非小细胞肺癌脑转移危险因素评估及意义  

Evaluation for risk factors of brain metastases in non-small cell lung cancer and its significance

作　　者：卢春青 王盼[1] 韩晓蓓[1] 李玉杰 王玉珏 刘明军[1] 孙桂荣[1] LU Chunqing;WANG Pan;HAN Xiaobei;LI Yujie;WANG Yujue;LIU Mingjun;SUN Guirong(Department of Laboratory,The Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong;Reproductive Center,The Women's and Children's Hospital Affiliated to Qingdao University,Qingdao 266034,Shandong,China;Department of Laboratory,The Women's and Children's Hospital Affiliated to Qingdao University,Qingdao 266034,Shandong,China)

机构地区：[1]青岛大学附属医院检验科,山东青岛266003 [2]青岛大学附属妇女儿童医院生殖中心,山东青岛266034 [3]青岛大学附属妇女儿童医院检验科,山东青岛266034

出　　处：《临床检验杂志》2022年第2期141-146,共6页Chinese Journal of Clinical Laboratory Science

摘　　要：目的探讨非小细胞肺癌(NSCLC)患者发生脑转移的危险因素及其临床应用价值。方法选取2014年5月至2021年5月在青岛大学附属医院住院治疗的NSCLC患者660例,其中发生脑转移者252例,未发生脑转移者408例。采用电化学发光法检测血清癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角蛋白19片段(CYFRA21-1)水平,化学发光法检测鳞状细胞癌相关抗原(SCCA)水平,酶法和免疫比浊法分别检测唾液酸(SA)和D-二聚体水平,荧光PCR法检测表皮生长因子受体基因(EGFR)突变,联合患者临床病理参数进行统计学分析。应用卡方检验/秩和检验和Logistic回归分析分别进行NSCLC脑转移的单因素及多因素分析,单因素分析中有临床意义指标的截断值(cut-off值)通过ROC曲线确定。结果Logistic多因素回归分析结果显示,血清CEA水平≥5.62 ng/mL(OR=2.417,95%CI:1.534~3.810,P<0.001)、CA125水平≥25.12 U/mL(OR=2.172,95%CI:1.311~3.598,P=0.003)、CYFRA21-1水平≥3.85 ng/mL(OR=2.550,95%CI:1.585~4.102,P<0.001)、中性粒细胞与淋巴细胞比值(NLR)水平≥2.09(OR=2.389,95%CI:1.374~4.155,P=0.002)、腺癌病理组织学分型(OR=2.597,95%CI:1.239~5.445,P=0.011)、纵隔淋巴结转移(OR=1.737,95%CI:1.081~2.792,P=0.023)、颅外器官转移(OR=5.778,95%CI:3.640~9.172,P<0.001)、EGFR突变(OR=2.883,95%CI:1.859~4.472,P<0.001)是NSCLC脑转移的独立危险因素。结论血清CEA、CA125、CYFRA21-1、NLR水平升高,组织病理学类型为腺癌、EGFR突变、纵隔淋巴结转移和颅外器官转移可预示NSCLC患者脑转移的发生。Objective To investigate the risk factors of brain metastasis in patients with non-small cell lung cancer(NSCLC)and its clinical application value.Methods A total of 660 patients with NSCLC hospitalized in The Affiliated Hospital of Qingdao University from May 2014 to May 2021 were selected,including 252 patients with brain metastasis and 408 patients without brain metastasis.The expression levels of serum carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125)and cytokeratin 19 fragment(CYFRA21-1)were detected by electrochemiluminescence,the expression levels of squamous cell carcinoma associated antigen(SCCA)were detected by chemiluminescence,the levels of sialic acid(SA)and D-dimer were detected by enzyme method and immunoturbidimetry respectively,and epithelial growth factor receptor gene(EGFR)mutation was detected by fluorescence PCR.The clinicopathological factors of the patients were simultaneously statistically analyzed.Chi square test/rank sum test and logistic regression analysis were used for univariate and multivariate analysis of NSCLC with brain metastasis.The cut-off value of each meaningful index in univariate analysis was determined by ROC curve.Results Logistic regression analysis showed that the independent risk factors for brain metastasis of NSCLC were as follows.Serum CEA level≥5.62 ng/mL(OR=2.417,95%CI:1.534-3.810,P<0.001),CA125 level≥25.12 U/mL(OR=2.172,95%CI:1.311-3.598,P=0.003),CYFRA21-1 level≥3.85 ng/mL(OR=2.550,95%CI:1.585-4.102,P<0.001),neutrophil to lymphocyte ratio(NLR)level≥2.09(OR=2.389,95%CI:1.374-4.155,P=0.002),histopathological classification of adenocarcinoma(OR=2.597,95%CI:1.239-5.445,P=0.011),mediastinal lymph node metastasis(OR=1.737,95%CI:1.081-2.792,P=0.023),extracranial organ metastasis(OR=5.778,95%CI:3.640-9.172,P<0.001),EGFR mutation(OR=2.883,95%CI:1.859-4.472,P<0.001).Conclusion The elevated levels of serum CEA,CA125,CYFRA21-1 and NLR,the histopathological types of adenocarcinoma,EGFR mutation,mediastinal lymph node metastasis and extracranial organ meta

关 键 词：非小细胞肺癌 脑转移 肿瘤标志物 EGFR突变 危险因素 

分 类 号：R446[医药卫生—诊断学]