肿瘤标记物联合检测在儿童神经母细胞瘤诊治中的意义

目的探讨24 h尿香草扁桃酸(VMA)、神经元特异性烯醇化酶(NSE)、乳酸脱氢酶(LDH)、血清铁蛋白(SF)及C-反应蛋白(CRP)在儿童神经母细胞瘤(NB)的诊断及疗效评估中的作用。方法对33例确诊为NB患儿的临床资料进行回顾性分析,应用高效液相色谱仪通过化学比色法测定24 h尿VMA;采用放射免疫法检测血清NSE和SF;应用全自动生化分析仪通过速率法测定血清LDH;采用固相免疫双抗体夹心法测定血CRP。分析以上患儿在初诊时5种肿瘤标记物的阳性率,对比初诊与化疗2个疗程后各指标的检测值;对比出现疾病进展的10例患儿在初诊、化疗2疗程后及进展时各标记物的检测值,并对比分析进展患儿与未进展患儿的检测值。结果初诊时5种肿瘤标记物阳性率均在65%以上,其中24 h尿VMA阳性率最高,达92.3%,其次为NSE,阳性率83.6%,LDH、SF及CRP阳性率分别为82.2%、75.6%及67.9%。经2个疗程化疗后,尿VMA、NSE、LDH及SF水平均初诊时明显下降(P<0.01)。在出现疾病进展时,尿VMA、NSE、LDH及SF较化疗2疗程后均升高(P<0.01),且均高于正常值,而疾病进展组的尿VMA、NSE、LDH明显高于未进展组(P<0.01)。结论 5种肿瘤标记物VMA、NSE、SF、LDH及CRP联合检测对NB早期诊断及评价疗效有一定价值。

The significance of tumor markers in the management of neuroblastoma

Objective To investigate the function of the combined detection of urinary vanillylmandelic acid(VMA),serum neuron-specific enolase(NSE),serum ferritin(SF),lactate dehydrogenase(LDH) and C-reactive protein(CRP) in the early diagnosis and therapeutic evaluation of patients with neuroblastoma(NB).Methods Thirty three patients with NB admitted in Beijing Children′s Hospital were analyzed retrospectively.Twenty-four-hour urinary VMA was measured by high performance liquid chromatography;serum NSE and SF were detected by radioimmunoassay;LDH was measured by automated clinical chemistry analyzer;CRP was measured by solid-phase immunoassay double antibody sandwich method.The positive rates at newly diagnosis and different stages of the disease,as well as the tumor-marker levels before and after chemotherapy were analyzed.The tumor-marker levels at newly diagnosis,2 cycles after chemotherapy and aggression period were compared in 10 patients who occurred tumor aggression.Results The positive rates of these 5 tumor markers were all above 65% at newly diagnosis(92.3% for VMA,83.6% for NSE,82.2% for LDH,75.6% for SF and 67.9% for CRP).After 2 cycles of chemotherapy,the levels of these 5 tumor markers were declined(P<0.01).When the patients occurred tumor aggression,4 tumor markers including urinary VMA,NSE,LDH and SF were elevated above the normal levels(P<0.01).Besides,urinary VMA,NSE and LDH in aggression patients were obviously higher than those in non-aggression patients(P<0.01).Conclusions The combination of tumor-marker detection is helpful for the early diagnosis and evaluation of therapeutic effect in the patients with NB.