基于炎症的预后评分（格拉斯哥预后评分）与晚期肺癌和胃肠道癌患者血清生化指标变化之间的关系。
The relationship between an inflammation-based prognostic score (Glasgow Prognostic Score) and changes in serum biochemical variables in patients with advanced lung and gastrointestinal cancer.
作者信息
Brown D J F, Milroy R, Preston T, McMillan D C
机构信息
St Columba's Hospice, Edinburgh, UK.
出版信息
J Clin Pathol. 2007 Jun;60(6):705-8. doi: 10.1136/jcp.2005.033217. Epub 2006 Apr 27.
BACKGROUND
The Glasgow Prognostic Score (GPS), an inflammation-based prognostic score formed from standard thresholds of C reactive protein (CRP) and albumin, has prognostic value in patients with advanced cancer. Little is known about the general biochemical disturbance associated with the systemic inflammatory response in cancer.
AIM
To examine the relationship between the GPS and blood biochemistry in patients with advanced lung and gastrointestinal cancer.
METHODS
The GPS (albumin <35 g/l = 1 and CRP >10 mg/l = 1 combined to form a prognostic score of 0 (normal) and 1 or 2 (abnormal)) and a variety of biochemical variables were examined in patients (n = 50) with advanced lung or gastrointestinal cancer and in a healthy control group (n = 13).
RESULTS
The GPS was normal in all the controls, but abnormal in 78% of the cancer group. Serum levels of sodium, chloride, creatine kinase, zinc and vitamin D were lower in the cancer group (all p<0.01), whereas levels of calcium, copper (both p<0.05), alkaline phosphatase, gamma-glutamyl transferase (both p<0.001) and lactate dehydrogenase (p<0.10) were raised. In the patient group, with increasing GPS, there was a median reduction in Karnofsky Performance Status (25%), haemoglobin (22%), sodium (3%), zinc (15%) and survival (93%, all p<0.05) and a median increase in white cell count (129%), alkaline phosphatase (217%), gamma-glutamyl transferase (371%) and lactate dehydrogenase (130%, all p<0.05). CRP levels were strongly and similarly correlated with alkaline phosphatase and gamma-glutamyl transferase, accounting for more than 25% of the variation in their activities.
CONCLUSION
Several correlations were seen between biochemical variables and increasing GPS. In particular, chronic activation of the systemic inflammatory response in cancer was associated with increase in gamma-glutamyl transferase and alkaline phosphatase activity in patients with advanced lung and gastrointestinal cancer.
背景
格拉斯哥预后评分（GPS）是一种基于炎症的预后评分，由C反应蛋白（CRP）和白蛋白的标准阈值构成，对晚期癌症患者具有预后价值。关于癌症中与全身炎症反应相关的一般生化紊乱知之甚少。
目的
研究晚期肺癌和胃肠道癌患者中GPS与血液生化之间的关系。
方法
对50例晚期肺癌或胃肠道癌患者及13例健康对照组进行GPS（白蛋白<35 g/l = 1且CRP>10 mg/l = 1，两者结合形成预后评分为0（正常）和1或2（异常））及多种生化变量检测。
结果
所有对照组的GPS均正常，但癌症组78%异常。癌症组血清钠、氯、肌酸激酶、锌和维生素D水平较低（均p<0.01），而钙、铜水平（均p<0.05）、碱性磷酸酶、γ-谷氨酰转移酶（均p<0.001）和乳酸脱氢酶水平（p<0.10）升高。在患者组中，随着GPS升高，卡氏功能状态中位数降低（25%）、血红蛋白降低（22%）、钠降低（3%）、锌降低（15%）和生存率降低（93%，均p<0.05），白细胞计数中位数升高（129%）、碱性磷酸酶升高（217%）、γ-谷氨酰转移酶升高（371%）和乳酸脱氢酶升高（130%，均p<0.05）。CRP水平与碱性磷酸酶和γ-谷氨酰转移酶强烈且相似相关，占其活性变化的25%以上。
结论
生化变量与升高的GPS之间存在多种相关性。特别是，癌症中全身炎症反应的慢性激活与晚期肺癌和胃肠道癌患者γ-谷氨酰转移酶和碱性磷酸酶活性增加有关。
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