非小细胞肺癌脑膜转移患者的脑脊液临床特征分析

doi:10.3969/j.issn.1673-8640.2018.08.006

摘要/Abstract

摘要：

目的探讨非小细胞肺癌（NSCLC）脑膜转移（LM）患者脑脊液临床特征对LM的诊断价值。方法选取31例NSCLC LM患者（NSCLC LM组）、30例原发性中枢神经系统淋巴瘤（PCNSL）患者（PCNSL组）,采用化学发光法检测所有患者血清甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原（CA）15-3及CA19-9水平,己糖激酶法检测脑脊液葡萄糖,溴甲酚绿/双缩脲法检测脑脊液蛋白,离子选择电极法检测脑脊液氯化物水平,酶联免疫吸附试验检测脑脊液白细胞介素（IL）-6及IL-10水平。比较2个组临床特征、影像学特征及脑脊液细胞学对肿瘤细胞的检出率。结果 NSCLC LM组和PCNSL组之间性别、年龄、影像学表现差异均无统计学意义（P>0.05）,NSCLC LM组血清AFP、CEA、CA15-3水平均高于PCNSL组（P<0.05）,而CA19-9水平2个组之间差异无统计学意义（P>0.05）。NSCLC LM组脑脊液葡萄糖、IL-10水平及IL-6/IL-10比值与PCNSL组比较,差异有统计学意义（P<0.05）,而脑脊液压力、有核细胞计数、蛋白、氯化物、IL-6水平2个组之间差异均无统计学意义（P>0.05）。结论 NSCLC LM的诊断应综合患者的临床体征、影像学表现、血清肿瘤标志物水平、脑脊液IL-6水平、IL-6/IL-10比值、细胞学检查结果进行,以提高NSCLC LM的诊断效率。

关键词: 非小细胞肺癌, 脑膜转移, 脑脊液

Abstract:

Objective To evaluate the role of cerebrospinal fluid clinical characteristic for non-small cell lung cancer（NSCLC） patients with leptomeningeal metastasis（LM）.Methods A total of 31 patients with NSCLC LM and 30 patients with primary central nervous system lymphoma（PCNSL） were enrolled. Their imaging characteristics were compared,and serum levels of alpha-fetoprotein（AFP）,carcinoembryonic antigen（CEA）,carbohydrate antigen（CA） 15-3 and CA19-9 were determined by chemiluminescence. The cerebrospinal fluid glucose,total protein and chloride level were determined by hexokinase kinase,bromcresol green/biuret and ion selective electrode methods,respectively. The levels of interleukin （IL）-6 and IL-10 in cerebrospinal fluid were determined by enzyme-linked immunosorbent assay. The determination rates of cerebrospinal fluid tumor cells according to cytology between the 2 groups were compared.Results There was no statistical significance in sex,age and imaging between NSCLC LM and PCNSL groups（P>0.05）. Serum levels of AFP,CEA and CA15-3 in NSCLC LM group were higher than those in PCNSL group（P<0.05）,and CA19-9 had no statistical significance between the 2 groups（P>0.05）. There was no statistical significance in cerebrospinal fluid pressure,nucleated cell count,chloride level and IL-6 between the 2 groups（P>0.05）,while cerebrospinal fluid glucose and IL-10 levels and IL-6/IL-10 ratio in NSCLC LM group had statistical significance compared with PCNSL group（P<0.05）.Conclusions The diagnosis of NSCLC LM should be integrated with clinical characteristics,imaging findings,serum tumor markers' levels and cerebrospinal fluid IL-6 level and IL-6/IL-10 ratio,which could improve the diagnosis of NSCLC LM.

Key words: Non-small cell lung cancer, Leptomeningeal metastasis, Cerebrospinal fluid

中图分类号:

R446.62

付小玲, 陈锟, 徐佳学, 关明. 非小细胞肺癌脑膜转移患者的脑脊液临床特征分析[J]. 检验医学, 2018, 33(8): 692-696.

FU Xiaoling, CHEN Kun, XU Jiaxue, GUAN Ming. Clinical characteristic of cerebrospinal fluid for non-small cell lung cancer patients with leptomeningeal metastasis[J]. Laboratory Medicine, 2018, 33(8): 692-696.

图/表 3

参考文献 21

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组别	例数	性别（男/女）	年龄	影像学表现[例（%）]
组别	例数	性别（男/女）	年龄	无占位	单发	多发
NSCLC LM组	23^*	13/18	57（47~63）	16（0.70）	0（0.00）	7（0.30）
PCNSL组	30	18/12	58（47~66）		9（0.30）	21（0.70）
P值		0.12	0.35		0.15

组别	例数	性别（男/女）	年龄	影像学表现[例（%）]
组别	例数	性别（男/女）	年龄	无占位	单发	多发
NSCLC LM组	23^*	13/18	57（47~63）	16（0.70）	0（0.00）	7（0.30）
PCNSL组	30	18/12	58（47~66）		9（0.30）	21（0.70）
P值		0.12	0.35		0.15

组别	例数	AFP（μg/L）	CEA（μg/L）	CA15-3（U/mL）	CA19-9（U/mL）
NSCLC LM组	31	3.02（2.00~4.49）^*	28.42（4.93~266.63）^*	26.11（17.30~129.45）^#	15.14（8.50~27.93）^*
PCNSL组	30	2.41（1.91~3.02）^△	2.06（1.58~2.88）^△	12.71（7.26~18.21）^▲	12.25（7.85~18.04）^△
P值		0.04	0.01	0.00	0.14

组别	例数	AFP（μg/L）	CEA（μg/L）	CA15-3（U/mL）	CA19-9（U/mL）
NSCLC LM组	31	3.02（2.00~4.49）^*	28.42（4.93~266.63）^*	26.11（17.30~129.45）^#	15.14（8.50~27.93）^*
PCNSL组	30	2.41（1.91~3.02）^△	2.06（1.58~2.88）^△	12.71（7.26~18.21）^▲	12.25（7.85~18.04）^△
P值		0.04	0.01	0.00	0.14

组别	例数	压力（mmH₂O）	有核细胞计数（个/μL）	蛋白（g/L）	葡萄糖（mmol/L）	氯化物（mmol/L）
NSCLC LM组	31	150.0（122.5~200.0）^*	1（0~9）	0.43（0.30~0.74）	3.33（2.86~3.70）	125.0（123.0~128.0）
PCNSL组	30	160.0（136.3~197.5）	4（1~17）	0.65（0.36~1.32）	3.89（3.20~4.68）	124.5（122.0~129.0）
P值		0.33	0.05	0.08	0.00	0.47
组别	IL-6（pg/mL）	IL-10（pg/mL）	IL-6/IL-10比值（pg/mL）	细胞学检查阳性[例（%）]
NSCLC LM组	13.94（6.09~43.85）	7.50（3.86~19.27）	1.99（1.07~8.14）	15（48）
PCNSL组	17.18（5.43~105.45）	66.60（10.52~420.01）	0.23（0.06~2.23）	15（50）
P值	0.48	0.00	0.00	0.55