乳腺癌患者血清雌二醇、卵泡刺激素及黄体生成素检测结果分析:西门子吖啶酯化学发光法检测报告

doi:10.3877/cma. j. issn.1674-0807.2012.03.002

目的

分析符合NCCN 指南绝经标准和正常月经状态的两组乳腺癌患者雌二醇(E2)、卵泡刺激素(FSH)和黄体生成素(LH)3 项性激素的水平,为判断60 岁以下、未接受卵巢去势但已停经的妇女是否达到绝经状态提供依据,以便合理应用芳香化酶抑制剂。

方法

前瞻性研究本院用西门子吖啶酯化学发光法检测的204 例年龄≥60 岁或双侧卵巢切除后的患者(绝经组),以及128 例处于正常月经状态患者(未绝经组)的性激素检测结果。采用核密度图描述3 种激素在绝经和未绝经患者的分布特点,用百分位数表分别描述这两组患者的3 项性激素数据。两组间3 项性激素水平的比较采用Wilcoxon 检验。

结果

绝经组中,E2 最高值为53.63 pg/ml, FSH 和LH 的最低值分别为9.68 mU/ml 和1.18 mU/ml。核密度图显示3 项性激素水平都呈偏态分布,它们在绝经和未绝经患者间的差别均有统计学意义(P 值均<0.01)。绝经和未绝经患者3 项性激素的分布都有重叠,尤以LH 为著。

结论

LH 不宜用于判断乳腺癌患者的绝经状态。对符合2011 年中国抗癌协会乳腺癌专业委员会绝经标准专家共识的患者,当西门子吖啶酯化学发光法检测E2<50 pg/ml、FSH>10 mU/ml 时,可初步判定其为绝经状态,并可考虑应用AIs, 但应追踪性激素的变化,以便及时发现误判的患者。

关键词: 乳腺肿瘤, 性腺甾类激素, 绝经期

Objective

To compare the levels of serum estradiol(E2), folliclestimulating hormone (FSH), and luteinizing hormone (LH) in definite premenopausal and postmenopausal breast cancer patients according to the criteria of NCCN guideline so as to provide the basis for the judgment of menopause status in amenorrhoea women <60 years without ovarian suppression as well as rational application of aromatase inhibitors.

Methods

A prospective study was performed among 204 patients with age≥60 years or receiving bilateral oophorectomy (postmenopausal group) and 128 patients with regular menses(premenopausal group). Serum sex hormone levels were measured by acridinium ester chemiluminescence (Siemens). Kernel density estimation was used to describe the distribution characteristic of three sex hormones in pre- and postmenopausal patients.Percentile table recorded the data measured from two groups in this study. Wilcoxon test was used to analyze three serum hormone levels between the two groups.

Results

In the postmenopausal group,the maximum value of E2 was 53.63 pg/ml,and the minimum values of FSH and LH were 9.68 mU/ml and 1.18 mU/ml respectively. There was significant difference in three serum hormone levels between premenopausal and postmenopausal patients(P <0.01). Kernel density estimation showed that three hormone levels was skewed distribution and overlaped a part between two groups, especially for LH level.

Conclusions

To determine the menopausal status of breast cancer patients using LH are no longer recommended. Patients who meet the postmenopausal criteria of the expert consensus of Chinese Anti-Cancer Association Committee Breast Cancer Society in 2011,if their serum E2<50 pg/ml and FSH>10 mU/ml detected using Siemens acridinium ester chemiluminescence,may be considered to suitable for AIs. But there certainly exist patients wrongly judged to be in menopausal status, so it is necessary to monitor the change of sex hormones.

Key words: breast neoplasms, gonadal steroid hormones, menopause

表1 绝经和未绝经乳腺癌患者的临床资料

临床资料	绝经组[例(%)]n=204	未绝经组[例(%)]n=128
肿瘤特征
复发转移	148(72.5)	5(3.9)
未复发转移	56(27.5)	123(96.1)
乳腺癌治疗史
有	156(76.5)	21(16.4)
无	48(23.5)	107(83.6)
化疗
是	151(74.0)	13(10.2)^a
否	53(26.0)	115(89.8)
内分泌治疗
是	87(42.6)	8(6.3)
否	117(57.3)	120(93.7)
靶向治疗
是	28(13.7)	4(3.1)
否	176(86.3)	124(96.9)
放疗
是	72(35.3)	5(3.9)
否	132(64.7)	123(96.1)

表1 绝经和未绝经乳腺癌患者的临床资料

临床资料	绝经组[例(%)]n=204	未绝经组[例(%)]n=128
肿瘤特征
复发转移	148(72.5)	5(3.9)
未复发转移	56(27.5)	123(96.1)
乳腺癌治疗史
有	156(76.5)	21(16.4)
无	48(23.5)	107(83.6)
化疗
是	151(74.0)	13(10.2)^a
否	53(26.0)	115(89.8)
内分泌治疗
是	87(42.6)	8(6.3)
否	117(57.3)	120(93.7)
靶向治疗
是	28(13.7)	4(3.1)
否	176(86.3)	124(96.9)
放疗
是	72(35.3)	5(3.9)
否	132(64.7)	123(96.1)

表2 两组患者的血清雌二醇(E2)、卵泡刺激素(FSH)和黄体生成素(LH)水平比较

组别	例数	E2(pg/ml)^a			FSH(mU/ml)^b			LH(mU/ml)
组别	例数	中位数	Q1~Q3	最小值~最大值	中位数	Q1~Q3	最小值~最大值	中位数	Q1~Q3	最小值~最大值
绝经组	204	18.27	9.06~29.22	＜7.00~53.63	51.26	36.79~65.23	9.68~125.59	25.52	18.16~36.81	1.18~72.05
未绝经组	128	90.73	54.28~206.20	＜7.00~1000.00	6.26	4.33~8.88	1.41~86.54	5.41	3.39~9.97	0.93~64.20
统计量		182.16			209.11			154.57
P值		0.00			0.00			0.00

表2 两组患者的血清雌二醇(E2)、卵泡刺激素(FSH)和黄体生成素(LH)水平比较

组别	例数	E2(pg/ml)^a			FSH(mU/ml)^b			LH(mU/ml)
组别	例数	中位数	Q1~Q3	最小值~最大值	中位数	Q1~Q3	最小值~最大值	中位数	Q1~Q3	最小值~最大值
绝经组	204	18.27	9.06~29.22	＜7.00~53.63	51.26	36.79~65.23	9.68~125.59	25.52	18.16~36.81	1.18~72.05
未绝经组	128	90.73	54.28~206.20	＜7.00~1000.00	6.26	4.33~8.88	1.41~86.54	5.41	3.39~9.97	0.93~64.20
统计量		182.16			209.11			154.57
P值		0.00			0.00			0.00

图1 绝经和未绝经患者雌二醇(E2)的核密度图

图2 绝经和未绝经患者卵泡刺激素(FSH)的核密度图

图3 绝经和未绝经患者黄体生成素(LH)的核密度图

表3 雌二醇(E2)、卵泡刺激素(FSH)和黄体生成素(LH)的百分位数表

百分位数	E2(pg/ml)^a		FSH(mU/ml)^b		LH(mU/ml)
百分位数	未绝经(128例)	绝经(204例)	未绝经(128例)	绝经(204例)	未绝经(128例)	绝经(204例)
0.5	7.00	7.00	1.41	13.00	0.93	2.77
2.5	16.33	7.00	1.98	15.12	1.32	5.72
5.0	23.14^c	7.00	2.51	18.66^c	1.60	9.17^c
10.0	28.12	7.00	2.99	25.96	2.37	11.89
15.0	36.82	7.00	3.62	28.90	2.69	15.16
20.0	43.26	7.00	3.98	33.75	2.97	16.50
25.0	54.28	9.06	4.33	36.79	3.39	18.16
30.0	57.38	10.19	4.90	38.60	3.73	20.20
35.0	63.11	12.35	5.40	40.77	4.14	22.27
40.0	71.26	13.94	5.65	44.28	4.52	23.75
45.0	79.41	15.85	6.02	47.43	4.99	24.39
50.0	90.73	18.27	6.26	51.26	5.41	25.52
55.0	118.00	20.07	6.85	53.66	6.11	28.23
60.0	145.00	21.57	7.03	55.78	6.63	29.58
65.0	161.00	23.76	7.43	59.71	7.96	31.87
70.0	183.00	26.41	7.88	62.33	9.06	33.75
75.0	206.00	29.22	8.88	65.23	9.97	36.81
80.0	261.00	31.52	10.30	70.65	12.12	39.10
85.0	321.00	35.28	13.00	76.81	12.96	42.02
90.0	562.00	37.50	19.52	83.38	21.22	44.44
95.0	779.00	44.04^d	27.89^d	94.14	27.92^d	58.24
97.5	963.00	46.67	46.31	111.00	37.41	64.23
99.5	1000.00	49.52	86.54	123.00	64.20	70.04

表3 雌二醇(E2)、卵泡刺激素(FSH)和黄体生成素(LH)的百分位数表

百分位数	E2(pg/ml)^a		FSH(mU/ml)^b		LH(mU/ml)
百分位数	未绝经(128例)	绝经(204例)	未绝经(128例)	绝经(204例)	未绝经(128例)	绝经(204例)
0.5	7.00	7.00	1.41	13.00	0.93	2.77
2.5	16.33	7.00	1.98	15.12	1.32	5.72
5.0	23.14^c	7.00	2.51	18.66^c	1.60	9.17^c
10.0	28.12	7.00	2.99	25.96	2.37	11.89
15.0	36.82	7.00	3.62	28.90	2.69	15.16
20.0	43.26	7.00	3.98	33.75	2.97	16.50
25.0	54.28	9.06	4.33	36.79	3.39	18.16
30.0	57.38	10.19	4.90	38.60	3.73	20.20
35.0	63.11	12.35	5.40	40.77	4.14	22.27
40.0	71.26	13.94	5.65	44.28	4.52	23.75
45.0	79.41	15.85	6.02	47.43	4.99	24.39
50.0	90.73	18.27	6.26	51.26	5.41	25.52
55.0	118.00	20.07	6.85	53.66	6.11	28.23
60.0	145.00	21.57	7.03	55.78	6.63	29.58
65.0	161.00	23.76	7.43	59.71	7.96	31.87
70.0	183.00	26.41	7.88	62.33	9.06	33.75
75.0	206.00	29.22	8.88	65.23	9.97	36.81
80.0	261.00	31.52	10.30	70.65	12.12	39.10
85.0	321.00	35.28	13.00	76.81	12.96	42.02
90.0	562.00	37.50	19.52	83.38	21.22	44.44
95.0	779.00	44.04^d	27.89^d	94.14	27.92^d	58.24
97.5	963.00	46.67	46.31	111.00	37.41	64.23
99.5	1000.00	49.52	86.54	123.00	64.20	70.04

表4 绝经者血清雌二醇(E2)、卵泡刺激素(FSH)和黄体生成素(LH)参考值范围比较

性激素	西门子检测仪说明书中绝经期正常人群			本研究中绝经期乳腺癌患者
性激素	例数	中位数	单侧97.5%的参考范围	例数	中位数	单侧97.5%的参考范围
E2(pg/ml)^a	140	14.40	ND~44.50	204	18.27	ND~46.67
FSH(mU/ml)^b	72	64.30	23.00~116.30	204	51.26	15.12~111.00
LH(mU/ml)	35	29.70	15.90~54.00	204	25.52	5.72~64.23

表4 绝经者血清雌二醇(E2)、卵泡刺激素(FSH)和黄体生成素(LH)参考值范围比较

性激素	西门子检测仪说明书中绝经期正常人群			本研究中绝经期乳腺癌患者
性激素	例数	中位数	单侧97.5%的参考范围	例数	中位数	单侧97.5%的参考范围
E2(pg/ml)^a	140	14.40	ND~44.50	204	18.27	ND~46.67
FSH(mU/ml)^b	72	64.30	23.00~116.30	204	51.26	15.12~111.00
LH(mU/ml)	35	29.70	15.90~54.00	204	25.52	5.72~64.23

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Analysis of the detection result of serum estradiol, follicle-stimulating hormone and luteinizing hormone in breast cancer patients: report of Siemens acridinium ester chemiluminescence detection

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Analysis of the detection result of serum estradiol, follicle-stimulating hormone and luteinizing hormone in breast cancer patients: report of Siemens acridinium ester chemiluminescence detection