目的 评估分析血清胃泌素释放肽前体(ProGRP)对小细胞肺癌(SCLC)的临床诊断价值.方法 用化学发光法和电化学发光法检测2010年9月至2011年4月期间,青岛大学医学院附属医院46例初诊SCLC(局限期26例、广泛期20例)、51例非小细胞肺癌(NSCLC)、45例肺良性疾病患者及56名健康体检者血清ProGRP和神经元特异性烯醇化酶(NSE)水平,以受试者工作特征( ROC)曲线确定ProGRP和NSE诊断SCLC的临界值及曲线下面积(ROC-AUC),评估2项指标诊断SCLC的敏感度和特异度.结果 健康对照组、肺良性疾病组、NSCLC组和SCLC组血清ProGRP水平分别为22.9(19.5～28.7)、23.7(20.0 ～ 27.8)、28.9(23.8 ～34.7)和370.9( 129.4 ～ 1951.6) ng/L;血清NSE水平分别为14.1(12.5～15.7)、13.3(10.3 ～ 15.3)、16.8(11.7 ～22.1)和39.9(16.1 ～93.9) μg/L；经非参数Kruskal-WallisH检验,各组间ProGRP和NSE的差异均有统计学意义(H值分别为92.116和55.481,P均＜0.001).局限期SCLC (LD-SCLC)组血清ProGRP[ 156.2(65.4～547.5) ng/L]也高于健康对照组、肺良性疾病组和NSCLC组(U值分别为57、70和144,P均＜0.001).广泛期SCLC (ED-SCLC)组血清ProGRP和NSE为[1933.1(325.9 ～4512.1) ng/L和61.0(35.4～115.5)μg/L],均高于LD-SCLC组ProGR和NSE[24.3(15.1～61.3) μg/L,U值分别为119和153,P均＜0.05].以健康组为对照,ROC曲线上取约登指数最大点确定ProGRP和NSE的临界值分别为34.0 ng/L和20.2μg/L,SCLC组ProGRP的ROC-AUC(0.96)较NSE(0.86)明显增高(Z=2.57,P＜0.05)；ProGRP和NSE联合检测的ROC-AUC(0.96)与ProGRP单项检测(0.96)比较,差异无统计学意义(Z =0.21,P＞0.05).ProGRP的敏感度(89.1％)也高于NSE(71.7％,x2 =4.90,P＜0.05)；其特异度(98.2％)与NSE比较的差异无统计学意义(96.4％,x2 =0.00,P＞0.05)；ProGRP和NSE联合检测的敏感度和特异度与ProGRP单项检测比较,差异无统计学意义(91.3％比89.1％,94.6％比98.2％,x2均为0.00,P＞0.05).以肺良性疾病组为对照,ROC曲线上取约登指数最大点确定ProGRP和NSE的临界值分别为49.5 ng/L和23.1 μg/L,SCLC组ProGRP的ROC-AUC(0.95)比NSE(0.87)明显升高(Z=1.99,P＜0.05)；ProGRP和NSE联合检测的ROC-AUC (0.95)与ProGRP单项检测(0.95)比较,差异无统计学意义(Z=0.02,P＞ 0.05).ProGRP的敏感度(84.8％)也高于NSE(69.6％,x2=4.00,P＜ 0.05);其特异度(97.8％)与NSE比较,差异无统计学意义(97.8％,x2=0.50,P＞0.05)；ProGRP和NSE联合检测的敏感度和特异度与ProGRP单项检测比较,差异无统计学意义(87.0％比84.8％,95.6％比97.8％,x2均为0.00,P＞0.05).以NSCLC组为对照,ROC曲线上取约登指数最大点确定ProGRP和NSE的临界值分别为49.1 ng/L和23.0μg/L,SCLC组ProGRP的ROC-AUC(0.90)较NSE(0.76)明显升高(Z=2.90,P＜0.05)；ProGRP和NSE联合检测的ROC-AUC(0.90)与ProGRP单项检测(0.90)比较,差异无统计学意义(Z=0.00,P＞0.05).ProGRP的敏感度(84.8％)也高于NSE(69.6％,x2 =4.00,P＜0.05),其特异度(96.1％)与NSE也明显升高(80.4％,x2=6.13,P＜0.05)；ProGRP和NSE联合检测的敏感度和特异度与ProGRP单项检测比较,差异无统计学意义(87.0％比84.8％,95.6％比96.1％,x2均为0.00,P＞0.05).结论 ProGRP用于诊断SCLC较好,其比NSE对SCLC有更高的辅助诊断价值.
目的 評估分析血清胃泌素釋放肽前體(ProGRP)對小細胞肺癌(SCLC)的臨床診斷價值.方法 用化學髮光法和電化學髮光法檢測2010年9月至2011年4月期間,青島大學醫學院附屬醫院46例初診SCLC(跼限期26例、廣汎期20例)、51例非小細胞肺癌(NSCLC)、45例肺良性疾病患者及56名健康體檢者血清ProGRP和神經元特異性烯醇化酶(NSE)水平,以受試者工作特徵( ROC)麯線確定ProGRP和NSE診斷SCLC的臨界值及麯線下麵積(ROC-AUC),評估2項指標診斷SCLC的敏感度和特異度.結果 健康對照組、肺良性疾病組、NSCLC組和SCLC組血清ProGRP水平分彆為22.9(19.5～28.7)、23.7(20.0 ～ 27.8)、28.9(23.8 ～34.7)和370.9( 129.4 ～ 1951.6) ng/L;血清NSE水平分彆為14.1(12.5～15.7)、13.3(10.3 ～ 15.3)、16.8(11.7 ～22.1)和39.9(16.1 ～93.9) μg/L；經非參數Kruskal-WallisH檢驗,各組間ProGRP和NSE的差異均有統計學意義(H值分彆為92.116和55.481,P均＜0.001).跼限期SCLC (LD-SCLC)組血清ProGRP[ 156.2(65.4～547.5) ng/L]也高于健康對照組、肺良性疾病組和NSCLC組(U值分彆為57、70和144,P均＜0.001).廣汎期SCLC (ED-SCLC)組血清ProGRP和NSE為[1933.1(325.9 ～4512.1) ng/L和61.0(35.4～115.5)μg/L],均高于LD-SCLC組ProGR和NSE[24.3(15.1～61.3) μg/L,U值分彆為119和153,P均＜0.05].以健康組為對照,ROC麯線上取約登指數最大點確定ProGRP和NSE的臨界值分彆為34.0 ng/L和20.2μg/L,SCLC組ProGRP的ROC-AUC(0.96)較NSE(0.86)明顯增高(Z=2.57,P＜0.05)；ProGRP和NSE聯閤檢測的ROC-AUC(0.96)與ProGRP單項檢測(0.96)比較,差異無統計學意義(Z =0.21,P＞0.05).ProGRP的敏感度(89.1％)也高于NSE(71.7％,x2 =4.90,P＜0.05)；其特異度(98.2％)與NSE比較的差異無統計學意義(96.4％,x2 =0.00,P＞0.05)；ProGRP和NSE聯閤檢測的敏感度和特異度與ProGRP單項檢測比較,差異無統計學意義(91.3％比89.1％,94.6％比98.2％,x2均為0.00,P＞0.05).以肺良性疾病組為對照,ROC麯線上取約登指數最大點確定ProGRP和NSE的臨界值分彆為49.5 ng/L和23.1 μg/L,SCLC組ProGRP的ROC-AUC(0.95)比NSE(0.87)明顯升高(Z=1.99,P＜0.05)；ProGRP和NSE聯閤檢測的ROC-AUC (0.95)與ProGRP單項檢測(0.95)比較,差異無統計學意義(Z=0.02,P＞ 0.05).ProGRP的敏感度(84.8％)也高于NSE(69.6％,x2=4.00,P＜ 0.05);其特異度(97.8％)與NSE比較,差異無統計學意義(97.8％,x2=0.50,P＞0.05)；ProGRP和NSE聯閤檢測的敏感度和特異度與ProGRP單項檢測比較,差異無統計學意義(87.0％比84.8％,95.6％比97.8％,x2均為0.00,P＞0.05).以NSCLC組為對照,ROC麯線上取約登指數最大點確定ProGRP和NSE的臨界值分彆為49.1 ng/L和23.0μg/L,SCLC組ProGRP的ROC-AUC(0.90)較NSE(0.76)明顯升高(Z=2.90,P＜0.05)；ProGRP和NSE聯閤檢測的ROC-AUC(0.90)與ProGRP單項檢測(0.90)比較,差異無統計學意義(Z=0.00,P＞0.05).ProGRP的敏感度(84.8％)也高于NSE(69.6％,x2 =4.00,P＜0.05),其特異度(96.1％)與NSE也明顯升高(80.4％,x2=6.13,P＜0.05)；ProGRP和NSE聯閤檢測的敏感度和特異度與ProGRP單項檢測比較,差異無統計學意義(87.0％比84.8％,95.6％比96.1％,x2均為0.00,P＞0.05).結論 ProGRP用于診斷SCLC較好,其比NSE對SCLC有更高的輔助診斷價值.
목적 평고분석혈청위비소석방태전체(ProGRP)대소세포폐암(SCLC)적림상진단개치.방법 용화학발광법화전화학발광법검측2010년9월지2011년4월기간,청도대학의학원부속의원46례초진SCLC(국한기26례、엄범기20례)、51례비소세포폐암(NSCLC)、45례폐량성질병환자급56명건강체검자혈청ProGRP화신경원특이성희순화매(NSE)수평,이수시자공작특정( ROC)곡선학정ProGRP화NSE진단SCLC적림계치급곡선하면적(ROC-AUC),평고2항지표진단SCLC적민감도화특이도.결과 건강대조조、폐량성질병조、NSCLC조화SCLC조혈청ProGRP수평분별위22.9(19.5～28.7)、23.7(20.0 ～ 27.8)、28.9(23.8 ～34.7)화370.9( 129.4 ～ 1951.6) ng/L;혈청NSE수평분별위14.1(12.5～15.7)、13.3(10.3 ～ 15.3)、16.8(11.7 ～22.1)화39.9(16.1 ～93.9) μg/L；경비삼수Kruskal-WallisH검험,각조간ProGRP화NSE적차이균유통계학의의(H치분별위92.116화55.481,P균＜0.001).국한기SCLC (LD-SCLC)조혈청ProGRP[ 156.2(65.4～547.5) ng/L]야고우건강대조조、폐량성질병조화NSCLC조(U치분별위57、70화144,P균＜0.001).엄범기SCLC (ED-SCLC)조혈청ProGRP화NSE위[1933.1(325.9 ～4512.1) ng/L화61.0(35.4～115.5)μg/L],균고우LD-SCLC조ProGR화NSE[24.3(15.1～61.3) μg/L,U치분별위119화153,P균＜0.05].이건강조위대조,ROC곡선상취약등지수최대점학정ProGRP화NSE적림계치분별위34.0 ng/L화20.2μg/L,SCLC조ProGRP적ROC-AUC(0.96)교NSE(0.86)명현증고(Z=2.57,P＜0.05)；ProGRP화NSE연합검측적ROC-AUC(0.96)여ProGRP단항검측(0.96)비교,차이무통계학의의(Z =0.21,P＞0.05).ProGRP적민감도(89.1％)야고우NSE(71.7％,x2 =4.90,P＜0.05)；기특이도(98.2％)여NSE비교적차이무통계학의의(96.4％,x2 =0.00,P＞0.05)；ProGRP화NSE연합검측적민감도화특이도여ProGRP단항검측비교,차이무통계학의의(91.3％비89.1％,94.6％비98.2％,x2균위0.00,P＞0.05).이폐량성질병조위대조,ROC곡선상취약등지수최대점학정ProGRP화NSE적림계치분별위49.5 ng/L화23.1 μg/L,SCLC조ProGRP적ROC-AUC(0.95)비NSE(0.87)명현승고(Z=1.99,P＜0.05)；ProGRP화NSE연합검측적ROC-AUC (0.95)여ProGRP단항검측(0.95)비교,차이무통계학의의(Z=0.02,P＞ 0.05).ProGRP적민감도(84.8％)야고우NSE(69.6％,x2=4.00,P＜ 0.05);기특이도(97.8％)여NSE비교,차이무통계학의의(97.8％,x2=0.50,P＞0.05)；ProGRP화NSE연합검측적민감도화특이도여ProGRP단항검측비교,차이무통계학의의(87.0％비84.8％,95.6％비97.8％,x2균위0.00,P＞0.05).이NSCLC조위대조,ROC곡선상취약등지수최대점학정ProGRP화NSE적림계치분별위49.1 ng/L화23.0μg/L,SCLC조ProGRP적ROC-AUC(0.90)교NSE(0.76)명현승고(Z=2.90,P＜0.05)；ProGRP화NSE연합검측적ROC-AUC(0.90)여ProGRP단항검측(0.90)비교,차이무통계학의의(Z=0.00,P＞0.05).ProGRP적민감도(84.8％)야고우NSE(69.6％,x2 =4.00,P＜0.05),기특이도(96.1％)여NSE야명현승고(80.4％,x2=6.13,P＜0.05)；ProGRP화NSE연합검측적민감도화특이도여ProGRP단항검측비교,차이무통계학의의(87.0％비84.8％,95.6％비96.1％,x2균위0.00,P＞0.05).결론 ProGRP용우진단SCLC교호,기비NSE대SCLC유경고적보조진단개치.
Objective To evaluate the clinical value of pro-gastrin-releasing peptide (ProGRP) for small cell lung cancer ( SCLC ).Methods Serum levels of ProGRP and neuron-specific enolase (NSE) were measured by both chemiluminescent immunoassay and electrochemiluminescent immunoassay in 46 patients with SCLC (26 patients with limited disease,20 patients with extensive disease ),51 patients with non-small cell lung cancer (NSCLC),45 patients with benign pulmonary diseases and 56 healthy subjects.Patients were recruited by the Affiliated Hospital of Medical College,Qingdao University,from September 2010 to April 2011.The receiver operating characteristic curves (ROC) was used to set the cutoff value of ProGRP and NSE and the areas under ROC ( ROC-AUC).The sensitivity and specificity of ProGRP and NSE were analyzed for diagnosing SCLC.Results Serum levels of ProGRP in healthy subjects,benign pulmonary diseases,NSCLC and SCLC groups were 22.9 ( 19.5 - 28.7 ),23.7 ( 20.0 - 27.8 ),28.9 (23.8-34.7) and 370.9( 129.4- 1951.6) ng/L respectively; the serum levels of NSE were 14.1 (12.5- 15.7),13.3(10.3- 15.3),16.8(11.7-22.1) and 39.9(16.1-93.9) μg/L,respectively.The Kruskal-Wallis H test showed significantly difference amoun groups of ProGRP and NSE (H =92.116 and 55.481,P ＜0.001 ).The serum levels of ProGRP in limited disease SCLC (LD-SCLC) group[ 156.2(65.4-547.5 ) ng/L]were also significantly higher than those in the healthy group,benign pulmonary diseases group and NSCLC group ( U =57,70 and 144,P ＜ 0.001 ).In extensive disease SCLC (ED-SCLC) group,the ProGRP and NSE results[ 1933.1 (325.9 -4512.1) ng/L and 61.0(35.4- 115.5 ) μg/L ]were higher than those in the LD-SCLC group ProGRP,NSE [ 24.3 ( 15.1 - 16.3 ) μg/L,U =119 and 153,P ＜ 0.05 ].Using healthy subjects group as control,the largest Youden index point of ROC was used to set the cut-off value of ProGRP and NSE (34.0 ng/L and 20.2 μg/L).The ROC-AUC of ProGRP (0.96 ) was statistically higher than that of NSE ( 0.86 ) in the SCLC group ( Z =2.57,P ＜0.05).The ROC-AUC results between combining detection of ProGRP and NSE (0.96 ) and ProGRP itself (0.96) were not significant difference ( Z =0.21,P ＞ 0.05 ).The sensitivity of ProGRP ( 89.1％ ) was statistically higher than that of NSE in the SCLC group (71.7％,x2 =4.90,P ＜0.05 ) ; the specificity of ProGRP (98.2％) compared with NSE did not have statistical significance (96.4％,x2 =0.00,P ＞0.05 ).The combining detection of ProGRP and NSE had no influence on the sensitivity and specificity compared with ProGRP itself (91.3％ vs 89.1％,94.6％ vs 98.2％,x2 were all 0.00,P ＞ 0.05 ).Using benign pulmonary diseases group as control,the largest Youden index point of ROC was used to set the cutoff value of ProGRP and NSE (49.5 ng/L and 23.1 μg/L).The ROC-AUC of ProGRP (0.95) was statistically higher than that of NSE (0.87) in the SCLC group (Z =1.99,P ＜0.05 ).The ROC-AUC of combining detection of ProGRP and NSE ( 0.95 ) and ProGRP itself ( 0.95 ) were not difference significantly ( Z =0.02,P ＞ 0.05 ).The sensitivity of ProGRP (84.8％ ) was statistically higher than that of NSE in the SCLC group (69.6％,x2 =4.00,P ＜0.05);the specificity of it (97.8％) was equal to that of NSE (97.8％,x2 =0.50,P ＞0.05 ).The combining detection of ProGRP and NSE had no obviously influence on the sensitivity and specificity compared with ProGRP itself ( 87.0％ vs 84.8％,95.6％ vs 97.8％,x2 were all 0.00,P ＞0.05 ).Using NSCLC group as control,the largest Youden index point of ROC was to set the cut-off value of ProGRP and NSE (49.1 ng/L and 23.0 μg/L).The ROC-AUC of ProGRP ( 0.90) was statistically higher than that of NSE (0.76) in the SCLC group (Z=2.90,P＜0.05).The ROC-AUC of combining detection of ProGRP and NSE (0.90 ) and ProGRP itself (0.90 ) were not difference significantly ( Z =0.00,P ＞ 0.05 ).The sensitivity of ProGRP ( 84.8％ ) was higher than that of NSE in the SCLC group ( 69.6％,x2 =4.00,P ＜ 0.05 ) ; the specificity of it ( 96.1％ ) was also higher than that of NSE (80.4％,x2 =6.13,P ＜ 0.05 ).The combining detection of ProGRP and NSE had no obviously influence on the sensitivity and specificity compared with ProGRP itself ( 87.0％ vs 84.8％,95.6％ vs 96.1％,x2 were all 0.00,P ＞ 0.05 ).Conclusion ProGRP has a higher diagnostic value than NSE in SCLC.
