清远地区肺腺癌和鳞癌患者胸部CT征象及免疫组化特征比较研究

Correlations between Chest CT Characteristics and Immunohistochemistry in NSCLC in Qingyuan District

目的比较清远地区肺腺癌和鳞癌患者胸部CT征象及免疫组化特征。方法回顾性研究2013年1月—2016年8月清远市人民医院60例非小细胞肺癌(NSCLC)患者,其中腺癌组30例,鳞癌组30例,比较两组血常规、血生化、肿瘤标志物、CT征象及免疫组化指标。结果两组患者咯血症状发生率比较,差异有统计学意义(P<0.05);性别、年龄、吸烟指数、病程比较,差异无统计学意义(P<0.05);两组血常规指标白细胞计数(WBC)、淋巴细胞计数(LYMPH)、血小板计数(PLT)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)比较,差异无统计学意义(P>0.05),但血红蛋白(Hb)比较,差异有统计学意义(P<0.05);血生化指标C反应蛋白(CRP)、红细胞沉降率(ESR)比较,差异有统计学意义(P<0.05),碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、类风湿因子(RF)比较,差异无统学意义(P>0.05);肿瘤标志物癌胚抗原(CEA)、细胞角蛋白19片段抗原(cyfra21-1)比较,差异有统计学意义(P<0.05),神经元烯醇化酶(NSE)比较,差异无统计学意义(P>0.05)。腺癌组和鳞癌组病灶部位、病灶形状、边缘形态比较,差异无统计学意义(P>0.05),两组肿瘤体积、内外部结构比较,差异有统计学意义(P<0.05);腺癌组和鳞癌组中央型特征比较,差异无统计学意义(P>0.05)。两组常见的CT征象如病灶形状、周围型肺癌特征、中央型肺癌特征均与免疫组化常见指标如CK、CK7、Ki-67、P63、TTF-1无相关性(P>0.05)。结论清远地区肺鳞癌患者容易出现咯血、贫血,CT征象上一般肿瘤较大,空洞多见,而腺癌主要表现为空泡征和胸膜凹陷征,Hb、CRP、ESR、CEA、cyfra21-1具有一定鉴别价值,但仍需支气管镜和肺活检确诊。

Objective To study the correlations between chest CT characteristics and immunohistochemistry in NSCLC in Qing Yuan district. Methods 64 cases NSCLC patients in the Sixth Affiliated Hospital of Guangdong Medical University from January 2013 to August 2016,which were divided into adenocarcinoma 30 cases and squamous cell carcinoma 30 cases. And then,we compared their blood counts, blood biochemical examinations, tumor makers, chest CT Characteristics and Immunohistochemistry. Results The two groups were statistically significant in hemoptysis symptom（ P 〈 0. 05）. However,there was no statistically significant in sex, years, smoking index, disease course. There was no statistically significant in WBC,LYMPH,PLT,NLR and PLR（ P 〉 0. 05）. The hemoglobin of adenocarcinoma was much higher than squamous cell carcinoma（ P 〈 0. 05）. CRP and ESR of adenocarcinoma was significant lower than squamous cell carcinoma（ P 〈 0. 05）,there was no statistically significant in ALP,LDH,RF（ P 〉 0. 05）. Level of plasma CEA was statistical higher than squamous cell carcinoma,cyfra21-1 was lower than squamous cell carcinoma（ P 〈 0. 05）. There was no statistically significant in NSE（ P 〉 0. 05）. There was no statistically significant in tumors sites,shapes,edges and central type lung cancer（ P 〉 0. 05）.The two groups were statistically significant in tumor sizes and structures of chest CT characteristics（ P 〈 0. 05）. The main images of adenocarcinoma were vacuole sign and pleural indentation sign, and squamous cell carcinoma was cavity sign. CT characteristics were no statistically significant with immunohistochemistry（ CK,CK7,Ki-67,P63,TTF-1）. Conclusion Lung squamous cell carcinoma patients who combine with cavity in CT characteristics,are prone to hemoptysis and anemia,and tumor size is greatly large. However,vacuole sign and pleural indentation sign is common in adenocarcinoma. Inaddition,Hb,CRP, ESR, CEA and cyfra21-1 contribute to diagnosing lung tumors, but bronchoscopy and lung biopsy are still necessary to confirm the diagnosis.