小细胞肺癌伴脑转移时心房利钠肽和精氨酸加压素的产生及其与低钠血症的关系。
The productions of atrial natriuretic peptide and arginine vasopressin in small cell lung cancer with brain metastases and their associations with hyponatremia.
机构信息
Central Blood Station, Yantai, Shandong Province, P.R. China.
出版信息
Eur Rev Med Pharmacol Sci. 2017 Sep;21(18):4104-4112.
OBJECTIVE
Hyponatremia is one of the most frequently encountered electrolyte disorder in small cell lung cancer (SCLC) patients. It was shown that some SCLC cell lines could produce atrial natriuretic peptide (ANP) and arginine vasopressin (AVP). The aim of the study was to assess the secretion of ANP, AVP and their relative contributions to hyponatremia in SCLC patients, especially in patients with brain metastases.
PATIENTS AND METHODS
In total, 194 SCLC patients including 51 patients with brain metastases were collected. The levels of ANP and AVP were measured with radioimmunoassay kits. And then their associations with serum sodium were investigated. The progression-free survival (PFS) was compared between the hyponatremia group and the normal serum sodium group.
RESULTS
Serum sodium was negatively correlated with the plasma levels of ANP (r=-0.171, p=0.017) and AVP (r = -0.244, p=0.001) in all SCLC patients. In the brain metastatic subgroup, there was also a negative correlation between serum sodium and ANP (r=-0.399, p=0.004), while there was no correlation between serum sodium and AVP (r=-0.232, p=0.101). The occurrence rate of hyponatremia (serum sodium values below 135 mmol/l) in patients with brain metastases (21/51, 41.18%) was higher than that in patients without brain metastases (37/143, 25.87%) (p=0.040). The progression-free survival (PFS) in the hyponatremia group was significantly shorter than that in patients of the group without hyponatremia (p=0.010). Moreover, compared with patients which regained normal serum sodium after the treatment, the PFS of patients still with hyponatremia after the treatment was significantly shorter (p=0.049).
CONCLUSIONS
ANP might play a leading role in the formation of hyponatremia of SCLC patients with brain metastases. Correcting hyponatremia timely and appropriately could improve SCLC patients' prognosis.
目的
低钠血症是小细胞肺癌（SCLC）患者最常见的电解质紊乱之一。已有研究表明，一些 SCLC 细胞系可以产生心房利钠肽（ANP）和精氨酸加压素（AVP）。本研究旨在评估 ANP、AVP 的分泌及其对 SCLC 患者，特别是合并脑转移患者低钠血症的相对贡献。
方法
共收集 194 例 SCLC 患者，其中脑转移患者 51 例。采用放射免疫试剂盒检测 ANP 和 AVP 水平，并分析其与血清钠的相关性。比较低钠血症组和正常血清钠组患者的无进展生存期（PFS）。
结果
所有 SCLC 患者中，血清钠与 ANP（r=-0.171，p=0.017）和 AVP（r=-0.244，p=0.001）的血浆水平呈负相关。在脑转移亚组中，血清钠与 ANP 之间也存在负相关（r=-0.399，p=0.004），而与 AVP 之间无相关性（r=-0.232，p=0.101）。脑转移患者（51/143，35.70%）低钠血症（血清钠值＜135mmol/L）的发生率高于无脑转移患者（37/143，25.87%）（p=0.040）。低钠血症组的无进展生存期（PFS）明显短于无低钠血症组（p=0.010）。此外，与治疗后血清钠恢复正常的患者相比，治疗后仍存在低钠血症的患者的 PFS 明显缩短（p=0.049）。
结论
ANP 可能在 SCLC 合并脑转移患者低钠血症的形成中起主导作用。及时、适当纠正低钠血症可改善 SCLC 患者的预后。
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