胃泌素释放肽前体对小细胞肺癌的诊断价值

目的 评估分析血清胃泌素释放肽前体(ProGRP)对小细胞肺癌(SCLC)的临床诊断价值.方法 用化学发光法和电化学发光法检测2010年9月至2011年4月期间,青岛大学医学院附属医院46例初诊SCLC(局限期26例、广泛期20例)、51例非小细胞肺癌(NSCLC)、45例肺良性疾病患者及56名健康体检者血清ProGRP和神经元特异性烯醇化酶(NSE)水平,以受试者工作特征( ROC)曲线确定ProGRP和NSE诊断SCLC的临界值及曲线下面积(ROC-AUC),评估2项指标诊断SCLC的敏感度和特异度.结果 健康对照组、肺良性疾病组、NSCLC组和SCLC组血清ProGRP水平分别为22.9(19.5～28.7)、23.7(20.0 ～ 27.8)、28.9(23.8 ～34.7)和370.9( 129.4 ～ 1951.6) ng/L;血清NSE水平分别为14.1(12.5～15.7)、13.3(10.3 ～ 15.3)、16.8(11.7 ～22.1)和39.9(16.1 ～93.9) μg/L;经非参数Kruskal-WallisH检验,各组间ProGRP和NSE的差异均有统计学意义(H值分别为92.116和55.481,P均＜0.001).局限期SCLC (LD-SCLC)组血清ProGRP[ 156.2(65.4～547.5) ng/L]也高于健康对照组、肺良性疾病组和NSCLC组(U值分别为57、70和144,P均＜0.001).广泛期SCLC (ED-SCLC)组血清ProGRP和NSE为[1933.1(325.9 ～4512.1) ng/L和61.0(35.4～115.5)μg/L],均高于LD-SCLC组ProGR和NSE[24.3(15.1～61.3) μg/L,U值分别为119和153,P均＜0.05].以健康组为对照,ROC曲线上取约登指数最大点确定ProGRP和NSE的临界值分别为34.0 ng/L和20.2μg/L,SCLC组ProGRP的ROC-AUC(0.96)较NSE(0.86)明显增高(Z=2.57,P＜0.05);ProGRP和NSE联合检测的ROC-AUC(0.96)与ProGRP单项检测(0.96)比较,差异无统计学意义(Z =0.21,P＞0.05).ProGRP的敏感度(89.1％)也高于NSE(71.7％,x2 =4.90,P＜0.05);其特异度(98.2％)与NSE比较的差异无统计学意义(96.4％,x2 =0.00,P＞0.05);ProGRP和NSE联合检测的敏感度和特异度与ProGRP单项检测比较,差异无统计学意义(91.3％比89.1％,94.6％比98.2％,x2均为0.00,P＞0.05).以肺良性疾病组为对照,ROC曲线上取约登指数最大点确定ProGRP和NSE的临界值分别为49.5 ng/L和23.1 μg/L,SCLC组ProGRP的ROC-AUC(0.95)比NSE(0.87)明显升高(Z=1.99,P＜0.05);ProGRP和NSE联合检测的ROC-AUC (0.95)与ProGRP单项检测(0.95)比较,差异无统计学意义(Z=0.02,P＞ 0.05).ProGRP的敏感度(84.8％)也高于NSE(69.6％,x2=4.00,P＜ 0.05);其特异度(97.8％)与NSE比较,差异无统计学意义(97.8％,x2=0.50,P＞0.05);ProGRP和NSE联合检测的敏感度和特异度与ProGRP单项检测比较,差异无统计学意义(87.0％比84.8％,95.6％比97.8％,x2均为0.00,P＞0.05).以NSCLC组为对照,ROC曲线上取约登指数最大点确定ProGRP和NSE的临界值分别为49.1 ng/L和23.0μg/L,SCLC组ProGRP的ROC-AUC(0.90)较NSE(0.76)明显升高(Z=2.90,P＜0.05);ProGRP和NSE联合检测的ROC-AUC(0.90)与ProGRP单项检测(0.90)比较,差异无统计学意义(Z=0.00,P＞0.05).ProGRP的敏感度(84.8％)也高于NSE(69.6％,x2 =4.00,P＜0.05),其特异度(96.1％)与NSE也明显升高(80.4％,x2=6.13,P＜0.05);ProGRP和NSE联合检测的敏感度和特异度与ProGRP单项检测比较,差异无统计学意义(87.0％比84.8％,95.6％比96.1％,x2均为0.00,P＞0.05).结论 ProGRP用于诊断SCLC较好,其比NSE对SCLC有更高的辅助诊断价值.     

不同治疗方案对多发性骨髓瘤患者骨病的影响

Objective To explore the difference of effects of two regimens (bortezomib and dexamethasone, BD; and thalidomide and dexamethasone, TD) on bone disease in multiple myeloma(MM).Methods Forty patients with newly diagnosed and refractory or relapsed MM were treated with BD or TD regimens from Dec 2006 to Sep 2008. Bone pain score and X-ray examination were carried out before and after therapy. Serum levels of DKK-1, sRANKL, OPG and TRACP-5b were measured by ELISA before and 3 months after therapy. Results Serum TRACP-5b concentration was significantly decreased in patients received TD regimen (5.94 U/L before therapy vs 4.84 U/L 3 months after therapy ,P ＜ 0.05), and so did for serum DKK-1 concentration in patients responded to BD regimen (35.11 μg/L before vs 32.03 μg/L 3 months after therapy,P ＜0.05) ;for serum concentration of sRANKL in patients responded to BD regimen (1.05 pmol/L before vs 0.67 pmol/L 3 months after therapy, P ＜ 0. 05); and for serum concentration of TRACP-5b in responders to BD regimen (5.57 U/L before therapy vs 4.90 U/L 3 months after therapy ,P ＜0.05). Conclusion Bortezomib lowers levels of serum DKK-1 and RANKL in responders, thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption. Thalidomide decreases bone resorption regardless of treatmant response.     

不同治疗方案对多发性骨髓瘤患者骨病的影响

Objective To explore the difference of effects of two regimens (bortezomib and dexamethasone, BD; and thalidomide and dexamethasone, TD) on bone disease in multiple myeloma(MM).Methods Forty patients with newly diagnosed and refractory or relapsed MM were treated with BD or TD regimens from Dec 2006 to Sep 2008. Bone pain score and X-ray examination were carried out before and after therapy. Serum levels of DKK-1, sRANKL, OPG and TRACP-5b were measured by ELISA before and 3 months after therapy. Results Serum TRACP-5b concentration was significantly decreased in patients received TD regimen (5.94 U/L before therapy vs 4.84 U/L 3 months after therapy ,P ＜ 0.05), and so did for serum DKK-1 concentration in patients responded to BD regimen (35.11 μg/L before vs 32.03 μg/L 3 months after therapy,P ＜0.05) ;for serum concentration of sRANKL in patients responded to BD regimen (1.05 pmol/L before vs 0.67 pmol/L 3 months after therapy, P ＜ 0. 05); and for serum concentration of TRACP-5b in responders to BD regimen (5.57 U/L before therapy vs 4.90 U/L 3 months after therapy ,P ＜0.05). Conclusion Bortezomib lowers levels of serum DKK-1 and RANKL in responders, thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption. Thalidomide decreases bone resorption regardless of treatmant response.     

影响老年充血性心力衰竭患者血清CA125的相关因素分析

目的 探讨老年冠心病慢性充血性心力衰竭(CHF)患者血清CA125水平与心功能等相关因素之间的关系.方法 测定178例老年冠心病CHF患者血清肿瘤标志物CA125、癌胚抗原(CEA)、甲胎蛋白(AFP)、CA199、CA15-3、CA724以及肝肾功能和N末端脑钠肽(NT-proBNP);超声心动图测定二尖瓣舒张早期E峰最大流速(Ve)、舒张晚期A峰最大流速(Va)、Ve/Va、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)、左心室射血时间.所有患者根据NYHA分为Ⅰ+Ⅱ、Ⅲ、Ⅳ级3组;统计其胸腔积液、外周水肿、心房颤动的发生率.结果 (1)178例患者中血清CA125≤35 U/ml 91例,CA125中位数9.9(3.4～33.7)U/ml;＞35 U/ml 87例,中位数64.4(20.2～462.1)U/ml.CA125＞35 U/ml组NYHA心功能Ⅲ+Ⅳ级82例,Ⅰ+Ⅱ级5例;≤35 U/ml组Ⅲ+Ⅳ级7例,Ⅰ+Ⅱ级84例,组间心功能差异有统计学意义(x2=133.3,P＜0.001).CA125增高组胸腔积液、心房颤动、外周水肿的发生率高于CA125≤35 U/ml组[32.2%(28/87)、5.5%(5/91),51.7%(45/87)、9.9%(9/91),78.2%(68/87)、19.8%(18/91),P均＜0.01],NT-proBNP、LVESD、LVEF、左心室射血时间比较差异均有统计学意义[2524.0(104.0～19 308.0)、356.0(32.0～5201.1)ng/L,35(27～55)、32(26～53)mm,49%(23%～66%)、59%(42%～69%),268(210～312)、290(260～340)ms,P均＜0.05].(2)直线回归显示:血清CA125与血浆NT-proBNP、尿素氮呈正相关(r=0.3326、P=0.002,r=0.3430、P=0.002),与LVEF、左心室射血时间呈负相关(r=-0.3016、P=0.006,r=-0.3336、P=0.004).结论 老年冠心病CHF患者血清CA125随着心功能分级恶化而升高,并且与血浆NT-proBNP水平、LVEF、左心室射血时间以及有无胸腔积液、心房颤动、外周水肿等因素有关.

Abstract：

Objective To assess the association between serum levels of carbohydrate antigen 125 (CA125) and the heart function in the elderly with congestive heart failure (CHF). Methods CA125, carcinoembryonic antigen (CEA) ,alpha-fetoprotein ( AFP), CA199, CA15-3, CA724, liver and kidney function and NT-proBNP were measured in 178 patients with heart failure. Ve, Va, Ve/Va, left ventricular end-diastolic diamete ( LVEDD), left ventricular end-systolic diamete ( LVESD ), left ventricular ejection fraction ( LVEF ) and time were measured using echocardiograph. All patients were classified as Ⅰ + Ⅱ , Ⅲ and Ⅳ level according to the criteria of New York Heart Assocation ( NYHA), and the incidence of pleural effusion, peripheral edema,atrial fibrillation were observed. Results Among the 178 patients,serum CA125 were ≤35 U/ml in 91 patients with median of 9.9( 3.4 - 33.7 ) U/ml, ＞ 35 U/ml in 87 patients with median of 64. 4 ( 20. 2 - 462. 1 ) U/ml.Among those patients with CA125 ＞ 35 U/ml ,heart function was classified as level Ⅲ + Ⅳ in 82 patients,and level Ⅰ + Ⅱ in 5 patients. Among the patients with CA125 ≤35 U/ml,heart function was classified as level Ⅲ + Ⅳin 7 patients,and level Ⅰ + Ⅱ in 84 patients. Heart function was significantly different between the two CA125 groups( x2= 133. 3 ,P ＜0. 001 ). The incidence of pleural effusion,atrial fibrillation ,peripheral edema in the higher CA125 group were 32. 2%, 51.7% and 78. 2%, respectively, which were significantly higher than those in the normal CA 125 group ( 5.5 %, 9. 9% and 19. 8 %, repactively ) ( P ＜ 0. 01 ). NT-proBNP, LVESD,LVEF and time in the higher CA125 group were 2524. 0( 104.0 - 19 308. 0) ng/L,35 (27 -55) mm,49% (23%-66% ) and 268 (210 -312)ms, which were significantly differenct from those in the normal CA125 group [356.0 ( 32.0 - 5201.0) ng/L, 32 ( 26 - 53 ) mm, 59% ( 42% - 69% ) and 290 ( 260 - 340 ) ms, respectively](Ps ＜0. 05). The linear regression showed that serum CA125 was positively correlated with NT-ProBNP and urea nitrogen ( BUN ) ( r= 0. 3326 and 0. 3430, Ps= 0. 002 ) , as well as negtively correlated with LVEF and time (r= -0. 3016,P =0. 006;r = -0. 336,P =0. 004). Conclusion Serum CA125 in the elderly with congestive heart failure increased with the worsing of heart function, and correlated with the level of NT-proBNP, LVEF and time,as well as pleural effusion, atrial fibrillation, peripheral edema.     

小细胞肺癌患者血清胃泌素释放肽前体和神经元特异性烯醇化酶表达及意义

目的探讨血清胃泌素释放肽前体(pro-gastrin-releasing peptide,ProGRP)和神经元特异性烯醇化酶(neuronspecific enolase,NSE)在小细胞肺癌(small cell lung cancer,SCLC)中的表达及临床意义。方法SLC患者82例为SCLC组,非SCLC(non-SCLC,NSCLC)患者77例为NSCLC组,良性肺疾病患者94例为对照组。采用电化学发光法检测3组血清ProGRP、NSE水平,分析血清ProGRP、NSE水平与SCLC患者临床病理特征的关系,ROC曲线分析血清ProGRP、NSE诊断SCLC的效能。结果SCLC组血清ProGRP[716.4(320.8,1 058.2)ng/L]、NSE[38.6(25.5,48.1)μg/L]水平均高于NSCLC组[37.4(33.5,45.8)ng/L、17.6(14.5,23.7)μg/L]和对照组[28.2(20.6,37.9)ng/L、13.4(11.2,17.5)μg/L](P0.05);NSCLC组血清ProGRP水平高于对照组(P0.05),NSE与对照组比较差异无统计学意义(P0.05);SCLC组TNM分期Ⅲ~Ⅳ期、有淋巴结转移、有远处转移者血清ProGRP[847.6(457.8,1 146.7)、868.4(565.0,1 345.6)、939.0(675.7,1 414.8)ng/L]、NSE[47.6(24.5,79.8)、46.6(29.8,85.6)、74.2(45.5,86.4)μg/L]水平高于TNM分期Ⅰ~Ⅱ期[567.2(184.2,741.3)ng/L、34.6(23.4,40.7)μg/L]、无淋巴结转移[595.4(178.9,845.1)ng/L、29.5(22.7,45.1)μg/L]、无远处转移[586.9(98.6,847.6)ng/L、27.4(18.9,45.1)μg/L]者(P0.05);血清ProGRP以66.9ng/L为最佳截断值,诊断SCLC的AUC为0.950(95%CI:0.913~0.987,P0.001),准确率、灵敏度、特异度分别为93.8%、87.8%、91.5%;血清NSE以23.5μg/L为最佳截断值,诊断SCLC的AUC为0.845(95%CI:0.783~0.907,P0.001),准确率、灵敏度、特异度分别为84.1%、80.5%、87.2%;ProGRP与NSE联合诊断SCLC的AUC为0.978(95%CI:0.947~0.999,P0.001),准确率、灵敏度、特异度分别为95.3%、95.1%、98.9%。结论 SCLC患者血清ProGRP、NSE水平均明显升高,且增高程度与TMM分期、淋巴结转移及远处转移有关,血清ProGRP、NSE在SCLC诊断中有较高价值,可作为诊断SCLC的分子标志物。     

血清四种肿瘤标记物联合检测对肺癌的诊断价值

目的 探讨血清癌胚抗原(CEA)、CA125、CA153、CA199联合检测对肺癌的诊断价值.方法 用化学发光免疫分析法测定58例肺癌患者、38例肺良性病变患者及40名健康体检者血清CEA、CA125、CA153、CA199的含量,评价四项肿瘤标记物联合应用对肺癌的诊断价值.结果 肺癌组的血清CEA、CA125、CA153、CA199含量分别为5.6(1.0～619.0)μg/L、124.5(5.3～994.8)U/ml、14.4(3.1～800.0)U/ml、21.8(2.0～1200.0)U/ml,肺良性病变组分别为1.9(0.6～14.4)μg/L、17.7(1.8～303.6)U/m1、6.8(2.4～20.1)U/ml、9.3(2.0～82.6)U/ml,健康对照组分别为1.4(0.6～5.0)μg/L、9.6(4.4～36.5)U/ml、6.6(3.8～19.9)U/ml、6.4(2.0～58.1)U/ml.肺癌组血清CEA、CA125、CA153、CA199含量明显高于肺良性病变组和健康对照组(P均＜0.01);四项指标联合检测的敏感性为94.8%(55/58),明显高于单一检测[CEA:48.3%(28/58)、CA125:75.9%(44/58)、CA153:20.7%(12/58)、CA199∶31.0%(18/58)].结论 联合检测CEA、CA125、CA153、CA199可提高肺癌的阳性检出率.

Abstract：

Objective To evaluate the clinical value of combined detection of serum CEA, CA125,CA153 and CA199 in lung cancer diagnostec. Methods The serum level of CEA,CA125,CA153 and CA199 in 58 patients with lung cancer,38 patients with benign lung diseases and 40 healthy persons were determinated by Chemiluminesent immunoassay. The data were analyzed to evaluate the diagnostic value of the combination use of four markers. Results The serum levels of CEA,CA125,CA153 and CA199 in lung cancer group were 5.6 (1.0-619. 0) μg/L,124. 5 (5.3 - 994. 8) U/ml,14.4(3. 1 - 800. 0) U/ml and 21.8(2.0 - 1200.0) U/ml respectively ;The serum levels of CEA, CA125, CA153 and CA199 in benign lung diseases were 1.9 (0. 6 -14.4) μg/L, 17. 7 ( 1.8 - 303.6 ) U/ml, 6. 8 ( 2. 4 - 20. 1 ) U/ml and 9. 3 ( 2. 0 - 82. 6 ) U/ml respectively. The serum levels of CEA, CA125, CA153 and CA 199 in healthy controls were 1.4 (0. 6 - 5.0 ) μg/L, 9.6 (4. 4 -36. 5 ) U/ml,6. 6 (3.8 - 19. 9) U/ml and 6. 4 (2.0 - 58. 1 ) U/ml respectively. The levels of markers in the lung cancer group were significantly higher than those in patients with benign lung disease and healthy controllers (Ps ＜ 0. 01 ). The sensitivity of combined measurement was 94. 8%, significantly higher than a single measurement ( CEA 48. 3% ,CA125 75.9% ,CA153 20.7% ,CA199 31.0% ,Ps ＜0. 01 ). Conclusion The combined detection of CEA, CA125, CA153 and CA199 can significantly improve detection sensitivity of lung cancer and might provide valuable laboratory proof for early diagnosis of lung cancer.     

进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.     

上海地区人群血清骨转换标志物参考区间的建立

Objective To establish the reference intervals of serum osteocalcin (OCN), C-terminal cross-linking telopeptide of type Ⅰ collagen (β-CTx) and total type Ⅰ procollagen N-terminal peptide (P1NP) by electrochemiluminescence assay. Methods According to the Clinical and Laboratory Standards Institute (CLSI) "CA8-A" document the appropriately healthy people, who were divided into three groups (men, premenopausal women, and postmenopausal women) by sex and pre- or postmenopausal status were screened. The levels of fasting serum of OCN,β-CTx, tPINP were detected by Roche Modular E170 electrochemical immunoassay. Results 393 appropriately healthy people consists of 112 men between the ages of 29 and 69 years, 148 premenopausal women between the ages of 29 and 69 years, 133 postmenopausal women between the ages of 29 and 69 years. The levels of serum OCN, β-CTx, tP1NP in men group were (15.33±4.76) μg/L, (413±189) ng/L, (42.15±17.14) μg/L, respectively. The levels of serum OCN, β-CTx, tP1NP in premenopausal women group were (12.99±4.53) μg/L, 265(30-820) ng/L, (36.43±14.23) μg/L, respectively. The levels of serum OCN, β-CTx, tP1NP in postmenopausal women group were (18.96±5.15) μg/L, (513±195) ng/L, 51.40 (8.98 -118.6)μg/L, respectively. Logarithmic transformation produced normal distributions for all markers but serum β-CTx of premenopausal women group and serum tPINP of postmenopausal women group. The 95% of the distribution intervals for serum OCN, β-CTx, tP1NP in men group was 6.00-24.66 μg/L, 43-783 ng/L, 9.06-76.24 μg/L, respectively. The 95% of the distribution intervals for serum OCN, β-CTx, tP1NP in premenopausal women group was 4.11-21.87 μg/L, 68-680 ng/L, 8.53-64.32 μg/L respectively. The 95% of the distribution intervals for serum OCN, β-CTx, tPl NP in postmenopausal women group were 8.87-29.05 βg/L, 131-900 ng/L, 21.32-112. 80 μg/L, respectively. Conclusions Compared with the reference intervals provided by manufacture, the reference intervals of three serum bone turnover markers established by our laboratory have great difference. Laboratory should pay attention to the reference intervals was cited.     

Fisher判别分析在预测异位妊娠中的价值探讨

Objective To discuss the value of Fisher discriminant analysis of serum progesterone and the growing rate of β-human chorionic gonadotropin in the prediction of early ectopic pregnancy. Methods 66 patients with ectopic pregnancy (11 cases were successfully treated expectantly and 55 cases were treated surgically including 40 cases of rupture of fallopian tube and 15 cases of tubal abortion) and 55 patients with intrauterine pregnancy and 50 patients with threatened abortion were chosen. Serum progesterone,β-HCG,48 hβ-HCG and the 48 h growing rate of β-HCG in each group were measured and a Fisher discriminant analysis was used. Results The serum progester-one was (30.27± 18.20) nmol/L in ectopic pregnancy group,( 108.44±23.27 ) nmol/L in intrauterine pregnancy group and (91.68±34.90) nmol/L in threatened abortion group. The first β-HCG was ( 3767.63 ± 3530.38 ) U/L in ectopie pregnancy group,(29 028.65 ± 10 874.01 )U/L in intrauterine pregnancy group and (13 457.47±16 367.65)U/L in threatened abortion group. The second β-HCG was (4349.24±3536.22)U/L in ectopic pregnancygroup,(56 139.46 ± 23 296.87 ) U/L in intrauterine pregnancy group and (23 270.63 ± 23 811.68 ) U/L in threat-ened abortion group. The growing rate of β-HCG ( β-HCG/the first serum β-HCG) was 1.29 ± 0.28 in ectopic preg-nancy group,1.93 ± 0.36 in intrauterine pregnancy group and 1.97±0.28 in threatened abortion group. There was significant difference in serum progesterone,the first β-HCG and the second β-HCG as well as the growing rate of β-HCG among the groups(P<0.05 or <0.01). Fisher discriminant analysis of combing progesterone and the growing rate of β-HCG were connected with diagnosis of ectopic pregnancy,however,the only one serum β-HCG was not con-nected with diagnosis of ectopic pregnancy. 98.5% of ectopic pregnancy,65.6% of intrauterine pregnancy and 64.0% of threatened abortion were correctly classified in the Fisher discfiminant analysis,with overall correct rate of 77.8%. Conclusion Fisher discriminant analysis of combing progesterone and the growing rate of β-HCG can bet-ter predict the early ectopic pregnancy.     

Fisher判别分析在预测异位妊娠中的价值探讨

Objective To discuss the value of Fisher discriminant analysis of serum progesterone and the growing rate of β-human chorionic gonadotropin in the prediction of early ectopic pregnancy. Methods 66 patients with ectopic pregnancy (11 cases were successfully treated expectantly and 55 cases were treated surgically including 40 cases of rupture of fallopian tube and 15 cases of tubal abortion) and 55 patients with intrauterine pregnancy and 50 patients with threatened abortion were chosen. Serum progesterone,β-HCG,48 hβ-HCG and the 48 h growing rate of β-HCG in each group were measured and a Fisher discriminant analysis was used. Results The serum progester-one was (30.27± 18.20) nmol/L in ectopic pregnancy group,( 108.44±23.27 ) nmol/L in intrauterine pregnancy group and (91.68±34.90) nmol/L in threatened abortion group. The first β-HCG was ( 3767.63 ± 3530.38 ) U/L in ectopie pregnancy group,(29 028.65 ± 10 874.01 )U/L in intrauterine pregnancy group and (13 457.47±16 367.65)U/L in threatened abortion group. The second β-HCG was (4349.24±3536.22)U/L in ectopic pregnancygroup,(56 139.46 ± 23 296.87 ) U/L in intrauterine pregnancy group and (23 270.63 ± 23 811.68 ) U/L in threat-ened abortion group. The growing rate of β-HCG ( β-HCG/the first serum β-HCG) was 1.29 ± 0.28 in ectopic preg-nancy group,1.93 ± 0.36 in intrauterine pregnancy group and 1.97±0.28 in threatened abortion group. There was significant difference in serum progesterone,the first β-HCG and the second β-HCG as well as the growing rate of β-HCG among the groups(P<0.05 or <0.01). Fisher discriminant analysis of combing progesterone and the growing rate of β-HCG were connected with diagnosis of ectopic pregnancy,however,the only one serum β-HCG was not con-nected with diagnosis of ectopic pregnancy. 98.5% of ectopic pregnancy,65.6% of intrauterine pregnancy and 64.0% of threatened abortion were correctly classified in the Fisher discfiminant analysis,with overall correct rate of 77.8%. Conclusion Fisher discriminant analysis of combing progesterone and the growing rate of β-HCG can bet-ter predict the early ectopic pregnancy.     

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.     

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(...     

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。     

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.     

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。