嗜铬粒蛋白A和胰多肽血浆水平联合检测在胃肠及胰腺内分泌肿瘤诊断中的应用价值
Utility of combined use of plasma levels of chromogranin A and pancreatic polypeptide in the diagnosis of gastrointestinal and pancreatic endocrine tumors.
作者信息
Panzuto F, Severi C, Cannizzaro R, Falconi M, Angeletti S, Pasquali A, Corleto V D, Annibale B, Buonadonna A, Pederzoli P, Delle Fave G
机构信息
Digestive and Liver Disease Unit, II School of Medicine, University La Sapienza, Rome, Italy.
出版信息
J Endocrinol Invest. 2004 Jan;27(1):6-11. doi: 10.1007/BF03350903.
BACKGROUND
Chromogranin A (CgA) is considered the most accurate marker in the diagnosis of gastro-entero-pancreatic (GEP) endocrine tumors. Pancreatic polypeptide (PP) has also been proposed to play this role, but then not used due to its low sensitivity. The aim of the present study was to determine whether the assessment of PP would improve the diagnostic reliability of CgA in patients with GEP tumors.
PATIENTS AND METHODS
Both markers were assessed in 68 patients [28 functioning (F), 40 non functioning (NF)]. Twenty-seven patients disease-free (DF) after surgery, and 24 with non-endocrine tumors (non-ETs) were used as control groups.
RESULTS
CgA sensitivity was: 96% in F, 75% in NF, 74% in pancreatic, and 91% in gastrointestinal (GI) tumors. Specificity was 89% vs DF, and 63% vs non-ETs. PP sensitivity was: 54% in F, 57% in NF, 63% in pancreatic, and 53% in GI tumors. Specificity was 81% vs DF, and 67% vs non-ETs. By combining the two markers a significant gain in sensitivity vs CgA alone was obtained: overall in GEP tumors (96% vs 84%, p = 0.04), in NF (95% vs 75%, p = 0.02), and in pancreatic (94% vs 74%, p = 0.04). More specifically, a 25% gain of sensitivity was obtained in the subgroup of NF pancreatic tumors (93% vs 68%, p = 0.04).
CONCLUSION
The combined assessment of PP and CgA leads to a significant increase in sensitivity in the diagnosis of GEP tumors, particularly in pancreatic NF.
背景
嗜铬粒蛋白A（CgA）被认为是胃肠胰（GEP）内分泌肿瘤诊断中最准确的标志物。也有人提出胰多肽（PP）可发挥这一作用，但因其敏感性低而未被采用。本研究的目的是确定评估PP是否会提高GEP肿瘤患者中CgA的诊断可靠性。
患者与方法
对68例患者[28例有功能（F），40例无功能（NF）]进行了两种标志物的评估。27例术后无疾病（DF）的患者和24例患有非内分泌肿瘤（非ETs）的患者作为对照组。
结果
CgA的敏感性为：有功能肿瘤中96%，无功能肿瘤中75%，胰腺肿瘤中74%，胃肠道（GI）肿瘤中91%。与无疾病患者相比特异性为89%，与非内分泌肿瘤患者相比为63%。PP的敏感性为：有功能肿瘤中54%，无功能肿瘤中57%，胰腺肿瘤中63%，胃肠道肿瘤中53%。与无疾病患者相比特异性为81%，与非内分泌肿瘤患者相比为67%。通过联合使用这两种标志物，与单独使用CgA相比，敏感性有显著提高：总体上在GEP肿瘤中（96%对84%，p = 0.04），在无功能肿瘤中（95%对75%，p = 0.02），以及在胰腺肿瘤中（94%对74%，p = 0.04）。更具体地说，在无功能胰腺肿瘤亚组中敏感性提高了25%（93%对68%，p = 0.04）。
结论
PP和CgA的联合评估导致GEP肿瘤诊断的敏感性显著提高，特别是在胰腺无功能肿瘤中。
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