嗜铬素A、突触素联合神经内分泌激素检测对胃肠胰神经内分泌肿瘤诊断及预后临床价值  

The diagnostic and prognostic value of chromogranin A 、Synaptophysim and neuroendocrine hormone in Gastroenteropancreatic neuroendocrine neoplasms

作　　者：钱小星[1] 杨仁保[1] 周杭城[1] 

机构地区：[1]安徽医科大学附属合肥医院肝胆外科,合肥230011

出　　处：《肝胆外科杂志》2015年第2期148-151,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨胰产神经内分泌激素联合嗜铬素A和突触素在胃肠胰神经内分泌肿瘤组织中的表达及临床意义。方法收集安徽省立医院2010年1月至2014年1月收治的31例GEP-NENs患者临床资料,分析GEP-NENs的发生部位、临床表现、病理特点、治疗及预后情况。通过对31例GEP-NENs的病理标本重新染色,分析嗜铬素A和突触素内分泌激素及胰产神经内分泌激素Gastrin、Insulin、Glucagon、Somatostatin在组织中的表达及临床意义,按组织学和增殖活性明确肿瘤分级(G1、G2、G3、G4),探讨其临床特点及预后情况。结果 22例(71.0%)肿瘤发生在胰腺,其他依次为十二指肠4例(12.9%)、胃3例(9.7%)、直肠1例(3.2%)、腹膜后1例(3.2%)。Cg A和Syn的免疫组织化学染色阳性率分别为77.4%(24/31)和83.3%(25/30),19例(63.3%)患者同时表达Cg A和Syn。胃泌素染色阳性率为35.5%(11/31),胰岛素表达阳性率为54.8%(17/31),生长抑素表达阳性率为22.6%(7/31),1例患者胰高糖素表达为阳性(3.2%)。NET和NEC中位生存时间分别为44个月和18个月,两者间差异有统计学意义(x2=10.877,P=0.001)。Cg A染色阳性为18例,阴性5例,两者间生存期差异有统计学意义(χ2=6.698,P=0.01)。结论 GEP-NENs可发生在消化系统的任何部位,临床表现多样,Cg A和Syn可作为诊断GEP-NENs的广谱性神经内分泌标志物,检测胰产神经内分泌激素可以有助于确定GEP-NENs的分类和判断预后及指导治疗。Objective To explore the expression and clinical significance of pancreatic neuroendocrine hormone （Gastrin, In- sulin,Glucagon,Somatostatin）, chromogranin A（CgA）and Synaptophysim（Syn）. Methods We collected 31 cases of GEP-NENs in AnHui province hospital from Jan. 2010 to Jan. 2014 and analyze the occurrence site, clinical manifestation, pathological characteris- tics, treatment and prognosis. The neuroendocrine markers CgA, Syn, and neuroendocrine hormone Gastrin,Insulin,Glucagon,Soma- tostatin were immunohistochemical staining. Then according to histology and proliferation activity, the GEP-NENs tumors were classi- fied as neuroendocrine tumorG1 ,G2 neuroendocrine cancer G3 ,G4. Results 22 cases（71.0% ） of GEP-NENs tumors were in pancre- as, followed by 4 cases （ 12. 9% ）in duodenum,3 cases （9.7 % ）in stomach, 1 case（3.2% ） in rectum, case （3.2%） in retroperitone- al. The positive rate of Syn and CgA were 77.4% （24/31） and 83.3% （25/30）, respectively. The Syn and CgA were simultaneously expressed in 19 cases （63.3%）. The positive rate of Gastrin were 35.5% （11/31） ,Insulin were 54. 8% （17/31） ,Somatostatin were 22. 6% （7/31） ,Glucagon were 3.2% （ 1/31 ）. The median survival time of G1, G2 and G3, G4 were 44 moths and 18 moths, differ- ences are statistically significant. The difference between the survival of CgA positive and CgA negative are statistically significant. Conclusions GEP-NENs may occur at any part of the digestive system, the clinical manifestations are variable. Syn and CgA could be used in diagnosis GEP-NENs, and detection of pancreatic neuroendocrine hormone production was help to confirm the classification of the GEP-NENs and indicates the prognosis.

关 键 词：胃肠肿瘤 胰腺肿瘤 神经内分泌肿瘤 肿瘤标记物 预后 

分 类 号：R735[医药卫生—肿瘤]