低剂量螺旋CT联合肿瘤标志物检测对社区肺癌高危人群的筛查效果

Effect of low-dose spiral CT combined with tumor markers detection on screening of high-risk lung cancer in community

目的探讨低剂量螺旋CT联合肿瘤标志物对社区肺癌高危人群的筛查效果。方法选取2016年1月至2017年1月间在常州市金坛区中医医院体检的1 388例社区肺癌高危人群,采用随机数表法分为试验组(632例)和对照组(756例)。试验组患者采用低剂量螺旋CT(LDCT)联合血清肿瘤标志物筛查,对照组患者采用胸部X线(CXR)筛查,比较两组体检者初筛阳性率和肺癌确诊率。根据筛查结果将试验组分为确诊肺癌组、初筛阳性但排除肺癌组和初筛阴性组,比较三组体检者癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原199(CA199)、人多效蛋白(PTN)、神经元特异性烯醇化酶(NSE)和细胞角质蛋白(Cyfra21-1)等肿瘤标志物水平,对试验组患者性别、年龄、吸烟指数、肺癌家族史、肺病病史和职业有害因素接触史等进行单因素和多因素Logistic回归分析,探讨LDCT初筛阳性的高危因素。结果试验组体检者初筛阳性率和确诊肺癌率,均显著高于对照组,差异均有统计学意义(均P<0.05)。确诊肺癌组的CEA、PTN、NSE和Cyfra21-1水平均显著高于初筛阳性但排除肺癌组和初筛阴性组,差异均有统计学意义(均P<0.05)。三组体检者CA125和CA199水平比较,差异无统计学意义(P>0.05)。多因素Logistic分析显示:年龄>50岁、吸烟指数>400支/年和有职业有害因素接触史等,为初筛阳性的高危因素。结论 LDCT可明显提高初筛阳性率,且与CEA、PTN、NSE和Cyfra21-1等肿瘤标志物检测联合,可进一步提高肺癌确诊率,具有高危险因素的人群应定期行肺癌早期筛查。

Objective To explore the effect of low-dose spiral CT combined with tumor markers detection on screening of high-risk lung cancer in community. Methods From January 2016 to January2017,1 388 people who had physical examination at Jinta Hospital of Traditional Chinese Medicine and had high risk of lung cancer were selected and randomly divided into an experimental group（ 632 patients） and control group（ 756 patients） using a random number table. The experimental group was screened by low dose spiral CT（ LDCT） combined with detection of serum tumor markers while the control group was screened by chest X-ray（ CXR）. The positive expression rates and diagnosis rates of lung cancer were compared between the two groups. The experimental group was divided into definitely diagnosed lung cancer group,initially detected positive but without the possibility of lung cancer group and initially detected negative group. The levels of tumor markers including carcino-embryonic antigen（ CEA）,carbohydrate antigen125（ CA-125）,CA199,human pleiotrophin（ PTN）,neuron-specific enolase（ NSE） and cytokeratin（ Cyfra21-1） were compared among the three groups. The gender,age,smoking index,family history of lung cancer,history of lung disease and occupational exposure to hazards were analyzed by univariate and multivariate logistic regression. The factors influencing initially detected positive results by LDCT were discussed. Results The initially detected positive rate and diagnosis rate were significantly higher in the experimental group than in the control group（ all P〈0. 05）. The levels of CEA,PTN,NSE and Cyfra 21-1 were significantly higher in the diagnosed lung cancer group than in other two groups（ all P〈0. 05）. There was no significant difference in the levels of CA125 and CA199 among the three groups. The multivariate logistic analysis showed that age 50 years old,smoking 400 cigarettes and occupational exposure to risk factors were independent risk factors for initially detected positive rates. Conclusion LDCT can significantly improve initially detected positive rates and can further improve the diagnosis rate of lung cancer when combined with tumor markers of CEA,PTN,NSE and Cyfra21-1. Those at high-risk for lung cancer should ensure lung cancer screening regularly.