血清sCD44、NGAL和MIC-1水平在孤立性肺结节的鉴别诊断价值

The Value of Serum sCD44,NGAL and MIC-1 Levels in the Differential Diagnostic of Solitary Pulmonary Nodules

目的:观察血清可溶性吞噬细胞糖蛋白-1(sCD44)、中性粒细胞明胶酶相关载脂蛋白(NGAL)和巨噬细胞抑制因子-1(MIC-1)水平在孤立性肺结节的鉴别诊断价值。方法:选择2019年1月至2021年12月在我院诊治的孤立性肺结节患者98例,设为观察组,根据术后病理分为良性组(41例)和恶性组(57例);选择同期在我院行健康体检者45例,设为对照组。观察两组的血清sCD44、NGAL和MIC-1水平;进行患者入院时临床指标与恶性孤立性肺结节相关性的单因素和多因素分析;分析血清sCD44、NGAL和MIC-1水平对恶性孤立性肺结节的诊断效能及各指标之间的相关性。结果:入院时观察组患者血清sCD44、NGAL和MIC-1水平较对照组明显更高(P<0.01);治疗后观察组患者血清sCD44、NGAL和MIC-1水平较入院时明显降低(P<0.01)。良性组与恶性组孤立性肺结节患者性别、年龄、吸烟史、肿瘤家族史和结节大小差异无统计学意义(P>0.05),而良性组与恶性组孤立性肺结节患者肿瘤部位、sCD44、NGAL和MIC-1水平差异具有统计学意义(P<0.05)。多因素分析发现,血清sCD44、NGAL和MIC-1水平是孤立性肺结节为恶性的独立危险因素(P<0.01)。血清sCD44、NGAL和MIC-1水平对恶性孤立性肺结节具有较高的诊断效能,联合检测的灵敏度为84.2%,特异度为92.7%,AUC为0.948,明显高于单个指标sCD44(Z=3.153,P=0.002)、NGAL(Z=2.967,P=0.003)和MIC-1(Z=3.180,P=0.001),而三个指标之间的AUC差异无统计学意义(P>0.05)。孤立性肺结节患者血清sCD44水平与NGAL(r=0.672,P<0.01)和MIC-1(r=0.728,P<0.01)水平呈正相关;血清NGAL水平与MIC-1水平也呈正相关(r=0.618,P<0.01)。结论:血清sCD44、NGAL和MIC-1水平是孤立性肺结节为恶性的独立危险因素,联合检测在孤立性肺结节的良恶性鉴别诊断中具有重要临床意义。

Objective:To observe the value of serum soluble phagocytic glycoprotein-1(sCD44),neutrophil gelatinase-associated lipocalin(NGAL)and macrophage inhibitory cytokine-1(MIC-1)levels in the differential diagnostic of solitary pulmonary nodules.Methods:98 patients with solitary pulmonary nodules treated in our hospital from January 2019 to December 2021 were selected as the observation group.According to postoperative pathology,they were divided into the benign group(41 cases)and the malignant group(57 cases).45 patients who underwent physical examination in our hospital during the same period were selected as the control group.The serum levels of sCD44,NGAL and MIC-1 were observed in the two groups,and the univariate and multivariate analysis were performed between the clinical indicators at admission and the occurrence of malignant solitary pulmonary nodules.The diagnostic efficacy of serum sCD44,NGAL and MIC-1 levels in malignant solitary pulmonary nodules and the correlation between the indicators was analyzed.Results:The serum levels of sCD44,NGAL and MIC-1 at admission of patients in the observation group were significantly higher than those in the control group(P<0.01).After treatment,serum levels of sCD44,NGAL and MIC-1 of patients in the observation group significantly decreased compared with those at admission(P<0.01).There was no statistical difference between solitary pulmonary nodules patients in the benign group and in the malignant group in terms of gender,age,smoking history,family history of tumor and nodule size(P>0.05).There were statistical differences in tumor site,sCD44,NGAL and MIC-1 levels between solitary pulmonary nodules patients in the benign group and in the malignant group(P<0.05).The multivariate analysis found that serum sCD44,NGAL and MIC-1 levels were the independent risk factors for malignancy of solitary pulmonary nodules(P<0.01).The serum sCD44,NGAL and MIC-1 levels had high diagnostic efficacy for malignant solitary pulmonary nodules.The sensitivity of combined detection was 84.2%,specificity was 92.7%,and AUC was 0.948,which were significantly higher than those of sCD44(Z=3.153,P=0.002),NGAL(Z=2.967,P=0.003)and MIC-1(Z=3.180,P=0.001),while there was no statistical difference in AUC among the three indicators(P>0.05).The serum sCD44 level of patients with solitary pulmonary nodules was positively correlated with the serum level of NGAL(r=0.672,P<0.01)and MIC-1(r=0.728,P<0.01),and the serum NGAL level was positively correlated with MIC-1 level(r=0.618,P<0.01).Conclusion:The serum levels of sCD44,NGAL and MIC-1 are independent risk factors for malignancy of solitary pulmonary nodules,and the combined detection has important clinical significance in the differential diagnosis of benign and malignant solitary pulmonary nodules.