspected, pre- and post-treatment marker concentrations did not differ significantly in patients with stable disease. In progressive small-cell lung cancer patients an increase of ProGRP and NSE was detectable. Overall, a decrease of NSE was seen in 18 (95%) of all responders, while an increase during progression could be detected in 6 (86%) of the patients. Because 6 patients in remission showed an increase in ProGRP concentrations, the corresponding data are 68% in responders and also 86% in progressive SCLC-patients. In conclusion, ProGRP was helpful as a diagnostic aid for therapy control in small-cell lung cancer patients. A long-term follow-up indicated that ProGRP can be used to monitor disease either with tumor regression under therapy as well as detection of subsequent progression. ProGRP could be well suited to complete thepresent diagnostic panel for lung cancer.     

血清和支气管肺泡灌洗液胃泌素前体释放肽片断31-98水平与小细胞肺癌不同病理分期的关系及其临床意义

目的 探讨血清和支气管肺泡灌洗液胃泌素前体释放肽片断31-98(ProGRP)水平与小细胞肺癌(SCLC)不同TNM分期的关系及其临床意义.方法 将明确痛理组织学分型的96例SCLC患者分为3组:Ⅰ～Ⅱ期SCLC(Ⅰ～Ⅱ期)组30例,Ⅲ期SCLC(Ⅲ期)组31例,Ⅳ期SCLC(Ⅳ期)组35例,并以90例确诊的肺部良性病变患者做为对照组.采用酶联免疫吸附实验对所有患者进行血清和支气管肺泡灌洗液ProGRP检测,同时以神经元特异性烯醇化酶(NSE)做对比研究,比较血清和支气管肺泡灌洗液ProGRP水平与SCLC不同TNM分期的关系.结果 Ⅰ～Ⅱ期、Ⅲ期、Ⅳ期组和对照组血清、支气管肺泡灌洗液ProGRP水平分别为(295.33±118.56)μs/mol与(516.67±208.45)μg/mol、(421.13±196.66)μg/mol与(1170.55±414.65)μg/mol、(758.76±326.19)μg/mol与(1739.12±696.08)μg/mol和(29.68±16.32)μg/mol与(49.23±22.50)μg/mol(P均＜0.01);各组血清、支气管肺泡灌洗液NSE水平分别为(10.36±6.76)mg/mol与(16.66±11.62)mg/mol、(24.19±10.88)mg/mol与(45.47±20.74)mg/mol、(35.76±17.30)mg/mol与(65.18±29.87)mg/mol和(9.70±5.28)mg/mol与(9.70±5.28)mg/mol(P均＜0.01).血清和支气管肺泡灌洗液ProGRP和NSE水平,Ⅰ～Ⅱ期、Ⅲ期、Ⅳ期组明显高于对照组(P均＜0.01).各组血清ProGRP检测阳性率分别为60.00%、70.97%、82.86%、6.67%(P均＜0.01),支气管肺泡灌洗液ProGRP检测阳性率分别为63.33%、74.19%、85.71%、4.44%(P均＜0.01);血清NSE检测阳性率分别为23.33%、67.74%、80.00%、22.22%(P均＜0.01),支气管肺泡灌洗液NSE检测阳性率分别为26.67%、70.97%、82.86%、26.67%(P均＜0.01);Ⅰ～Ⅱ期、Ⅲ期、Ⅳ期组支气管肺泡灌洗液ProGRP和NSE检测阳性率均高于血清检测,且均随其分期级别提升而增高;但Ⅲ期组和Ⅳ期组比较差异无统计学意义(P＞0.05).结论 血清和支气管肺泡灌洗液ProGRP及NSE检测对SCLC的诊断与TNM分期均有较大的临床价值;对不同TNM分期SCLC的诊断,支气管肺泡灌洗液ProGRP和NSE检测优于血清检测;对SCLC的早期诊断血清和支气管肺泡灌洗液ProGRP检测优于NSE.     

血清胃泌素释放肽前体在小细胞肺癌中的临床价值

目的探讨胃泌素释放肽前体(Pro-GRP)在小细胞肺癌(SCLC)诊断和治疗监测中的价值。方法检测96例SCLC患者(SCLC组,其中局限期74例、广泛期22例)、63例非小细胞肺癌(NSCLC)患者(NSCLC组)和76名体检健康者(正常对照组)的血清Pro-GRP、癌胚抗原(CEA)、鳞状上皮细胞癌抗原(SCC-Ag)、细胞角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)水平。96例SCLC患者中有86例患者完成1个疗程的化疗。结果 SCLC组血清Pro-GRP、NSE水平均高于正常对照组和NSCLC组(P<0.001)。SCLC组和NSCLC组血清SCC-Ag水平高于正常对照组(P<0.001)。NSCLC组血清CEA、CYFRA21-1水平均高于正常对照组和SCLC组(P<0.001)。广泛期SCLC患者血清Pro-GRP水平高于局限期SCLC患者(P<0.01)。SCLC患者化疗后血清Pro-GRP、NSE水平低于化疗前(P<0.001)。ROC曲线分析结果显示,Pro-GRP和NSE诊断SCLC的曲线下面积(AUC)分别为0.960、0.849,最佳临界值分别为76.31ng/L、13.87ng/mL,敏感性分别为84.5%、77.6%,特异性分别为98.6%、79.5%。结论 Pro-GRP在SCLC的诊断、临床分期和治疗监测中均有一定的价值。     

肿瘤标志物联合检测及非线性映射在肺癌组织分型及病情评估的价值

目的 运用非线性映射技术，评价血清癌胚抗原(CEA)、糖类抗原125(CA125)、胃泌素、神经元特异性烯醇化酶(NSE)水平对肺癌病情评估和组织分型的临床价值。方法 采用放射免疫分析法测定51例肺癌患者血清CEA、CA125、胃泌素、NSE水平，并观察了这些患者血清该4项肿瘤标志物水平在不同的组织分型、不同的恶性肿瘤国际临床病期(TNM)分期以及治疗前后的变化；同时采用非线性映射技术，探讨该4项肿瘤标志物在肺癌组织分型中的价值。结果 小细胞肺癌(SCLC)患者胃泌素、NSE水平显著高于非小细胞肺癌(NSCLC)患者，而CEA、CA125水平却明显低于NSCLC患者；TNM分期越晚，CEA、CA125、胃泌素、NSE水平越高，其增高的程度与TNM分期有一定的关系；化疗前后该4项肿瘤标志物水平差异有统计学意义，化疗后呈现明显下降，总有效率为45．09％；非线性映射判别SCLC与NSCLC总的符合率为94．1％。结论 该4项肿瘤标志物联合检测在肺癌组织分型、病情监测和疗效判断方面可为临床提供有价值的参考资料；此外非线性映射技术在SCLC与NSCLC判别中有一定的参考价值。     

血清NSE、CEA、CA125水平在小细胞肺癌患者诊断和疗效评估中的价值

目的 探讨血清神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、糖类抗原125(CA125)水平在小细胞肺癌(SCLC)患者诊断和疗效评估中的价值.方法 选取郑州人民医院收治的SCLC患者(SCLC组)48例、非小细胞肺癌患者(NSCLC组)53例,另选取同期在我院体检的正常人作为对照组,分别检测各组血清NSE、CE...     

Monoclonal immunoradiometric assay and polyclonal radioimmunoassay compared for measuring neuron-specific enolase in patients with lung cancer.

Neuron-specific enolase (NSE) is the most sensitive and specific tumor marker for small-cell lung cancer (SCLC). We evaluated a new monoclonal IRMA (Sangtec) for NSE and compared it with a polyclonal RIA (Pharmacia) in patients with SCLC or other lung cancers (NSCLC). We measured NSE concentrations in 100 healthy subjects (NI group), 100 patients with benign pulmonary diseases (BPD group), and 194 patients with advanced lung cancer (97 SCLC and 97 NSCLC). Intra- and interassay CVs were less than 7% for both assays, and dose-dilution curves paralleled their respective standard curves. Values measured by both assays were highly correlated in all groups. NSE concentrations were significantly (P less than 0.001) lower by IRMA than by RIA in NI and BPD groups. The upper 95th percentile values for NSE in the NI group were 11.7 micrograms/L in the RIA and 9.2 micrograms/L in the IRMA. In NSCLC, the values were significantly (P less than 0.05) lower by IRMA but the percentage of subjects with increased values was higher (vs the NI group, 31% for RIA and 44% for IRMA, P less than 0.005). Diagnostic sensitivity for SCLC was improved with IRMA: 83% of values with RIA and 93% with IRMA were increased above the NI group values (P less than 0.005); the corresponding values for SCLC vs BPD were 81% and 89% (P less than 0.05). NSE values measured in 39 patients with SCLC after chemotherapy were more often increased and were significantly higher with the IRMA than with the RIA (P less than 0.005).     

血清癌胚抗原和神经元特异性烯醇化酶联合检测小细胞肺癌的研究

目的探讨患者血清中癌胚抗原(CEA)和神经元特异性烯醇化酶(NSE)含量对小细胞肺癌(SCLC)诊断、疗效监测和预后判断的临床意义。方法用免疫分析法检测SCLC患者、非小细胞肺癌(NSCLC)患者、肺部良性疾病患者和健康体检者的血清CEA和NSE含量,比较各组之间含量的差异,同时比较其对肺癌诊断的敏感性、特异性和诊断符合率。结果 SCLC患者的NSE血清含量明显高于其他组(P<0.01),而SCLC患者的CEA血清含量仅次于NSCLC患者,高于其他组(P<0.01)。SCLC患者的NSE含量与CEA含量比值最大。比较不同肺癌之间的NSE和CEA含量,SCLC患者的NSE血清含量最高,且与CEA含量比值最大(P<0.01)。NSE、CEA单独检测及NSE与CEA联合检测对SCLC诊断结果显示,NSE与CEA联合检测对病情诊断的敏感性最高。结论血清中的NSE和CEA检测均能作为SCLC的诊断指标,而NSE与CEA联合检测的效率最高,有助于SCLC的诊断,可提高肺癌诊断的敏感性、特异性和准确性。     

血清ProGRP、TPS及NSE在小细胞肺癌患者治疗监测中的应用

目的 分析评价血清ProGRP、TPS和NSE在SCLC患者临床诊断和疗效监测中的临床意义.方法 分别采用化学发光法、ELISA法和电化学发光法测定51例SCLC患者(SCLC组,局限期患者36例,广泛期患者15例)、60例肺良性疾病患者(良性疾病对照组)及60名健康人(健康对照组)血清ProGRP、TPS和NSE浓度;分析评价3项指标在SCLC患者治疗前、化疗第1周期和第2周期的变化.结果 局限期SCLC患者治疗前的血清ProGRP、TPS和NSE浓度分别为136.9(22.8～631.7)ng/L、78.2(56.4～114.6)U/L和28.1(20.9～46.1)μg/L;广泛期为1 106.6(41.2～2 161.1)ng/L、230.9(143.5～259.0)U/L和81.1(34.3～140.0)μgL;肺良性疾病组为19.7(9.5～29.1)ng/L、48.7(17.9～95.4)U/L和12.1(1.2～13.9)μg/L;健康对照组为20.3(10.7～30.6)ng/L、50.3(19.5～70.7)U/L和11.7(1.1～13.4)μg/L;经Kruskal-Wallis检验,3项指标在各组间的差异均有统计学意义(x2值分别为51.368、36.532和81.645,P均＜0.01);两个对照组分别与局限期SCLC比较,差异均有统计学意义(U值分别为491、827、609和476、831、585,P均＜0.05);两个对照组分别与广泛期SCLC比较,差异亦有统计学意义(U值分别为314、532、456和302、553、430,P均＜0.01).血清ProGRP诊断SCLC的ROC曲线AUC为0.832±0.029(95%CI:0.774～0.890),以37.7 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71%(36/51)、97%(116/120)、90%(36/40)、89%(116/131)和67%.联合检测时,ProGRP+TPS+NSE、ProGRP+TPS、ProGRP+NSE和TPS+NSE组合的敏感度分别为92%、86%、92%和88%,特异度分别为77%、77%、92%和77%.经非参数Fridman检验,3项指标在不同治疗阶段的差异均有统计学意义(x2值分别为49.120、10.614和44.392,P均＜0.01).经过连续2个周期化疗后,血清ProGRP浓度持续降低,分别降低至68.0(18.6～158.4)和21.0(14.9～63.5)ng/L,与化疗前组比较,差异均有统计学意义(Z值分别为-4.889、-5.594,P均＜0.01);血清TPS在第1周期化疗结束后升高至105.2(54.1～181.2)U/L,但差异无统计学意义(Z=-1.248,P＞0.05),在第2周期化疗结束后明显降低至79.0(48.7～155.3)U/L,差异有统计学意义(Z=-2.484,P＜0.05);血清NSE在第1周期化疗后迅速降低至11.8(8.0～16.0)μg/L,差异有统计学意义(Z=-5.568,P＜0.01),第2周期化疗后降为10.6(9.0～12.7)μg/L,与第1化疗周期结束后相比,差异无统计学意义(Z=-1.851,P＞0.05).在2个周期化疗后,临床治疗有效的SCLC患者46例(CR 3例,PR 43例),其中3项指标的检测结果全部正常或仅有1项超过临界值的患者为38例(各19例),占83%;3项指标全部异常的患者2例,临床疗效评价均为PD;还有2例临床疗效评价为SD和1例未评价的患者均有2项指标结果异常.结论 血清ProGRP、TPS和NSE均为诊断和监测SCLC治疗疗效的较好的指标,尤其以ProGRP+NSE组合的临床诊断价值最高.联合应用3项指标,有助于SCLC患者的疗效监测和预后判断.

Abstract：

Objective To evaluate the clinical significance of serum levels of ProGRP, TPS and NSE in diagnosis and therapy monitoring in small cell lung cancer patients. Methods The levels of serum ProGRP, TPS and NSE in 51 SCLC patients (SCLC group), 60 benign pulmonary disease patients (benign disease group ) and 60 healthy people (healthy group ) were determined using chemiluminescent immunoassay, ELISA and electrochemiluminescent immunoassay respectively. Blood samples were collected and detected prior to therapy, before the second course of chemotherapy and the third course of chemotherapy consecutively in all the 51 SCLC patients. Results The serum ProGRP, TPS and NSE concentrations prior to chemotherapy in limited stage SCLC (LSCLC) were 136. 9(22.8-631.7)ng/L, 78. 2(56.4-114.6) U/L and 28.1(20.9-46.1)μg/L, respectively; And in extensive stage SCLC patients (ESCLC) were 1 106.6(41.2-2161.1) ng/L, 230. 9( 143.5-259.0) U/L and 81.1 (34.3-140.0)μg/L, respectively. The serum concentrations of the 3 markers in benign disease group were 19. 7 ( 9. 5-29. 1 )ng/L, 48. 7 ( 17.9-95.4) U/L and 12. 1(1.2-13.9) μg/L; and in healthy group were 20.3(10.7-30.6) ng/L, 50.3(19.5-70.7) U/L and 11.7 (1.1-13.4)μg/L, respectively. The Kruskal-Wallis test showed significantly statistical difference in different groups of the 3 tumor markers, Chi-Square were 51. 368,36. 532 and 81. 645( P ＜0. 01 ). Significant statistically differences showed when the concentrations of the 3 marks of the 2 control group were compared with that of the LSCLC group ( U =491, 827, 609 and 476, 831, 585,respectively, P ＜ 0. 05 ). Differences were also statistically significant when the 2 control group compared with that of the ESCLC group ( U = 314,532,456 and 302,553,430, respectively, P ＜ 0. 01 ). The AUC of ProGRP was 0.832 +0.029(95% CI:0.774-0.890). When cutoff value of ProGRP set as 37.7 ng/L, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and Youden's index were 71% (36/51), 97% (116/120), 90% (36/40), 89% ( 116/131 ) and 67%, respectively; show good detection performance. The sensitivity increased to 92%, 86%, 92% and 88%, when combination detection of ProGRP + TPS + NSE, ProGRP + TPS, ProGRP + NSE and TPS + NSE were used, and the specificities were 77%, 77% , 92% and 77% accordingly. The Fridman test showed significantly statistical difference in the 3 tumor markers at different stages of treatment, x2 were 49. 120, 10. 614 and 44. 392, P ＜0. 01. After the first chemotherapy course, all the tumor marker levels except TPS decreased significantly in comparison with the pretreatment concentrations. However, only ProGRP levels showed a progressive drop during the two consecutive courses of therapy, and the median concentrations were 68.0 ( 18. 6-158.4 ) and 21.0( 14. 9-63.5) ng/L (compared to the level before therapy,Z=-4. 889 and -5. 594, P ＜0. 01 ). The median of serum TPS increased slightly to 105.2 (54. 1-181.2 ) U/L after the first chemotherapy course (Z=-1.248, P＞0.05), and decreased significantly to 79.0(48.7-155.3) U/L after the second chemotherapy course (Z=-2.484, P＜0. 05 ). As to the NSE, the median concentration decreased to 11.8(8.0-16.0)μg/L after the first chemotherapy course ( Z= - 5. 568, P ＜ 0. 01 ). However, the median was 10. 6(9.0-12.7)μg/L, which showed no significant decrease after the second chemotherapy course (Z=-1.851, P＞0.05).Forty-six SCLC patients evaluated as clinical remission ( 3 CR and 43 PR) after the second chemotherapy course, among them there were 38 patients (83%) with normal serum ProGRP, TPS and NSE level ( 19 patients) or with only 1 abnormal tumor level ( 19 patients). There were only 2 patients with all abnormal serum ProGRP, TPS and NSE level, and both patients were evaluated as clinical PD. Two patients with 2 abnormal tumors results were classified as SD, the only 1 patient without therapy evaluation also had 2 abnormal tumor marker results. Conclusions The serum ProGRP, TPS and NSE are valuable tumor markers for diagnosis and treat monitoring of SCLC, particularly the ProGRP + NSE shows the highest clinical value. Combing detection of the 3 tumor markers are valuable for therapy monitoring and prognosis in SCLC patients.