本文選題：小細胞肺癌　切入點：胃泌素釋放肽前體　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:評估血清胃泌素釋放肽前體(Pro-gastrin-releasing peptide,ProGRP)、神經(jīng)原特異性烯醇化酶(Neuron specific enolase,NSE)對小細胞肺癌的診斷和療效評估中的應用價值。方法:1.采用電化學發(fā)光法(Electrochemiluminescence immunoassay)檢測小細胞肺癌(Small cell lung cancer,SCLC)初診病例47例,其中局限期(Limited-stage disease small cell lung cancer,LD-SCLC)26例,廣泛期(Extensive-stage disease small cell lung cancer,ED-SCLC)21例。非小細胞肺癌(Non-small cell lung cancer,NSCLC)53例,其中腺癌31例,鱗癌22例。肺良性疾病患者(Benign pulmonary disease,BPD)59例,健康體檢者71例。分別檢測ProGRP、NSE,分析它們在SCLC診斷中的價值。各組ProGRP、NSE的檢測數(shù)據(jù)呈偏態(tài)分布,采用中位數(shù)及四分位數(shù)[M(P25-P75)]來表示結果。多組間比較采用非參數(shù)Kruskal-wallis H檢驗,P0.05為差異有統(tǒng)計學意義。兩兩組間比較采用非參數(shù)Mann-whitney U檢驗,根據(jù)Bonferroni校正將檢驗水準調整為P0.008有統(tǒng)計學意義上的差異。以受試者工作特征曲線(Receiver operator characteristic curve,ROC)判定ProGRP和NSE的臨界值,計算出診斷敏感度和特異度,敏感度的比較采用配對卡方檢驗。ROC曲線確定曲線下面積(Area under the curve,AUC),曲線下面積的比較用Z檢驗。2.SCLC化療方案采用依托泊苷+順鉑。通過觀察SCLC治療前和2周期化療、4周期化療后ProGRP和NSE的動態(tài)水平變化結合肺癌化療后緩解程度,探討ProGRP與NSE在小細胞肺癌化療療效中的監(jiān)測價值。組間比較采用相關樣本配對Mann-whitney U檢驗,檢驗水準(a=0.05)。結果:1.經(jīng)非參數(shù)kruskal-wallish檢驗,sclc、nsclc、bpd組、健康對照組間progrp、nse水平差異有統(tǒng)計學差異(h值分別為70.121、38.309,p0.001)。經(jīng)非參數(shù)kruskal-wallish檢驗,ld-sclc、ed-sclc、nsclc、肺良性疾病組、健康對照組間各組間progrp、nse水平差異有統(tǒng)計學差異(h值分別為74.472、49.31,p0.001)。采用非參數(shù)mann-whitneyu檢驗方法比較,sclc組progrp,nse的水平高于健康對照組,肺部良性疾病組,nsclc組(progrp的u值分別為329.0、341.0和348.5p0.001,nse的u值為682.0、565.0和648.0p0.001)。ld-sclc組血清progrp濃度較健康對照組(u=290.0,p0.001)肺良性疾病組(u=306.0,p0.001)和nsclc組(u=301.5,p0.001)升高顯著。ld-sclc組血清nse水平顯著高于健康對照組(u=567.0,p0.008)肺良性疾病組(u=436.5,p0.008),而ld-sclc組nse與nsclc組nse比較,差異沒有統(tǒng)計學意義(u=524.0,p0.008)。ed-sclc組progrp和nse水平顯著高于ld-sclc組(u值分別為113.0和129.0,p0.008)。2.roc曲線分析結果顯示sclc組progrp的roc-auc分別以健康對照組,肺良性疾病組,nsclc組為對照均顯著高于nse的roc-auc(z值分別為2.01、1.99、2.05,p0.05),而聯(lián)合檢測的roc-auc與progrp單項檢測沒有統(tǒng)計學差異(z值分別為0.02、0.04、0.11,p0.05)。分別以健康對照組,bpd組,nsclc組為對照,progrp對sclc組的診斷敏感度均高于nse(x2值分別為4.9、4.9、4.0,p0.05)。與健康對照組、bpd組和nsclc組比較,progrp對ld-sclc組的敏感度高于nse(x2值分別為5.81、5.81、4.0,p0.05)。3.sclc化療過程中progrp與nse的水平有助于化療方案選擇和療效動態(tài)監(jiān)測。10例ld-sclc病例(a組)化療效果顯著,療效達到控制(cr+pr+sd),progrp與nse血清水平通過配對非參數(shù)mann-whitneyu檢驗化療2周期后較化療前濃度減低(z值分別為-2.803,-2.803,p0.05)。3例ld-sclc病例(b組)化療效果差(pd),化療前后progrp與nse血清水平變化無統(tǒng)計學差異(z值分別為-1.069,-1.604,p0.05),1例progrp極高值ed-sclc病例(c組)部分緩解(pr),progrp與nse顯著下降。2例progrp極高ed-sclc病例(d組)例腫瘤明顯增大,其病情進展與progrp與nse水平相關(z值分別為-1.342,-0.447,p0.05)。結論:在SCLC的診斷和療效監(jiān)測過程中ProGRP與NSE均表現(xiàn)出較高的臨床應用價值,就對SCLC的早期診斷價值而言ProGRP優(yōu)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.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R734.2;R730.43

【參考文獻】

相關期刊論文 前6條

1 康淑霞;朱安友;;胃泌素釋放肽前體實驗室檢測及臨床應用進展[J];中華全科醫(yī)學;2012年01期

2 羅疏薇;歐春萍;張莉萍;陳宏礎;;應用ROC曲線評價CEA、CYFRA21-1、SCC對非小細胞肺癌的診斷價值[J];重慶醫(yī)學;2011年03期

3 張志平;陳名聲;任麗芬;劉田;盧寶弼;郝曉柯;;聯(lián)合檢測血清胃泌素釋放肽前體和特異性組織多肽抗原在小細胞肺癌診斷中的臨床價值[J];現(xiàn)代腫瘤醫(yī)學;2009年09期

4 Petra STIEBER;;胃泌素釋放肽前體(Pro-GRP)——小細胞肺癌診斷標志物(英文)[J];中國肺癌雜志;2009年03期

5 楊謹,李蓉,李昂,李恩孝,王曉琴;胃泌素釋放肽前體片段31-98檢測對小細胞肺癌的臨床意義[J];中華腫瘤雜志;2000年03期

6 張家祺;王迎難;李強;;胃泌素釋放肽前體在小細胞肺癌診斷及預后的臨床價值[J];國際腫瘤學雜志;2007年03期

，

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