高分辨率CT联合多种血清肿瘤标志物对不同病理类型早期肺癌的诊断价值

Diagnostic value of high resolution CT scan combined with various serum tumor markers in different pathological types of early lung cancer

    摘要
  • 摘要:
    目的 探讨高分辨率CT（HRCT）联合多种血清肿瘤标志物对不同病理类型早期肺癌的诊断价值。
    方法 回顾性分析2019年8月至2021年10月首都医科大学附属北京天坛医院收治的164例早期肺癌患者（肺癌组）的临床资料，同时选取同期参加体检的78名健康者作为对照组。肺癌组男性94例、女性70例，年龄（52.4±3.6）岁；其中，腺癌90例、鳞癌62例、小细胞癌12例。所有患者均经组织病理学检查结果证实。比较2组间和不同病理类型患者间血清神经元特异性烯醇化酶（NSE）、癌胚抗原（CEA）、鳞状细胞癌抗原（SCCA）、细胞角蛋白19片段抗原21-1（CYFRA21-1）、糖类抗原125（CA125）水平；以组织病理学检查结果为确诊肺癌的“金标准”，分别计算HRCT、5种肿瘤标志物、HRCT+5种肿瘤标志物诊断肺癌的灵敏度、特异度和准确率。计量资料的比较采用两独立样本t检验，计数资料的比较采用χ2检验。
    结果 肺癌组的各项血清肿瘤标志物水平均高于对照组，且差异有统计学意义（t=8.107~30.460，均P<0.001）。腺癌患者的血清CEA、CA125水平均高于鳞癌和小细胞癌患者，且差异有统计学意义（t=12.712~4.326，均P<0.001）。鳞癌患者的血清CEA、CA125水平与小细胞癌患者的相比，差异均无统计学意义（t=1.342、1.256，均P>0.05）。腺癌与鳞癌患者的NSE和CYFRA21-1水平均低于小细胞癌患者，且差异有统计学意义（t=10.342~11.534，均P<0.001）。HRCT+5种肿瘤标志物联合检测对肺癌的诊断灵敏度为95.62%，特异度为96.43%，准确率为98.65%，均高于任意一种单独诊断（χ2=55.823、48.652、62.718，均P<0.001）。
    结论 HRCT联合多种血清肿瘤标志物检测有助于提高对早期肺癌的诊断特异度、灵敏度和准确率，对肺癌的诊断具有较高的临床价值。

     

    Abstract:
    Objective To investigate the diagnostic value of high resolution CT (HRCT) scan combined with various serum tumor markers in different pathological types of early lung cancer.
    Methods The clinical data of 164 patients with early lung cancer (lung cancer group) admitted to Beijing Tiantan Hospital, Capital Medical University from August 2019 to October 2021 were analyzed retrospectively, and 78 healthy people who participated in physical examination at the same time were selected as the control group. There were 94 males and 70 females in the lung cancer group, aged (52.4±3.6) years. Among them, 90 cases were adenocarcinoma, 62 cases were squamous cell carcinoma, and 12 cases were small cell carcinoma. All the patients were confirmed by histopathological examination. The serum levels of neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), cyto-keratin 19 fragment antigen 21-1, squamous cell carcinoma antigen and carbohydrate antigen 125 (CA125) were compared between the two groups and different pathological types of patients. The sensitivity, specificity and accuracy of HRCT scan, five tumor markers and HRCT scan + five tumor markers in the diagnosis of lung cancer were calculated based on the results of histopathological examination as the gold standard. The measurement data were compared by two independent samples t-test, and the counting data were compared by Chi-square test.
    Results The levels of serum tumor markers in lung cancer group were higher than those in control group (t=8.107–30.460; all P<0.001). The serum CEA and CA125 levels in patients with adenocarcinoma were higher than those in squamous cell carcinoma and small cell carcinoma (t=12.712–4.326; all P<0.001). No significant difference was found in serum CEA and CA125 levels between patients with squamous cell carcinoma and those with small cell carcinoma (t=1.342, 1.256; both P>0.05). The NSE level in patients with adenocarcinoma and squamous cell carcinoma was lower than that in patients with small cell carcinoma (t=10.342–11.534; all P<0.001). The sensitivity, specificity and accuracy of HRCT scann + five tumor markers in the diagnosis of lung cancer were 95.62%, 96.43% and 98.65% respectively, which were higher than any single diagnosis (χ2=55.823, 48.652, 62.718; all P<0.001).
    Conclusion HRCT scan combined with detection of various serum tumor markers can improve the sensitivity, specificity and accuracy of early lung cancer diagnosis, and this method has high clinical value in the diagnosis of lung cancer.

     

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