血浆嗜铬粒蛋白A对胃肠胰腺内分泌肿瘤的诊断价值

背景：嗜铬粒蛋白A（CgA）广泛存在于神经内分泌细胞中，其血浆水平升高提示存在神经内分泌来源的肿瘤。目的：确定血浆CgA诊断胃肠胰腺内分泌肿瘤的临界点，并探讨其诊断价值。方法：以酶联免疫吸附测定（EUSA）检测39例胃肠胰腺内分泌肿瘤和37例嗜铬细胞瘤患者的血浆C外水平，以30例非内分泌肿瘤消化疾病患者和30例正常人作为对照。绘制接受者操作特征曲线（ROC曲线），确定ROC曲线下面积（AUROC）和血浆C小的诊断临界点。结果：胃肠胰腺内分泌肿瘤、嗜铬细胞瘤和非内分泌肿瘤消化疾病组的血浆CgA水平均显著高于正常对照组（86、135和30U／L对20U／L，P〈0．001）。以正常对照组和胃肠胰腺内分泌肿瘤组数据绘制ROC曲线，AUROC为0．912．CgA的诊断临界点为30U／L，敏感性为80．0％，特异性为96．7％；以正常对照组和嗜铬细胞瘤组数据绘制ROC曲线，AUROC为0．914，CgA的诊断临界点为30．5U／L，敏感性为89．2％，特异性为96．7％。结论：血浆C外水平对神经内分泌肿瘤，尤其是胃肠胰腺内分泌肿瘤具有较高诊断价值，可作为可靠的肿瘤标志物应用于临床。

Diagnostic Value of Plasma Chromogranin A in Gastroenteropancreatic Endocrine Tumors

Background： Chromogranin A （CgA） presents in most neuroendocrine cells ubiquitously. Elevated plasma level of CgA indicates the presence of tumors of neuroendocrine origin. Aims： To establish the cut-off value of plasma CgA in diagnosing gastroenteropancreatic endocrine tumors, and to appraise its diagnostic value. Methods： Plasma level of CgA was measured by enzyme-linked immunosorbent assay （ELISA） in 39 patients with gastroenteropancreatic endocrine tumor and in 37 patients with pheochromocytoma; 30 patients with gastrointestinal diseases but without endocrine tumor and 30 healthy adults served as controls. Receiver operating characteristic curve （ROC curve） was constructed to obtain the area under ROC curve （AUROC） and the cut-off value of plasma CgA. Results： Plasma levels of CgA in gastroenteropancreatic endocrine tumors, pheochromocytomas and gastrointestinal diseases without endocrine tumor were significantly higher as compared with that in the healthy controls （86, 135 and 30 U/L vs. 20 U/L, P〈0.001, respectively）. The cut-off value between healthy controls and gastroenteropancreatic endocrine tumors was 30 U/L, with a sensitivity of 80.0% and specificity of 96.7%; and that between healthy controls and pheochromocytomas was 30.5 U/L, with a sensitivity of 89.2% and specificity of 96.7%. The AUROC were 0.912 and 0.914, respectively. Conclusions： Plasma level of CgA can be used as a reliable marker for neuroendocrine tumors with high diagnostic value, especially for gastroenteropancreatic endocrine tumors.