多层螺旋CT灌注成像联合血清CYFRA21-1、CEA、NSE对周围型非小细胞肺癌的诊断价值

Diagnostic value of multi-slice spiral CT perfusion imaging combined with serum CYFRA21-1,CEA and NSE for peripheral non-small cell lung cancer

目的探讨多层螺旋CT(MSCT)灌注成像联合血清细胞角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)对周围型非小细胞肺癌(NSCLC)的临床诊断价值。方法选取2017年8月-2019年8月新乡市中心医院收治的109例疑似周围型NSCLC患者,根据诊断结果将其分为周围型NSCLC组65例、肺良性结节组44例,另选取同期在我院体检的健康受试者56例作为对照组。比较3组的MSCT灌注成像参数及血清CYFRA21-1、CEA、NSE水平,采用受试者工作特征(ROC)曲线分析MSCT灌注成像联合血清CYFRA21-1、CEA、NSE对周围型NSCLC的诊断价值。结果周围型NSCLC组的血容量(BV)大于肺良性结节组、对照组[(10.76±1.26)ml/100 mg vs.(4.01±0.59)ml/100 mg、(2.32±0.42)ml/100 mg],表面通透性(PS)高于肺良性结节组、对照组[(42.56±5.60)ml/(100 mg·min)vs.(16.13±1.88)ml/(100 mg·min)、(8.49±0.91)ml/(100 mg·min)],对比剂平均通过时间(MTT)大于肺良性结节组、对照组[(20.14±3.67)s vs.(12.85±1.49)s、(7.21±0.95)s],肺良性结节组的上述指标均大于对照组(P<0.05);周围型NSCLC组的血清CYFRA21-1水平高于肺良性结节组、对照组[(8.94±1.67)ng/ml vs.(4.73±0.51)ng/ml、(1.93±0.26)ng/ml],CEA水平高于肺良性结节组、对照组[(27.91±3.25)ng/ml vs.(7.88±0.92)ng/ml、(2.06±0.47)ng/ml],NSE水平高于肺良性结节组、对照组[(19.53±2.16)ng/ml vs.(15.02±1.74)ng/ml、(11.96±1.22)ng/ml],肺良性结节组的上述指标均高于对照组(P<0.05)。ROC结果显示,MSCT灌注成像,血清CYFRA21-1、CEA、NSE单独及联合诊断周围型NSCLC的AUC分别为0.802、0.794、0.698、0.712、0.841,四者联合检测的诊断价值高于单独检测。结论MSCT灌注成像联合血清CYFRA21-1、CEA、NSE对周围型NSCLC有较高的诊断价值。

Objective To investigate the diagnostic value of multi-slice spiral CT (MSCT) perfusion imaging combined with serum cytokeratin 19 fragment antigen 21-1 (CYFRA21-1),carcinoembryonic antigen (CEA) and neuron specific enolase (NSE) for peripheral non-small cell lung cancer (NSCLC).Methods Based on diagnosis,109 patients with suspected peripheral NSCLC admitted from Aug.2017 to Aug.2019 in the Xinxiang Central Hospital were divided into peripheral NSCLC group (n=65) and benign pulmonary nodule group (n=44).Another 56 healthy subjects undergone physical examination during the same period were selected as control group.The parameters of MSCT perfusion imaging and serum levels of CYFRA21-1,CEA and NSE in the 3 groups were compared.The receiver operating curve (ROC) was used to analyze the diagnostic value of MSCT perfusion imaging combined with serous levels of CYFRA21-1,CEA and NSE for peripheral NSCLC.Results The blood volume (BV) was larger in peripheral NSCLC group than those in benign pulmonary nodule group and control group [(10.76±1.26) ml/100 mg vs.(4.01±0.59) ml/100 mg and (2.32±0.42) ml/100 mg];the same was for surface permeability (PS) [(42.56±5.60) ml/(100 mg·min) vs.(16.13±1.88) ml/(100 mg·min) and (8.49±0.91) ml/(100 mg·min)];and for the mean transit time (MTT) of contrast medium [(20.14±3.67) s vs.(12.85±1.49) s and (7.21±0.95) s].All the BV,PS and contrast medium MTT were higher (larger) in benign pulmonary nodule group than those in control group (P<0.05).The serum level of CYFRA21-1 was higher in peripheral NSCLC group than that in benign pulmonary nodule group and control group [(8.94±1.67) ng/ml vs.(4.73±0.51) ng/ml and (1.93±0.26) ng/ml];the same was for the CEA level [(27.91±3.25) ng/ml vs.(7.88±0.92) ng/ml and (2.06±0.47) ng/ml];and for the NSE level [(19.53±2.16) ng/ml vs.(15.02±1.74) ng/ml and (11.96±1.22) ng/ml].All the serum levels of CYFRA21-1,CEA and NSE were higher in benign pulmonary nodule group than those in control group (P<0.05).The ROC results showed that the diagnosis of peripheral NSCLC alone and combined with MSCT perfusion imaging,serum levels of CYFRA21-1,CEA and NSE were 0.802,0.794,0.698,0.712 and 0.841,respectively.The diagnostic value of combined detection of the four methods was higher than that of individual detection.Conclusion MSCT perfusion imaging combined with serum levels of CYFRA21-1,CEA and NSE have high diagnostic value for peripheral NSCLC.