血清ProGRP、NSE水平與小細胞肺癌化療療效及預后的相關(guān)性研究

黃遠東　何朗　趙曉平　張盛　徐毅

[摘要] 目的 探討小細胞肺癌（SCLC）患者血清胃泌素前體釋放鈦（ProGRP）和神經(jīng)元特異性烯醇化酶（NSE）水平與其化療療效及預后的相關(guān)性研究。 方法 選擇2016年2月～2017年2月于成都市第五人民醫(yī)院腫瘤科及呼吸內(nèi)科就診的符合診斷標準的SCLC患者103例為研究對象，給予2個周期及以上的標準化療方案。采用酶聯(lián)免疫吸附試驗（ELISA）檢測血清中ProGRP水平，采用電化學發(fā)光法（ECLIA）檢測血清NSE水平。以中位血清ProGRP和NSE為界將研究對象分為ProGRP高水平組和ProGRP低水平組，NSE高水平組和NSE低水平組。分析兩指標與療效及預后的關(guān)系。 結(jié)果 腫瘤直徑≥4 cm、臨床分期為廣泛期、遠處轉(zhuǎn)移、有吸煙史的SCLC患者血清ProGRP和NSE水平高于腫瘤直徑<4 cm、臨床分期為局限期、無遠處轉(zhuǎn)移、無吸煙史的SCLC患者（P < 0.05）。ProGRP低水平組化療效果優(yōu)于ProGRP高水平組，NSE低水平組PFS高于NSE高水平組。影響SCLC患者預后的因素有臨床分期（OR = 4.986，95%CI：3.774～9.876，P = 0.003）、遠處轉(zhuǎn)移（OR = 3.659，95%CI：2.182～7.569，P = 0.016）及血清NSE（OR = 2.879，95%CI：1.487～6.721，P = 0.005）。 結(jié)論 血清ProGRP可預測SCLC患者的臨床療效，血清NSE可預測SCLC患者的預后，臨床治療中應(yīng)綜合評估兩個指標，同時密切關(guān)注有遠處轉(zhuǎn)移或臨床分期為廣泛期的SCLC患者。

[關(guān)鍵詞] 小細胞肺癌;胃泌素前體釋放肽;神經(jīng)元特異性烯醇化酶;化療療效;預后

[中圖分類號] R734.2? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）06（b）-0084-05

Correlation study of serum ProGRP， NSE levels with chemotherapy efficacy and prognosis in patients with small cell lung cancer

HUANG Yuandong1? ?HE Lang1? ?ZHAO Xiaoping2? ?ZHANG Sheng1? ?XU Yi1

1.Department of Oncology， Chengdu Fifth People′s Hospital， Sichuan Province， Chengdu? ?611130， China; 2.Department of Respiratory， Chengdu Fifth People′s Hospital， Sichuan Province， Chengdu? ?611130， China

[Abstract] Objective To investigate the relationship of serum levels of pro-gastrin-releasing peptide （ProGRP） and neuron-specific enolase （NSE） with chemotherapy efficacy and prognosis in patients with small cell lung cancer （SCLC）. Methods A total of 103 SCLC patients who met the diagnostic criteria diagnosed in Oncology and Respiratory Department of Chengdu Fifth People′s Hospital from February 2016 to February 2017 were selected as study objects. Two cycles or more of the standard chemotherapy regimens were given to them. Serum ProGRP level was measured by enzyme-linked immunosorbent assay （ELISA）， and serum NSE level was measured by electrochemiluminescence immunoassay （ECLIA）. Taking the median serum ProGRP and NSE level as the boundary， the objects were divided into high ProGRP level group and low ProGRP level group， high NSE level group and low NSE level group， the relationship of the two indexes with efficacy and prognosis was analyzed. Results The serum levels of ProGRP and NSE in SCLC patients with tumor diameter ≥4 cm， extensive metastasis， distant metastasis and smoking history were higher than those in SCLC patients with tumor diameter <4 cm， limited clinical stage， no distant metastasis and no smoking history （P < 0.05）. The chemotherapeutic efficacy of low ProGRP level group was higher than that of high ProGRP level group， and PFS of low NSE level group was higher than that of high NSE level group. The factors affecting the prognosis of SCLC patients were clinical stage （OR = 4.986， 95%CI： 3.774-9.876， P = 0.003）， distant metastasis （OR = 3.659， 95%CI： 2.182-7.569， P = 0.016） and serum NSE （OR = 2.879， 95%CI： 1.487-6.721， P = 0.005）. Conclusion Serum ProGRP can predict the clinical efficacy of SCLC patients， serum NSE can predict the prognosis of SCLC patients. Two indicators should be evaluated comprehensively in clinical treatment， and close attention should be paid to SCLC patients with distant metastasis or extensive clinical stage.

[Key words] Small cell lung cancer; Pro-gastrin-releasing peptide; Neuron-specific enolase; Chemotherapy efficacy; Prognosis

小細胞肺癌（small cell lung cancer，SCLC）是一種惡性度較高的肺癌類型，占肺癌總數(shù)的15%～20%，具有生長迅速、早期轉(zhuǎn)移、侵襲性高等特點[1]。SCLC的腫瘤細胞對化療和放療都非常敏感，局限期經(jīng)過強化治療完全緩解率可達到50%以上，但是多數(shù)患者確診時已為晚期，一線治療后預后仍較差，因此借助多種指標或腫瘤標志物來判斷病情程度和預后效果是非常有必要的。胃泌素釋放鈦（gastrin-releasing peptide，GRP）是一種由胃腸道分泌的促胃液素釋放肽，可以通過自分泌或細胞間的相互作用參與腫瘤發(fā)生、發(fā)展、轉(zhuǎn)移過程，因其半衰期較短，臨床上通常將與其等摩爾釋放的胃泌素前體釋放鈦（pro gastrin releasing peptide，ProGRP）作為檢測依據(jù)[2]。……