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Received:June 16, 2022 Published Online:March 20, 2023
Received:June 16, 2022 Published Online:March 20, 2023
中文摘要: 目的 探讨小细胞肺癌（SCLC）患者化疗前后血清乳酸脱氢酶（LDH）、血浆D-二聚体（D-D）、血清胃泌素释放肽前体（proGRP）水平变化在化疗疗效及预后评估中的意义。方法 选取2018年1月至2021年6月陕西中医药大学附属医院肿瘤医院住院无法手术的SCLC患者100例，其中局限期（LS）39例，广泛期（ES）61例，分别于化疗前及依托泊苷联合铂类2周期化疗后，清晨空腹抽取静脉血，检测血清LDH、proGRP和血浆D-D水平，对检测结果进行分析，并进行随访，记录患者无疾病进展生存期（PFS）。结果 2周期化疗结束后治疗有效75例，治疗无效25例，在治疗有效组化疗后LDH、D-D、proGRP水平比化疗前下降，差异有统计学意义（P＜0.05），在治疗无效组化疗后与化疗前LDH、D-D、proGRP水平比较差异无统计学意义（P＞0.05）。化疗后LDH＜正常参考值上限（ULN）与≥ULN、proGRP＜ULN与proGRP≥ULN者疗效比较，差异有统计学意义（P＜0.05），而化疗后D-D不同水平者疗效差异无统计学意义（P＞0.05）。在肿瘤分期LS、化疗后LDH＜ULN、化疗后LDH水平下降、化疗前proGRP＜ULN、化疗后proGRP水平下降者的PFS明显延长（P＜0.05）；化疗后有效组LDH＜ULN较LDH≥ULN者、proGRP＜ULN较proGRP≥ULN者PFS延长（P＜0.05）。多因素Cox回归分析结果显示，肿瘤分期、化疗前proGRP、化疗后LDH水平及化疗前后LDH、proGRP变化是SCLC 患者预后的影响因素（P＜0.05）。Spearman相关性分析结果显示，化疗前后LDH、D-D、proGRP变化率与化疗疗效存在相关性（P＜0.05），化疗前后LDH、proGRP变化率与预后存在相关性（P＜0.05），D-D变化率与预后无相关性（P＞0.05）。结论 LDH、D-D、proGRP检测可以评估SCLC患者化疗疗效、监测患者病情动态变化及预测其预后。
Abstract:Objective To explore the significance of serum lactate dehydrogenase (LDH), plasma D-dimer (D-D) and serum progastrin-releasing peptide (proGRP) levels in the evaluation of chemotherapy efficacy and prognosis in patients with small cell lung cancer (SCLC). Methods From January 2018 to June 2021,100 patients with inoperable SCLC hospitalized in the Affiliated Tumor Hospital of Shaanxi University of Chinese Medicine were selected, including 39 limited-stage (LS) patients and 61 extensive-stage (ES) patients. Before and after etoposide combined with platinum chemotherapy for 2-cycle, venous blood was drawn to detect the serum levels of LDH, proGRP and plasma D-D, which were observed and analyzed. The patients' progression-free survival (PFS) period was recorded during follow-up period. Results After chemotherapy, the patients were divided into effective group (n=75) and ineffective group (n=25). In effective group, the levels of LDH, D-D and proGRP after chemotherapy were significantly lower than those before chemotherapy (P＜0.05), and there was no significant difference in them in ineffective group (P＞0.05). There were statistical differences in the curative effects between patients with LDH ＜ the upper limit of normal (ULN) and patients with LDH ≥ ULN and between patients with proGRP ＜ ULN and patients with proGRPH ≥ ULN (P＜0.05). However, there was no significant differences in the curative effect between patients with different D-D levels (P＞0.05). PFS was significantly prolonged in the patients in LS and with LDH＜ULN, decreased LDH level after chemotherapy, proGRP＜ULN before chemotherapy and decreased proGRP level after chemotherapy (P＜0.05). In effective group, PFS in the patients with LDH＜ULN and proGRP＜ULN was significantly longer than that of patients with LDH ≥ ULN and proGRP ≥ ULN (P＜0.05). Multivariate Cox regression analysis showed that tumor stage and proGRP level before chemotherapy , LDH level after chemotherapy, and changes of LDH and proGRP before and after chemotherapy were the prognostic factors of SCLC patients (P＜0.05). Spearman correlation analysis showed that the change rates of serum LDH, proGRP and plasma D-D levels between pre-chemo therapy and post-chemotherapy were before and after chemotherapy was significantly correlated with the efficacy of chemotherapy (P＜0.05), the change rates of serum LDH and proGRP levels were correlated with prognosis (P＜0.05), and the change rate of D-D was not related to prognosis (P＞0.05). Conclusion The combined detection of serum LDH, proGRP and plasma D-D can evaluate the efficacy of chemotherapy, monitor the dynamic changes of patients' condition and predict the prognosis of patients with SCLC.
keywords: Small cell lung cancer Lactate dehydrogenase D-dimer Progastrin-releasing peptide Chemotherapy Evaluation of efficacy Prognosis
文章编号： 中图分类号：R734.2 文献标志码：B
基金项目:国家自然科学基金（81072757）
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