Prognostic evaluation of primary non-small cell lung carcinoma patients using biological fluid variables. A systematic review

We have systematically reviewed the biomedical literature to try to establish whether laboratory variables might give any additional prognostic information in non-small-cell lung cancer (NSCLC) patients independently of the usual radioclinical parameters. In each study, we acknowledged the independent prognostic value of a biological fluid variable if it had been demonstrated through a multivariate statistical analysis in which at least the following had been included: patient's weight loss, age, gender, performance status, histology, stage and extent of the disease. The clearest conclusion that can be derived from the 42 studies we reviewed is that it remains to be clearly demonstrated whether or not the "new" tests (tumour markers, p53 antibodies, etc.) are superior to the "old" tests (serum LDH, calcium, albumin or other proteins, blood cell counts, etc.), even though a number of studies did suggest that serum cyfra 21-1 has a pre-therapeutic prognostic significance in NSCLC. From the four studies in which the same powerful statistical methodologies were used (i.e. Cox models in association with RECPAM analysis), it could be derived that serum calcium and perhaps the blood neutrophil and lymphocyte counts might have independent pre-therapeutic prognostic significance in advanced NSCLC. Further studies are needed to demonstrate whether repeated measurements during therapeutic follow-up can bring any independent prognostic information. Provided that both laboratory and statistical expertise is clearly guaranteed in future primary studies published in this particular biomedical field, it might perhaps become possible to propose laboratory variables as additional prognostic parameters in NSCLC.     

广泛期小细胞肺癌临床预后因素分析

目的本研究旨在回顾性分析广泛期小细胞肺癌患者临床预后相关因素,指导广泛期小细胞肺癌预后评价。方法2000年1月至2006年12月收治的广泛期小细胞肺癌患者134例,采用Kaplan—Meier和Cox多因素回归模型分析：性别、年龄、一般状况评分、发病时体质量减轻、血清乳酸脱氢酶水平、血清碱性磷酸酶水平、肿瘤标志物、有无贫血、血清白蛋白水平、血小板计数等因素的预后价值。结果全组6、12、24个月生存率分别为58．2％、24．6％、0．7％;中位生存期为7个月。单因素分析显示血乳酸脱氢酶、血清白蛋白、贫血、一般状况评分与广泛期小细胞肺癌生存期相关（P〈0．05）;性别、年龄、发病时是否体质量减轻、血清碱性磷酸酶水平、血小板计数增高与其生存期无关。多因素分析剐显示贫血（RR1．531）、血清白蛋白（RR1．493）、血清乳酸脱氢酶水平（RR1．462）是广泛期小细胞肺癌患者的独立预后因素。结论广泛期小细胞肺癌患者,贫血、血清白蛋白降低、血清乳酸脱氢酶水平增高是其预后不良的主要因素。     

ProGRP: a new biomarker for small cell lung cancer

Progastrin-releasing peptide (ProGRP) is a recently identified biomarker of small cell lung cancer (SCLC), a disorder of neuroendocrine tissue differentiation. The upper normal limit of ProGRP in the circulation is 50 pg/ml. Impaired glomerular filtration tends to increase circulating levels and confound the tumor marker significance of modestly elevated values. Excluding patients with renal failure, circulating levels did not exceed 80 pg/ml in benign disease (3% of cases in excess of the upper normal limit) or 120 pg/ml in malignancy other than lung cancer and neuroendocrine tumors (5% of cases in excess of the upper limit). ProGRP serum levels are clearly related to the lung cancer histological type with significantly higher levels observed in SCLC than in nonsmall cell lung cancer (NSCLC). Circulating ProGRP in excess of 120 mg/ml was found in only 4% of cases of NSCLC with another 22% presenting with modestly elevated levels in excess of the upper normal limit. By contrast, abnormal ProGRP results are found in 60-70% and in 75-90% of SCLC patients with local and extensive disease, respectively. ProGRP is a more sensitive biomarker than is neuron-specific enolase (NSE) for SCLC, but thus far has not been found in multivariate analysis to have independent prognostic significance. Preliminary studies suggest ProGRP will have utility in conjunction with NSE in monitoring the therapy of established SCLC.     

血清神经元烯醇化酶水平对小细胞肺癌预后影响的系统评价

目的评价血清神经元烯醇化酶（NSE）水平对小细胞肺癌患者的预后影响。方法计算机检索MEDLINE、EMbase、CBMdisc、Cochrane Central Register of Controlled Trials等数据库,并从符合纳入标准的文献中查找相关文献。检索时间从1950年到2007年12月;由2名评价者独立检索、评价文献交叉核对后提取有效数据进行Meta分析。结果共纳入9个研究共2021例小细胞肺癌患者。按作者对NSE水平的截断值,其中66．0％（36．5％～79％）的病例血清NSE浓度呈现高水平。NSE浓度高水平对患者的危害是NSE低水平的1．27倍[95％CI（1．19,1．35）,P=0．28]。结论治疗前NSE浓度高水平患者预后总生存率较NSE低水平患者差,NSE水平对小细胞肺癌预后有一定的预测价值。但由于本研究纳入文献可能存在发表偏倚、选择偏倚、测量偏倚的高度可能性,上述结论应慎重对待。期待更多高质量、同质性的研究来精确评价NSE的预后价值。     

Are laboratory investigations recommended in current medical practice guidelines supported by available evidence?

It has been suggested that evidence-based laboratory medicine (EBLM) could help to improve the pertinence and accuracy of medical guidelines. In order to demonstrate this, we have used an EBLM approach (i.e. a systematic review) to examine three recently published guidelines that gave quite conflicting recommendations regarding the use of laboratory variables in the management of primary non-small cell lung cancer patients. In recommending the routine measurement of serum albumin, and, to a lesser extent, that of serum calcium in the pre-therapeutic prognostic evaluation of the advanced disease, the American Thoracic Society and the European Respiratory Society were probably correct with regard to calcium but perhaps mistaken regarding albumin. Some of the recommendations of the European Group on Tumour Markers regarding the usefulness of routine measurements of tumour markers (carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), tissue-polypeptide antigen (TPA)) in the pre- and/or post-therapeutic prognostic evaluation can also be criticised. In addition, the latter society as well as the Société de Pneumologie de Langue Fran?aise did not even try to list laboratory variables, others than tumour markers, that would be useful to stratify patients participating in clinical trials (i.e. lactate dehydrogenase (LDH), albumin, calcium, blood cell count, etc.), and the laboratory variables listed by the two former societies were probably not the right ones in this context: in particular LDH and tumour markers (fragments of cytokeratin 19 (Cyfra 21-1), tissue-polypeptide-specific antigen (TPS), neuron-specific enolase (NSE)) were not mentioned. Most, if not all of these discrepancies in the current medical practice guidelines might have been avoided had an EBLM approach been used by the authors.     

112例小细胞肺癌患者多因素生存分析

目的 分析小细胞肺癌患者顸后的影响因素.方法 收集112例经组织病理学或细胞学明确的小细胞肺癌患者临床资料,分析性别、年龄、分期、血红蛋白水平、乳酸脱氢酶水平、一线化疗疗效、放疗及手术治疗等因素与患者生存期的关系,采用Kaplan-Meier法生存分析,进行Log-rank非参数检验,用COX比例风险模型进行多因素生存分析.结果 全组患者1、2、3年生存率分别为71.4%、38.4%和14.3%,其中局限期1、2、3年生存率分别为80.0%、47.1%和17.1%,广泛期1、2、3年生存率分别为57.1%、23.8%和9.5%.全组中位生存时间为22个月,其中局限期生存时间24个月,广泛期生存时间16个月.单因素分析发现分期、血红蛋白水平、乳酸脱氢酶水平、一线化疗疗效、放疗及手术治疗均可影响患者的生存期.多因素分析则提示分期、一线化疗疗效、放疗及手术治疗是患者生存的独立影响因素,其相对危险度分别为0.687、0.635、0.412、0.203.结论分期、化疗疗效、是否接受放疗及手术治疗可能是影响小细胞肺癌患者预后的主要因素.     

The significance of NSE and CEA as a differentiation marker for the cellular heterogeneity of small cell lung cancer

Neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) levels in the culture supernatant of the 65 pulmonary carcinoma cell lines: Small cell lung cancer (SCLC) 18, large cell carcinoma 14, squamous cell carcinoma 14, adenocarcinoma 14 and adenosquamous cell carcinoma 5, were measured by a radioimmunoassay (RIA). The mean value of NSE was 30.8+/-22.4 ng/ml and 9.2+/-8.7 ng/ml in SCLC and non-SCLC, respectively. The mean value of CEA was 15.1+/-20.9 ng/ml and 26.6+/-72.3 ng/ml in SCLC and non-SCLC, respectively. A significant difference in NSE levels was obtained between SCLC cell lines and non-SCLC cell lines. In SCLC cell lines, a significant inverse proportional correlation was observed between NSE and CEA levels. The CEA production tended to be higher in cells with low levels of NSE than in those with high NSE production. With respect to correlation between marker production and growth characteristics of SCLC cells in vitro, significantly higher NSE and lower CEA levels were found in cells growing with floating colony or neurite like characteristics (classic cell type) than those in cells with epithelial or intermediate growth characteristics (variant cell type). A significant positive correlation between NSE levels and the survival periods was found in follow-up studies of 10 patients who underwent surgery with complete resection of the primary tumor. All of 4 long term survivors over 3 years after surgery had significantly high NSE and relatively low CEA producing tumors. The relationship of these markers to clinical status of the patient suggests that an analysis for correlation of NSE and CEA levels in SCLC patients may be useful to discriminate between a pure neuroendocrine SCLC tumor and a mixed small cell/large cell tumor, and in monitoring therapeutic effect and prognosis of each patient.     

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).     

Carcinoembryonic antigen,squamous cell carcinoma antigen,CYFRA 21-1, and neuron-specific enolase in squamous cell lung cancer patients

BACKGROUND: Carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), and CYFRA 21-1 are the most useful markers for non-small cell lung cancer (NSCLC), but neuron-specific enolase (NSE) is a tumor maker of choice for SCLC. The determination of NSE in NSCLC could allow selection of patients with neuroendocrine features. NSCLC patients whose tumors have neuroendocrine properties may be more responsive to chemotherapy; however, these tumors have been reported to be more aggressive. Tumor markers are not suitable for diagnosis; their principal applications are in monitoring of therapy and prognosis. METHODS: Tumor markers were measured in 200 untreated patients with squamous cell lung cancer (SQC) and a reference group (n = 220; 124 healthy persons and 96 patients with nonmalignant lung disease). CEA and SCC-Ag were measured by microparticle enzyme immunoassays on Abbott AxSYM and IMx analyzers. CYFRA 21-1 and NSE were measured by electrochemiluminescence immunoassays on the Roche Elecsys 2010. RESULTS: CEA, SCC-Ag, CYFRA 21-1, and NSE were increased above the cutoffs in 26%, 32%, 67%, and 28% of tested patients, respectively. The area under the ROC curve for CYFRA 21-1 was higher than those for CEA, SCC-Ag, and NSE (SQC vs controls). CYFRA 21-1 and CEA were significantly higher in advanced SQC than in early stages of disease (P <0.0001 and P <0.0004, respectively). In multivariate analysis of survival, CYFRA 21-1 was an independent but nonspecific prognostic factor in the operable group of SQC patients, whereas NSE was an independent prognostic factor in the advanced stages of disease. CONCLUSION: CYFRA 21-1 is an independent prognostic factor in earlier stages and NSE in the advanced stages of SQC.     

四项肿瘤标志联合检测在小细胞肺癌中的临床价值

目的 探讨小细胞肺癌(SCLG)患者血清中组织多肽特异性抗原(TPS)、神经元特异烯醇化酶(NSE)、癌抗原125(CA125)和癌胚抗原(CEA)水平,对SCLC临床诊断、病情监测的临床意义.方法 用ELISA法检测271例SCLC和80例肺良性疾病患者及224名健康对照者血清TPS水平;同时用电化学发光法检测血清NSE、CA125和CEA水平;并用约登指数和受试者工作特征曲线(ROC曲线)分析4项肿瘤标志及其各项肿瘤标志联合检测SCLC患者的效能.结果 SCLC组的TPS、NSE、CA125和CEA血清水平明显高于肺良性疾病组和健康对照组(Z均＞1.90,P均＜0.01);广泛期SCLC患者的血清TPS和NSE明显高于局限期患者(Z分别为2.69、2.27,P分别为0.009、0.02).治疗后不同预后患者的TPS和NSE浓度差异有统计学意义(Z分别为4.06、3.11,P分别为0.001、0.007).多指标联合检测时,以TPS+NSE组合的敏感度最高(86.7%),其特异度、阳性预测值(PPV)和阴性预测值(NPV)分别为75.0%、81.0%和82.2%.结论 血清TPS、NSE、CA125和CEA均可作为SCLC的诊断指标,以TPS+NSE联合检测的临床价值最好.     

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...     

肺癌肺泡灌洗液与血清中CYFRA21-1、NSE的对比研究

目的：评价CYPRA21-1、NSE对肺癌诊断和预后的价值。方法：将肺癌患者分为NSCLC组和SCLC组。良性疾病为对照组。所有患者均收集患、健侧BALF、静脉血，测CYFRA21-1、NSE。结果：NSCLC中CYFRA21-1明显高于SCLC和对照组。SCLC中NSE则显著高于NSCLC和对照。二项指标均以患侧BALF增高明显。而且NSE是提示SCLC预后、CYFR21-1则是提示NSCLC预后的有价值的指标；联合检测正确率增高，以患侧最优。结论：联合检测患侧BALF中CYFRA21-1、NSE诊断肺癌阳率最高，对预后判断有重要价值。     

Evidence for a substantial genetic influence on biochemical liver function tests: results from a population-based Danish twin study

BACKGROUND: Biochemical liver function tests are widely used in the clinic and are some of the most frequently used tests in screening for diseases in older age groups. The aim of the present study was to estimate the relative importance of genetic and environmental factors to variations in these tests among the elderly. METHODS: We conducted a survey among Danish twins, 73-102 years of age, identified in the population-based Danish Twin Registry. Among the 2749 individuals in the study population, an interview was conducted with 79%. From these, a blood sample was collected from 290 same-sex twin pairs, total of 580 subjects, within a 6-month period and analyzed for alanine aminotransferase (ALT), lactate dehydrogenase (LDH), gamma-glutamyltransferase (GGT), bilirubin, and albumin. The interview included questions about alcohol consumption and body mass index (BMI; self-calculated height and weight). Heritability (proportion of the population variance attributable to genetic variation) was estimated using structural-equation analyses before and after correction for alcohol consumption and BMI. RESULTS: Structural-equation analyses revealed a substantial heritability (35-61%) for the four biochemical liver function tests: ALT, GGT, LDH, and bilirubin. The remaining variation could be attributed to individuals' nonfamilial environments. Adjustment for alcohol consumption and BMI had no influence on the heritability for ALT, GGT, LDH, and bilirubin. For albumin, two models fit equally well before adjustment for alcohol and BMI: a model including additive genetic and nonshared environmental factors (AE), and a model including shared and nonshared environmental factors (CE). After adjustment, the model including shared and nonshared environment was clearly the best fitting model. CONCLUSIONS: For both males and females, the effect of genetic factors on the biochemical liver function tests ALT, GGT, LDH, and bilirubin is substantial and accounts for one-third to two-thirds of the variation among individuals 73-102 years of age. The heritability is equal for males and females and does not change notably after controlling for alcohol consumption and BMI. For albumin, no major impact of genetic factors was found independent of BMI and alcohol consumption. An understanding of the genetic mechanisms underlying biochemical liver function tests among the very old may be of value in the interpretation of these tests in this age group.     

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。     

High lactate dehydrogenase levels at admission for painful vaso-occlusive crisis is associated with severe outcome in adult SCD patients

Objectives

The aim of this study is to assess biological prognostic factors at the onset of vaso-occlusive crisis (VOC) in adults with sickle cell disease (SCD).

Methods

A monocentric prospective study including all patients admitted for VOC in a reference center for SCD was utilized. We used multivariate logistic regression to find independent predictors of severe evolution, defined by death or a worsening clinical state indicating transfusion or transfer to the intensive care unit.

Results

Eighty eight patients were included, 63% were women, median age of 23 years, and 90% of patients were homozygous SCD, 10% compound heterozygous. VOC became severe in 17 patients. Patients with severe VOC were more frequently males, who also had higher white blood cell (WBC) count, procalcitonin (PCT), and lactate dehydrogenase (LDH) levels. LDH level was the best predictor of the outcome; WBC and PCT had no significant added predictive values when coupled with LDH in multivariable models, even in patients with fever or acute chest syndrome. Severe evolution always occurred when LDH levels were over 4 times the upper limit of the normal range at admission and never occurred when LDH levels were within the normal range.

Conclusion

Further studies should confirm the predictive value of LDH before its widespread use as a prognostic factor. If it is confirmed, the benefit of preemptive transfusion when LDH levels at admission are very high could be investigated.     

The prognostic value of albumin fluorescence test in the evaluation of outcome of acute intoxication with psychotropics

Two hundred and five patients with toxicogenic and somatogenic intoxication with psychotropics (PT) were examined for the purpose of evaluating the prognostic value of the albumin fluorescence test. An analysis of distributions of laboratory indices in the groups of survived (n = 176) and diseased (n = 29) patients demonstrated the following: the parameter "efficient albumin concentration" (EAC) measured by fluorescence is informative in respect to prognosticating an outcome of PT intoxication of both toxicogenic and somatogenic forms. EAC provides for isolating a subgroup of patients with the risk of unfavorable outcome that is 3-4-fold higher versus the mean value. The routine laboratory parameters, e.g. level of creatinine, serum urea, are rather of a less prognostic significance versus the EAC fluorescence parameter.     

血清胃泌素释放肽前体检测对小细胞肺癌诊断及预后的临床价值

目的 探讨血清胃泌素释放肽前体(pro-GRP)对小细胞肺癌(SCLC)的诊断及预后价值.方法 选取2018年1月至2021年1月吉林大学第一医院经病理组织学确诊为肺癌的2584例患者,其中SCLC 132例,非小细胞肺癌(NSCLC)2452例.采用电化学发光免疫分析法(Roche Cobas e601)检测各组血清...     

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。