良恶性肺肿瘤CT显像与相关生物标志物水平的临床研究

Clinical research of CT imaging of benign and malignant lung tumor and relative biomarkers levels

目的探讨良恶性肺肿瘤CT显像与血清铁蛋白(serum ferritin,SF),CA19-9和D-二聚体(D-dimer,D-D)水平与TNM分期的临床研究。方法采用64排螺旋CT对225例肺癌患者和53例对照组患者显像。化学发光免疫分析和免疫比浊法测定了血清SF、CA19-9和D-D水平并进行了对比性分析。结果回顾性分析了经手术后病理证实的225例肺癌患者和53例对照组患者的CT图像。周围型肺癌为小支气管上皮癌变,主要在肺实质生长与肺组织分解清楚,无包膜;中央型肺癌好发于支气管壁上,以鳞状细胞癌、小细胞肺癌、大细胞癌和类癌多见;弥漫型肺癌可占据肺段大部分并可累及一个以上的肺叶,肺癌周边部与肺组织呈移行状态,无明显分界。53例对照组以肺内结核、肺炎和支气管扩张为主。225例肺癌患者血清生物标志物(SF、CA19-9和D-D)水平较53例对照组患者明显升高,而且随肺癌的严重程度而增高,差异均有统计学意义(P<0.05)。结论 CT显像具有手术定位和肺肿瘤良恶性鉴别诊断的临床价值,血清生物标志物具有肺癌早期诊断和治疗随访的临床意义。

Objective To investigate the clinical significance of CT imaging of benign and malignant lung tumors and serum ferritin（ SF）,CA19-9 and D-dimer（ D-D） levels as well as TNM staging. Methods 225 cases of lung cancer and 53 cases of controls were visualized with 64-slice spiral CT. Chemiluminescence immunoassay and immunoturbidimetric method were used to detect the levels of serum SF,CA19-9 and D-D,and comparative study was performed. Results A retrospective analysis was conducted on the CT images of 225 cases of pathologically confirmed lung cancer and 53 cases of controls. Peripheral lung cancer was small bronchial epithelial carcinogenesis,mainly grow in the lung parenchyma,with clear lung tissue decomposition and no capsule; central lung cancer was mainly detected on the bronchial wall,with squamous cell carcinoma,small cell lung cancer,large cell carcinoma and carcinoid the majority; diffuse lung cancer could occupy the majority of the lung segment and affect more than one lobe,peripheral tissue of lung cancer and the normal lung tissue were in transitional state,with no obvious boundary. Tuberculosis,pneumonia and bronchiectasis-based were dominant in the 53 cases of controls. The serum biomarkers（ SF,CA19-9 and D-D） levels in the 225 cases of lung cancer were significantly higher than 53 cases of controls,and increased with the severity of lung cancer,with the differences statistically significant（ P 〈0. 05）. Conclusion CT imaging is of clinical value in surgical localization and differential diagnosis of benign and malignant lung cancer,and serum biomarkers is of clinical significance in the early diagnosis of lung cancer and follow-up.