磨玻璃结节样肺腺癌MSCT征象与Ki67、PKM2、SPINK1蛋白表达的相关性研究

The correlation between MSCT signs and the expression of Ki67,PKM2,SPINK1 protein in ground glass nodular lung adenocarcinoma

目的:探讨磨玻璃结节(GGO)样肺腺癌的MSCT征象与Ki67、蛋白酪氨酸磷酸酶PKM2蛋白及丝氨酸蛋白酶抑制剂Kazal 1型(SPINK1)表达间的相关性。方法:选择手术治疗的80例肺腺癌患者作为研究对象,对患者进行胸部MSCT扫描,测量并记录结节大小、实性部分最大径、类型、个数、形态、边缘及内部结构特征;采用免疫组织化学检测组织标本中的Ki67、PKM2、SPINK1蛋白表达水平。结果:单因素分析结果显示,Ki67的表达水平与MSCT征象中的结节单发或多发(χ^2=5.805,P=0.016)、有无分叶征(χ^2=5.725,P=0.017)相关;PKM2的表达水平与MSCT征象中的形态(χ^2=4.357,P=0.037)、有无分叶征(χ^2=11.116,P=0.001)、胸膜凹陷征(χ^2=5.440,P=0.020)及实性部分最大径(t=3.119,P=0.003)相关;SPINK1的表达水平与MSCT征象中的结节类型(χ^2=4.692,P=0.030)、有无分叶征(χ^2=9.483,P=0.002)和胸膜凹陷征(χ^2=4.357,P=0.037)相关。二元Logistic分析结果显示,MSCT征象中出现分叶征是肺腺癌Ki67高表达的独立危险因素(OR=3.842,95%CI:1.501~9.839,P=0.005),出现分叶征(OR=5.861,95%CI:1.970~17.439,P=0.001)和胸膜凹陷征(OR=3.874,95%CI:1.348~11.138,P=0.012)是PKM2高表达的独立危险因素,出现分叶征(OR=5.472,95%CI:1.978~15.138,P=0.001)和胸膜凹陷征(OR=3.536,95%CI:1.284~9.735,P=0.015)是肺腺癌PKM2高表达的独立危险因素。结论:MSCT征象中的分叶征和胸膜凹陷征有助于预测磨玻璃结节样肺腺癌Ki67、PKM2、SPINK1的表达状态,从而为疾病的预后评估和临床诊治提供参考依据。

Objective:To explore the correlation between the multi-slice SPIRAL CT(MSCT)signs of ground-glass nodules of lung adenocarcinoma and the expression of Ki67,protein tyrosine phosphatase PKM2 and serine protease inhibitor Kazal 1(SPINK1).Methods:80 patients with lung adenocarcinoma who underwent surgical treatment were selected as study subjects.Chest MSCT was performed on the patients,and the size of the nodules,maximum diameter of the solid part,type,number,shape,edge and internal structure characteristics were measured and recorded.Immunohistochemistry was used to detect the expression levels of Ki67,PKM2 and SPINK1 proteins in tissue samples.Results:Univariate analysis showed that the expression level of Ki67 was associated with single or multiple nodules and presence or absence of foliation on MSCT(P<0.05).The expression level of PKM2 was related to the morphology of MSCT signs,presence or absence of foliation sign,pleural depression sign and the maximum diameter of the solid part(P<0.05).SPINK1 expression level was correlated with tuberous type,presence or absence of foliation sign and pleural pitting sign on MSCT(P<0.05).Binary Logistic analysis showed that the presence of lobed MSCT was an independent risk factor for high expression of Ki67 in lung adenocarcinoma(P<0.05).The presence of foliation sign and pleural pitting sign were independent risk factors for the high expression of PKM2(P<0.05).Lobules and mixed GGN were independent risk factors for high expression of PKM2 in lung adenocarcinoma(P<0.05).Conclusion:The foliation sign and pleural pitting sign in MSCT signs are helpful to predict the expression status of Ki67,PKM2 and SPINK1 in ground glass nodular lung adenocarcinoma,so as to provide reference for the prognosis assessment and clinical diagnosis and treatment of the disease.