摘要
目的探讨甲氧基肾上腺素类物质(MNs)和神经元特异性烯醇化酶(NSE)在儿童神经母细胞瘤(NB)辅助诊断与转移监测中的临床价值。方法回顾性分析2020年1月至2024年5月四川大学华西医院小儿外科收治的82例14岁以下肿瘤患儿的临床资料,根据肿瘤类型分为NB组(41例)和非NB组(41例)。分析比较两组患者甲氧基肾上腺素(MN)、甲氧基去甲肾上腺素(NMN)、3-甲氧酪胺(3-MT)、NSE水平,并绘制受试者工作特征(ROC)曲线,评估各指标单独及联合检测在NB诊断及转移监测中的效能。结果NB组中,转移20例,无转移21例;原发肿瘤部位以腹膜后为主,占82.9%(34/41),其中19例患儿初诊时即发现转移,占46.3%;具体病理学分型为未分化型10例、分化差型14例、分化型9例、节细胞型8例。非NB组肿瘤类型包括脂肪母细胞瘤5例、小细胞恶性肿瘤2例、肝母细胞瘤5例、横纹肌肉瘤3例、皮质腺瘤3例、嗜铬细胞瘤1例、肾恶性肿瘤5例、畸胎瘤7例、肾母细胞瘤5例、淋巴瘤5例。NB组NMN、3-MT、NSE水平显著高于非NB组[2.71(1.21,5.15)nmol/L比0.46(0.26,0.80)nmol/L、22.8(7.1,88.1)ng/L比2.8(1.4,3.9)ng/L、73(28,224)μg/L比24(19,48)μg/L](P<0.01)。在单独检测中,3-MT检测诊断NB的效能最优,曲线下面积(AUC)为0.899,灵敏度为85.7%,特异度为85.0%;在联合检测中,NMN+3-MT诊断NB的AUC为0.884,灵敏度为80.2%,特异度为92.8%,NMN+3-MT+NSE诊断NB的AUC为0.895,灵敏度为73.2%,特异度为92.7%。NB转移组NSE水平显著高于NB无转移组[217(137,300)μg/L比40(22,51)μg/L](P<0.01),NSE预测NB转移的灵敏度为87.5%,特异度为80.0%,AUC为0.901,截断值为99.15μg/L;而NB转移组和NB无转移组的MN、NMN、3-MT水平比较差异无统计学意义(P>0.05)。结论NMN、3-MT、NSE在辅助诊断NB中具有重要价值,其中NSE在预测NB转移方面表现出较高的灵敏度和特异度,可作为临床NB诊断及病情监测的关键指标。
Objective To explore the clinical value of metanephrines(MNs)and neuron-specific enolase(NSE)in the auxiliary diagnosis and metastasis monitoring of neuroblastoma(NB)in children.Methods Retrospective analysis of 82 children with tumors under the age of 14 admitted to the Department of Pediatric Surgery at West China Hospital of Sichuan University from Jan.2020 to May 2024 was done.They were divided into a NB group(41 cases)and a non-NB group(41 cases)based on tumor type.The levels of methoxyepinephrine(MN),normetanephrine(NMN),3-methoxytyramine(3-MT),and NSE were compared,and receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of individual and combined detection of various indicators in the diagnosis and metastasis monitoring of NB.Results In the NB group,there were 20 cases of metastasis and 21 cases without metastasis.The primary tumor site was mainly retroperitoneal,accounting for 82.9%(34/41).Among them,metastasis was found at the initial diagnosis in 19 children,accounting for 46.3%.The specific pathological classifications were 10 cases of undifferentiated type,14 cases of poorly differentiated type,9 cases of differentiated type,and 8 cases of ganglion cell type.The tumor types in the non-NB group included 5 cases of adipoblastoma,2 cases of small cell malignancy,5 cases of hepatoblastoma,3 cases of rhabdomyosarcoma,3 cases of cortical adenoma,1 case of pheochromocytoma,5 cases of renal malignant tumor,7 cases of teratoma,5 cases of nephroblastoma,and 5 cases of lymphoma.The levels of NMN,3-MT and NSE in the NB group were significantly higher than those in the non-NB group[2.71(1.21,5.15)nmol/L vs 0.46(0.26,0.80)nmol/L,22.8(7.1,88.1)ng/L vs 2.8(1.4,3.9)ng/L,73(28,224)μg/L vs 24(19,48)μg/L](P<0.01).In the individual detection,the 3-MT detection had the best efficacy in diagnosing NB,with an area under curve(AUC)of 0.899,a sensitivity of 85.0%and a specificity of 85.7%.In the combined detection,the AUC of NMN+3-MT in diagnosing NB was 0.884,with a sensitivity of 80.2%and a specificity of 92.8%.The AUC of NMN+3-MT+NSE in diagnosing NB was 0.895,with a sensitivity of 73.2%and a specificity of 92.7%.The NSE level in the NB group was significantly higher than that in the non-NB group[217(137,300)μg/L vs 40(22,51)μg/L](P<0.01).The sensitivity of NSE in predicting NB metastasis was 87.5%,the specificity was 80.0%,and the AUC was 0.901.The cut-off value was 99.15μg/L;there was no statistically significant difference in the levels of MN,NMN and 3-MT between the NB group and the non-NB group(P>0.05).Conclusion NMN,3-MT and NSE have significant value in the auxiliary diagnosis of NB.Among them,NSE shows high sensitivity and specificity in predicting NB metastasis and can be used as a key indicator for clinical NB diagnosis and disease monitoring.
作者
刘欢
苗强
蔡蓓
张君龙
徐一心
LIU Huan;MIAO Qiang;CAI Bei;ZHANG Junlong;XU Yixin(Department of Experimental Medicine,West China Hospital of Sichuan University,Chengdu 610041,China;Clinical Laboratory,the First Affiliated Hospital of Guangxi University of Science and Technology,Liuzhou 545002,China)
出处
《医学综述》
2025年第14期1767-1771,1778,共6页
Medical Recapitulate
