ICTP诊断肺癌骨转移的临床观察

A Clinical Evaluation of ICTP as an Index for the Diagnosis of Bone Metastasis in Patients with Lung Cancer

目的 :评价I型胶原羧基端吡啶并啉交联肽 (Carboxyterminalcross_linkedtelopeptideoftyplcollagenICTP)诊断肺癌早期骨转移的效能。方法 :用放射免疫的方法测定 86例肺癌患者和30例健康者血清中ICTP ,并随访半年至二年。根据诊断标准评价ICTP和核素全身骨显像诊断肺癌早期骨转移的诊断效能。结果 :骨转移者血清中ICTP的浓度 (7 2 4 μg/L)明显高于无骨转移 (4 19μg/L ,P <0 .0 5)和健康者 (3 83μg/L ,P <0 0 5)。ICTP、核素骨显像诊断肺癌骨转移的准确性 (ROC曲线下的面积 )分别是 0 82、0 74 (P <0 0 5)。Logistic回归分析 ,ICTP与骨转移的相关系数 (r=0 38,P <0 0 5)比核素骨显像与骨转移的相关系数 (r =0 2 5,P >0 0 5)高。ICTP、核素骨显像诊断骨转移的灵敏度和特异度分别为 86 %、80 % ;81%、72 %。随访发现ICTP的浓度随骨转移的范围增多而增高 ;结论 :ICTP是诊断肺癌早期骨转移的良好标志物 ,有助于随访和监测肺癌骨转移 ,能早于骨显像发现骨转移。若ICTP低于正常值则骨转移的可能性相当低。相反 ,高于正常值有骨转移的可能。

Objective:To evaluate the efficacy of carboxyterminal cross_linked telopeptide of type I collogen (ICTP) in the diagnosis of early bone metastasis from lung cancer.Methods:The serum ICTP in 86 cases with lung cancer and 30 healthy people was measured using the method of radioimmunoassay,and was followed up for half a year to two years. According to the commonly accepted diagnostic standard for early bone metastasis,ICTP and bone stintigrapy were evaluated for their efficacy in diagnosing early bone metastasis in patients with lung cancer. Results:The serum ICTP concentration in patients with bone metastasis (7.24±3.09μg/L) was obviously higher than that in patients without bone metastasis (4.19±2.49μg/L, P <0.005) or that in the healthy control (3.83±1.07μg/L, P <0.005). The accuracy of the diagnosis by ICTP (expressed as the area under ROC curve)was 0.82,higher than that by bone scintigraphy (0.74, P <0.05). By analysis of Logistic regression,the correlation coefficient between ICTP and bone metastasis was 0.38,higher than that between bone scintigraphy and bone metastasis (0.25, P <0.05). The sensitivity and specificity of ICTP and bone scintigraphy in diagnosing bone metastasis were 86%、80%;81%、72%. In follow_up study,it was found that the concentration of TCTP increased with the enlargement of the bone metastasis range. Conclusion: ICTP is a good index for the diagnosis of early bone metastasis from lung cancer,which is helpful for the follow_up and monitoring of the bone metastasis from lung cancer,so that bone metastasis could be found earlier than diagnosed by bone scintigraphy. If ICTP is lower than that of normal value the possibility of bone metastasis will be very little, otherwise, there is possibly bone metastasis.