超声造影定量参数结合血清肿瘤标志物对胸膜下肺结核、肺癌、胸膜下肺结核合并肺癌的鉴别诊断价值

Differential Diagnostic Value of Quantitative Parameters of Contrast-Enhanced Ultrasound Combined with Serum Tumor Markers for Subpleural Tuberculosis,Lung Cancer,and Subpleural Tuberculosis Combined with Lung Cancer

目的 探讨超声造影定量参数与血清肿瘤标志物结合鉴别胸膜下肺结核、肺癌、胸膜下肺结核合并肺癌的价值。方法 回顾性分析142例可疑胸膜下肺结核、肺癌患者的临床资料。患者均接受超声造影定量检查,并采用酶联免疫法检测血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、血管内皮生长因子(VEGF)]。比较不同疾病患者超声造影定量参数[始增时间(AT)、峰值强度(PI)、达峰时间(TTP)、时间比例(TR)]、血清肿瘤标志物水平。绘制受试者工作特征(ROC)曲线分析不同方法对肺癌的鉴别价值。结果 胸膜下肺结核63例,胸膜下肺癌66例,胸膜下肺结核合并肺癌13例。肺癌AT和TTP均短于肺结核合并肺癌、肺结核(P<0.05),且肺结核合并肺癌AT和TTP均短于肺结核(P<0.05)。肺癌PI、血清CEA、CA125和VEGF水平均高于肺结核合并肺癌、肺结核(P<0.05),且肺结核合并肺癌PI和血清VEGF水平均高于肺结核(P<0.05)。肺癌TR低于肺结核合并肺癌、肺结核(P<0.05),且肺结核合并肺癌TR低于肺结核(P<0.05)。超声造影定量参数结合血清肿瘤标志物对肺癌鉴别诊断的灵敏度、特异度、曲线下面积(AUC)分别为100.00%、90.48%、0.934(95%CI:0.880~0.969),且灵敏度和AUC均高于单独鉴别诊断(P<0.05)。结论 与胸膜下肺结核相比较,胸膜下肺结核合并肺癌AT和TTP缩短,TR下降,PI和血清CEA、CA125和VEGF水平升高,且肺癌AT和TTP更短,TR更低,PI和VEGF水平更高,超声造影定量参数结合血清肿瘤标志物可提高对是否合并肺癌诊断的可靠性。

Objective To explore the value of combining quantitative parameters of contrast-enhanced ultrasound with serum tumor markers in distinguishing subpleural pulmonary tuberculosis,lung cancer,and subpleural pulmonary tuberculosis with lung cancer.Methods The clinical data from 142 suspected cases of subpleural pulmonary tuberculosis,lung cancer were retrospectively analyzed.All patients underwent quantitative contrast-enhanced ultrasound examination and serum tumor markers,including carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),and vascular endothelial growth factor(VEGF),were detected by enzyme-linked immunosorbent assay.The quantitative parameters of contrast-enhanced ultrasound in patients with different diseases,including acceleration time(AT),peak intensity(PI),time to peak(TTP),time ratio(TR),and serum tumor marker levels were compared among different disease.Receiver operating characteristic(ROC)curves were drawn to analyze the differential value of different methods for lung cancer.Results There were 63 cases of subpleural pulmonary tuberculosis,66 cases of subpleural lung cancer,and 13 cases of subpleural pulmonary tuberculosis combined with lung cancer.The AT and TTP of lung cancer were shorter than those of pulmonary tuberculosis combined with lung cancer or pulmonary tuberculosis(P<0.05),and the AT and TTP of pulmonary tuberculosis combined with lung cancer were shorter than those of pulmonary tuberculosis(P<0.05).The PI,serum levels of CEA,CA125,and VEGF in lung cancer were higher than those in pulmonary tuberculosis combined with lung cancer or pulmonary tuberculosis(P<0.05),and the PI and serum levels of VEGF in pulmonary tuberculosis combined with lung cancer were higher than those in pulmonary tuberculosis(P<0.05).The TR of lung cancer was lower than those of pulmonary tuberculosis combined with lung cancer or pulmonary tuberculosis(P<0.05),and the TR of pulmonary tuberculosis combined with lung cancer was lower than that of pulmonary tuberculosis(P<0.05).The sensitivity,specificity,and area under the curve(AUC)of contrast-enhanced ultrasound quantitative parameters combined with serum tumor markers in the differential diagnosis of lung cancer were 100.00%,90.48%,and 0.934(95%CI:0.880-0.969),respectively,and the sensitivity and AUC were higher than those of individual differential diagnosis(P<0.05).Conclusion Compared with subpleural pulmonary tuberculosis,subpleural pulmonary tuberculosis with lung cancer has shortened AT and TTP,decreased TR,increased PI and serum CEA,CA125,and VEGF levels,and lung cancer has shorter AT and TTP,lower TR,and higher PI and VEGF levels.The combination of quantitative parameters of contrast-enhanced ultrasound and serum tumor markers can improve the reliability of the diagnosis of lung cancer.