激光诱发荧光光谱诊断肺癌的初步临床研究

The Preliminary Clinical Study of Laser-Induced Fluorescence in the Diagnosis of Lung Cancer

目的 探讨利用激光诱发荧光光谱对肺癌进行临床诊断的可行性。方法 使用 35 5nm的Nd :YAG激发光和荧光探测系统 ,将特制光导纤维通过纤维支气管镜的活检通道送入患者支气管 ,对 2 1例患者的正常支气管壁及可疑部位进行激光诱发荧光光谱测定 ,随后在各检测点咬取组织行病理检查。结果 2 1例患者共测定 74条曲线 ,经病理证实 ,肺癌 32条 ,正常支气管组织 4 2条。正常支气管组织主峰 (4 6 2 4±7 5 )nm和肺癌主峰 (4 6 0 5± 7 0 )nm位置无显著性差异 (P >0 0 5 ) ;正常支气管组织的荧光强度 (84 35 2±5 0 4 2 8)明显大于肺癌 (336 0 2± 196 0 9) (P <0 0 0 1) ;正常支气管组织在 5 80～ 6 0 0nm波段表现为一小坪 (I580nm/I60 0 nm =1 0 6 4± 0 133) ,而肺癌平滑下降 (I580nm/I60 0nm=1 32 9± 0 0 85 ) (P <0 0 0 1)。以I580nm/I60 0nm比值为判据诊断肺癌的敏感性、特异性、阳性预测值、阴性预测值及总符合率分别为 87 5 %、80 9%、77 8%、89 5 %和 83 8%。结论 用激光诱发荧光光谱对肺癌进行临床诊断是可行的。

Objective To explore the clinical feasibility of laser-induced fluorescence spectroscopy in the diagnosis of lung cance. Methods The LIF spectra of normal bronchus and doubtful sites of lung cancer in 21 lung cancer patients were measured with a detecting system which consist of an YAG laser (wavelength 355 nm) and an optical multichannel analyzer (OMA). A specially made optical fibre was placed in patient's bronchus by bronchoscopy. Biopsy of all the detected sites was performed. Results 74 spectrum curves were detected in 21 patients and 32 were lung cancer and 42 were normal bronchus confirmed by the pathological examinations. The location of the principal spectral peaks of the normal bronchial tissue (462.4±7.5 nm) and lung cancer (460.5±7.0 nm) showed no significant difference (P>0.05). The fluorescence intensity of the normal bronchial tissue (84 352±50 428) was much higher than that of the lung cancer (33 602±19 609)(P<0.001). The shape of spectrum between the normal bronchial tissue and the lung cancer was different at the right site of the peak. There was a flat spectrum in the normal bronchial tissue at the wavelength of 580 nm to 660 nm (I 580 nm/I 600 nm=1.081±0.090), while the cancer tissue spectrum showed an smoother descending profile (I 580 nm/I 600 nm=1.260±0.157). The criterion for detection of lung cancer was defined as a fluorescence intensity ratio of I 580 nm/I 600 nm larger or equal to 1.221. Using the criterion of I 580 nm/I 600 nm, the sensitivity, specificity, positive predictive value, negative predictive value and the overall accuracy of LIF spectroscopy for detection of lung cancer was 87.5%, 80.9%, 77.8%, 89.5% and 83.8%, respectively. Conclusion The LIF spectroscopy in the clinical diagnosis of lung cancer is feasible.