HRCT联合肿瘤标志物在诊断孤立性肺结节中的临床价值

Clinical value of HRCT combined with tumor markers in the diagnosis of solitary pulmonary nodules

目的探讨高分辨率CT(high resolution CT,HRCT)联合血清肿瘤标志物在诊断孤立性肺结节(solitary pulmonary nodule,SPN)中的临床价值。方法 SPN患者224例,恶性SPN患者126例为观察组,良性SPN患者98例为对照组,患者均进行血清肺癌肿瘤标志物4项[血清癌胚抗原(carcino-embryonic antigen,CEA)、鳞状上皮细胞癌抗原(squamous cell carcinoma antigen,SCC)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、细胞角蛋白19片段抗原(cytokeratin 19 fragment,CYFRA21-1)]检测和HRCT检测,以病理检测结果为金标准,以HRCT检测、血清肿瘤标志物任意一项阳性为联合检测阳性,采用ROC曲线判断比较单项检测、联合检测的诊断效能。结果恶性组典型结节并深分叶、胸膜凹陷、短细毛刺、多囊性亮影、支气管血管集束征、棘状突起检出率高于良性组,而相邻胸膜增厚和卫星灶检出率低于良性组,差异均有统计学意义(P<0.05)。HRCT诊断的灵敏度为78.57%,特异度为89.80%,诊断准确率为83.48%。恶性组血清CEA、SCC、NSE、CYFRA21-1浓度显著高于良性组(P<0.05),灵敏度为53.17%,特异度为88.78%,准确度65.18%。联合检测灵敏度为92.06%,显著高于单项检测(P<0.05),特异度为71.42%,显著低于单项检测;联合检测的准确度、阳性预测值、阴性预测值分别为83.04%、80.56%、87.50%,其ROC曲线下面积为0.869,显著高于单项检测0.745、0.707(P<0.05)。结论 HRCT联合肿瘤标志物对于SPN具有较高的诊断效能,能显著提高灵敏度,具有较高的准确度和预测价值,值得临床应用推广。

Objective To study the effect of high resolution CT(HRCT)combined with serum tumor markers in the diagnose of solitary pulmonary nodule(SPN).Methods The 126 cases of malignant SPN patients were selected as observation groups,98 cases of benign SPN patients from the same time were selected as control group.They were detected by HRCT and serum carcino-embryonic antigen(CEA),squamous cell carcinoma antigen(SCC),neuron-specific enolase(NSE),cytokeratin 19 fragment(CYFRA21-1)detection separately,the pathological diagnosis result were set as gold standard.Any of the HRCT detection or tumor markers positive was regarded as joint detection positive,ROC curve was used to evaluate single detection and joint detection diagnostic efficacy.Results The two groups had significant differences in the detection rate of deep lobulation,bronchovascular convergence sign,short fine spiculation,adjacent pleural thickening,pleural indentation,polycystic light shadows,spinous processes and satellite lesions,etc(P<0.05).The sensitivity was 78.57%,the specificity was 89.80%,diagnosis accuracy was 83.48%.The serum CEA,SCC,NSE,CYFRA21-1 of observation group were significantly higher than control group,the sensitivity was 53.17%,the specificity was 88.78%,the accuracy was 65.18%.The sensitivity of joint detection was 92.06%,which was significantly higher than single detection(P<0.05).The specificity was 71.42%,which was significantly lower than single detection(P<0.05).The accuracy,the positive predictive value and the negative predictive value were 83.04%,80.56%,and 87.50%,respectively.The area under ROC curve of joint detection was 0.869,which was significantly higher than single detection 0.745 and 0.707(P<0.05).Conclusion Joint detection of HRCT combined with serum tumor markers can be applied in the detection of SPN,which can significantly improve the sensitivity and diagnosis efficacy,and with a good specificity,with is worth of applying.