伴神經(jīng)內(nèi)分泌分化肺腺癌血清癌胚抗原水平的分析

黃宇筠　袁潤強(qiáng)　陳應(yīng)智　袁小玲　繆卓峰　莊楚璇

伴神經(jīng)內(nèi)分泌分化肺腺癌血清癌胚抗原水平的分析

黃宇筠★袁潤強(qiáng)陳應(yīng)智袁小玲繆卓峰莊楚璇

［摘要］目的探討伴神經(jīng)內(nèi)分泌分化（neuroendocrine differentiation，ND）的肺腺癌血清癌胚抗原（carcinoembryonic，CEA）水平及其與ND的關(guān)系。方法對160例確診肺腺癌肺組織標(biāo)本（包括手術(shù)切除及經(jīng)纖支鏡活檢取得）采用免疫組化S-P法檢測神經(jīng)內(nèi)分泌標(biāo)志物的表達(dá)。治療前抽取患者靜脈血，用化學(xué)發(fā)光法檢測血清CEA水平。結(jié)果160例肺腺癌中具有ND的共19例（10．61%），其中突觸素（synaptophysin，Syn）陽性5例（26．32%）、嗜鉻顆粒蛋白（chromogranin，CgA）陽性7例（36．84%）、神經(jīng)元特異性烯醇酶（neuron specific enolase，NSE）陽性1例（5．26%）、Syn和CgA同時(shí)陽性6例（31．58%）。伴ND的及不伴ND的肺腺癌組血清CEA水平分別為［16．54（2．5－89．92）］ng／mL和［2．71（1．56－4．97）］ng／mL，兩者比較有統(tǒng)計(jì)學(xué)差異（P＜0．05）。在伴ND的肺腺癌中Syn陽性組、CgA陽性組、Syn＋CgA陽性組血清CEA水平分別為［49．36（4．05－181．71）］ng／mL、［2．5（2．1－28．02）］ng／mL和［87．7（16．54－171．25）］ng／mL。Syn陽性組與CgA陽性組、Syn陽性組與Syn＋CgA陽性組比較均無統(tǒng)計(jì)學(xué)差異（P分別為0．198 和0．462）。CgA陽性組與Syn＋CgA陽性組比較有統(tǒng)計(jì)學(xué)差異（P＝0．044）。Syn與血清CEA水平有相關(guān)性。以不伴ND的肺腺癌為對照組，診斷伴ND的肺腺癌的血清CEA的最佳折點(diǎn)為15．89ng／mL，敏感性44．4%，特異性90．6%，曲線下面積為0．76。結(jié)論血清CEA可能是預(yù)測肺腺癌伴ND的一個(gè)簡單有效的指標(biāo)。

［關(guān)鍵詞］神經(jīng)內(nèi)分泌分化；肺腺癌；癌胚抗原

作者單位：中山市人民醫(yī)院呼吸內(nèi)科，廣東，中山528403

The analysis of serum carcinoembryonic in neuroendocrine differentiation of lung adenocarcinoma

HUANG Yujun★, YUAN Runqiang, CHEN Yingzhi, YUAN Xiaoling, MIAO Zhuofeng, ZHUANG Chuxuan
(Department of Respiratory Medicine, Zhongshan People’s Hospital, Zhongshan, Guangdong, China, 528403)

[ABSTRACT]ObjectiveTo explore the levels of carcinoembryonic antigen（CEA）and the correlation between CEA and neuroendocrine differentiation（ND）in patients with lung adenocarcinoma of neuroendocrine．Methods160 lung tissue samples with lung adenocarcinoma（including surgical resection and biopsy by bronchoscopy）were taken in．The levels of neuroendocrine markers were detected by immunohistochemical S-P method．And the levels of serum CEA were detected by chemiluminescence before treatment．Results There were 19 lung adenocarcinomas（10．61%）with neuroendocrine differentiation in the 160 cases of lung adenocarcinomas．Among the 19 cases，5 cases（26．32%）were positive of synaptophysin（Syn），7 cases（36．84%）were positive of chromogranin（CgA），1 case（5．26%）was positive of neuron specific enolase（NSE），and 6 cases（31．58%）were positive of both Syn and CgA．The levels of serum CEA in lung adenocarcinoma with ND and non-neuroendocrine differentiation were［16．54（2．5－89．92）］ng／mL and［2．71（1．56－4．97）］ng／mL，respectively．And there was a significant difference in the levels of serum CEA between the two groups（P＜0．05）．In the lung adenocarcinoma with ND，the levels of serum CEA in group positive of Syn，group positive of CgA and group positive of Syn and CgA were ［49．36（4．05－181．71）］ng／mL，［2．5（2．1－28．02）］ng／mL and［87．7（16．54－171．25）］ng／mL，respectively．There were no significant differences in the levels of serum CEA between the group positive of CgA，either between the group positive of Syn and the group positive of both Syn and CgA（P＝0．198 and P＝0．462，respectively）There was a significant difference in the levels of serum CEA（P＝0．044）between the group positive of CgA and the group positive of both Syn anf CgA．And there was a correlation between Syn and the levels of serum CEA．Taking the lung adenocarcinoma with non-neuroendocrine differentiation as a control group，the cut-off of serum CEA to distinguish lung adenocarcinoma with ND was 15．89 ng／mL，while the sensitivity，specificity and the area under curve were 44．4%，90．6%and 0．76，respectively．Conclusion The serum CEA is possibly a simple and effective marker to predict the lung adenocarcinoma with ND．

[KEY WORDS] Neuroendocrine differentiation; Lung adenocarcinoma; Carcinoembryonic antigen(CEA)

據(jù)2008年我國36個(gè)腫瘤登記點(diǎn)發(fā)布數(shù)據(jù)顯示，肺癌新發(fā)病例數(shù)約52．2萬，占所有惡性腫瘤病例數(shù)18．5%。肺癌死亡病例數(shù)約45．3萬，占所有惡性腫瘤死亡例數(shù)的23．1%。肺癌的發(fā)病率和死亡率均居所有惡性腫瘤之首［1］。肺癌分小細(xì)胞肺癌與非小細(xì)胞肺癌。……