ProGRP与NSE在小细胞肺癌的诊断和疗效监测中的临床意义

发布时间：2018-03-23 04:03

本文选题：小细胞肺癌　切入点：胃泌素释放肽前体　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评估血清胃泌素释放肽前体(Pro-gastrin-releasing peptide,ProGRP)、神经原特异性烯醇化酶(Neuron specific enolase,NSE)对小细胞肺癌的诊断和疗效评估中的应用价值。方法:1.采用电化学发光法(Electrochemiluminescence immunoassay)检测小细胞肺癌(Small cell lung cancer,SCLC)初诊病例47例,其中局限期(Limited-stage disease small cell lung cancer,LD-SCLC)26例,广泛期(Extensive-stage disease small cell lung cancer,ED-SCLC)21例。非小细胞肺癌(Non-small cell lung cancer,NSCLC)53例,其中腺癌31例,鳞癌22例。肺良性疾病患者(Benign pulmonary disease,BPD)59例,健康体检者71例。分别检测ProGRP、NSE,分析它们在SCLC诊断中的价值。各组ProGRP、NSE的检测数据呈偏态分布,采用中位数及四分位数[M(P25-P75)]来表示结果。多组间比较采用非参数Kruskal-wallis H检验,P0.05为差异有统计学意义。两两组间比较采用非参数Mann-whitney U检验,根据Bonferroni校正将检验水准调整为P0.008有统计学意义上的差异。以受试者工作特征曲线(Receiver operator characteristic curve,ROC)判定ProGRP和NSE的临界值,计算出诊断敏感度和特异度,敏感度的比较采用配对卡方检验。ROC曲线确定曲线下面积(Area under the curve,AUC),曲线下面积的比较用Z检验。2.SCLC化疗方案采用依托泊苷+顺铂。通过观察SCLC治疗前和2周期化疗、4周期化疗后ProGRP和NSE的动态水平变化结合肺癌化疗后缓解程度,探讨ProGRP与NSE在小细胞肺癌化疗疗效中的监测价值。组间比较采用相关样本配对Mann-whitney U检验,检验水准(a=0.05)。结果:1.经非参数kruskal-wallish检验,sclc、nsclc、bpd组、健康对照组间progrp、nse水平差异有统计学差异(h值分别为70.121、38.309,p0.001)。经非参数kruskal-wallish检验,ld-sclc、ed-sclc、nsclc、肺良性疾病组、健康对照组间各组间progrp、nse水平差异有统计学差异(h值分别为74.472、49.31,p0.001)。采用非参数mann-whitneyu检验方法比较,sclc组progrp,nse的水平高于健康对照组,肺部良性疾病组,nsclc组(progrp的u值分别为329.0、341.0和348.5p0.001,nse的u值为682.0、565.0和648.0p0.001)。ld-sclc组血清progrp浓度较健康对照组(u=290.0,p0.001)肺良性疾病组(u=306.0,p0.001)和nsclc组(u=301.5,p0.001)升高显著。ld-sclc组血清nse水平显著高于健康对照组(u=567.0,p0.008)肺良性疾病组(u=436.5,p0.008),而ld-sclc组nse与nsclc组nse比较,差异没有统计学意义(u=524.0,p0.008)。ed-sclc组progrp和nse水平显著高于ld-sclc组(u值分别为113.0和129.0,p0.008)。2.roc曲线分析结果显示sclc组progrp的roc-auc分别以健康对照组,肺良性疾病组,nsclc组为对照均显著高于nse的roc-auc(z值分别为2.01、1.99、2.05,p0.05),而联合检测的roc-auc与progrp单项检测没有统计学差异(z值分别为0.02、0.04、0.11,p0.05)。分别以健康对照组,bpd组,nsclc组为对照,progrp对sclc组的诊断敏感度均高于nse(x2值分别为4.9、4.9、4.0,p0.05)。与健康对照组、bpd组和nsclc组比较,progrp对ld-sclc组的敏感度高于nse(x2值分别为5.81、5.81、4.0,p0.05)。3.sclc化疗过程中progrp与nse的水平有助于化疗方案选择和疗效动态监测。10例ld-sclc病例(a组)化疗效果显著,疗效达到控制(cr+pr+sd),progrp与nse血清水平通过配对非参数mann-whitneyu检验化疗2周期后较化疗前浓度减低(z值分别为-2.803,-2.803,p0.05)。3例ld-sclc病例(b组)化疗效果差(pd),化疗前后progrp与nse血清水平变化无统计学差异(z值分别为-1.069,-1.604,p0.05),1例progrp极高值ed-sclc病例(c组)部分缓解(pr),progrp与nse显著下降。2例progrp极高ed-sclc病例(d组)例肿瘤明显增大,其病情进展与progrp与nse水平相关(z值分别为-1.342,-0.447,p0.05)。结论:在SCLC的诊断和疗效监测过程中ProGRP与NSE均表现出较高的临床应用价值,就对SCLC的早期诊断价值而言ProGRP优于NSE。
[Abstract]:Objective: To evaluate the serum gastrin releasing peptide (Pro-gastrin-releasing, peptide, ProGRP), neuron specific enolase (Neuron specific, enolase, NSE) application value on diagnosis and curative effect evaluation of small cell lung cancer. Methods: 1. by electrochemiluminescence (Electrochemiluminescence immunoassay) detection of small cell lung cancer (Small cell lung cancer SCLC), newly diagnosed 47 cases, including Limited (Limited-stage disease small cell lung cancer, LD-SCLC) in 26 cases, extensive stage (Extensive-stage disease small cell lung cancer, ED-SCLC). 21 cases of non-small cell lung cancer (Non-small cell lung cancer, NSCLC) in 53 cases, including 31 cases of adenocarcinoma, 22 cases of squamous cell carcinoma. Patients with benign lung diseases (Benign pulmonary, disease, BPD) in 59 cases, 71 cases of healthy persons were detected. ProGRP, NSE, SCLC in their analysis of the diagnostic value of each group. ProGRP, NSE of the testing data is Partial distribution, using the median and four percentile of [M (P25-P75)] to represent the results. Multiple comparisons with non parametric Kruskal-wallis H test, P0.05. There was a significant difference between the 22 groups were compared using non parametric Mann-whitney U test, according to the Bonferroni will test the water level adjustment for correction of P0.008 have statistically significant difference.. the receiver operating characteristic curve (Receiver operator characteristic curve, ROC ProGRP and NSE) to determine the critical value, calculate the diagnostic sensitivity and specificity and sensitivity were compared using paired chi square test.ROC curve to determine the area under the curve (Area under the curve, AUC), the area under the curve compared with Z test of.2.SCLC chemotherapy with etoposide + cisplatin. Through the observation of SCLC before treatment and 2 cycles of chemotherapy, combination chemotherapy of lung cancer the dynamic changes of levels of ProGRP and NSE after 4 cycles of chemotherapy after the remission rate of Pro The value of GRP and NSE in the monitoring of small cell lung cancer chemotherapy. Comparison between groups using paired samples Mann-whitney U test, the test level (a=0.05). Results: 1. the non parameter kruskal-wallish test, SCLC, NSCLC, BPD group, ProGRP control group, there were significant differences in NSE level differences (H = 70.121,38.309, p0.001). The non parameter kruskal-wallish test, LD-SCLC, ED-SCLC, NSCLC, lung benign disease group and healthy control group between groups ProGRP, statistically significant differences in the level of NSE (H = 74.472,49.31, p0.001). Compared with the non parameter mann-whitneyu test method, SCLC group ProGRP, NSE levels higher than the healthy control group, benign lung disease group, group NSCLC (ProGRP u = 329.0341.0 and 348.5p0.001 NSE, the U value of 682.0565.0 and 648.0p0.001) in.Ld-sclc group serum ProGRP concentration compared with the healthy control group (u=290.0, p0.001) of lung Benign disease group (u=306.0, p0.001) and NSCLC group (u=301.5, p0.001) significantly increased the levels of serum NSE in.Ld-sclc group was significantly higher than that of the control group (u=567.0, p0.008) in benign lung disease group (u=436.5, p0.008), LD-SCLC group and NSCLC NSE group NSE, the difference was not statistically significant (u=524.0, p0.008).Ed-sclc group ProGRP and NSE were significantly higher than that of group LD-SCLC (U = 113 and 129, p0.008).2.roc curve analysis showed that the SCLC group of ProGRP ROC-AUC respectively in the healthy control group, benign lung disease group, NSCLC group were significantly higher than that of NSE ROC-AUC (z = 2.01,1.99,2.05, P0.05, and ROC-AUC) with ProGRP single detection, combined detection was not statistically significant (z = 0.02,0.04,0.11, P0.05) respectively. In healthy control group, BPD group, NSCLC group, ProGRP group of SCLC diagnostic sensitivity was higher than that of NSE (x2 = 4.9,4.9,4.0, P0.05 ). Compared with the healthy control group, BPD group and NSCLC group, ProGRP of group LD-SCLC was more sensitive than NSE (x2 = 5.81,5.81,4.0, P0.05) ProGRP and NSE.3.sclc in the process of chemotherapy is helpful to chemotherapy and the curative effect of dynamic monitoring of.10 LD-SCLC cases (group A) chemotherapy effect to control the effect of (cr+pr+sd), ProGRP and NSE serum levels through paired non parametric mann-whitneyu test after 2 cycles of chemotherapy were lower than before chemotherapy (z = -2.803, -2.803, P0.05).3 LD-SCLC cases (B group) and chemotherapy effect (PD), no significant difference between the changes of ProGRP and NSE serum levels before and after chemotherapy (z = -1.069, -1.604, P0.05), 1 cases of high ProGRP value ED-SCLC cases (C group) partial remission (PR), ProGRP and NSE decreased significantly in.2 cases of ProGRP high ED-SCLC cases (D group) cases were significantly increased, and the progress of ProGRP and NSE levels (Z value Don't be -1.342, -0.447, P0.05). Conclusion: in the process of SCLC diagnosis and efficacy monitoring, ProGRP and NSE both show high clinical value. ProGRP is better than NSE. for the early diagnosis value of SCLC.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R730.43

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