多层螺旋CT联合肿瘤标志物检测在尘肺合并肺癌诊断中的临床价值

The Clinical Value of Multi-slice Spiral CT Combined with Detection of Tumor Markers in the Diagnosis of Pneumoconiosis Complicated with Lung Cancer

目的在尘肺合并肺癌患者的诊断过程中应用多层螺旋CT与肿瘤标志物CEA、CA125、NSE、CYFRA21-1联合检测方法的临床效果进行分析。方法方便选取2014年1月—2019年1月该院收治的68例确诊尘肺合并肺癌患者,对患者进行多层螺旋CT联合肿瘤标志物检测,并在1周内检测血清中肿瘤标志物,分析两种检查之间的差异和相互关系。结果①中央型尘肺合并肺癌36例,周围型尘肺合并肺癌32例。其中腺癌32例,鳞癌26例,小细胞癌10例。②尘肺合并肺癌组患者的CEA指标为(23.49±16.37)ng/mL,CA125指标为(28.40±13.33)U/mL,NSE指标为(25.63±16.28)ng/mL,CYFRA21-1指标为(17.23±7.91)ng/mL,良性肺病组患者的各项指标分别为(2.43±1.32)ng/mL、(22.35±6.78)U/mL、(11.96±4.09)ng/mL、(2.26±1.36)ng/mL,尘肺合并肺癌组明显较高,差异有统计学意义(t=11.031、3.450、6.989、16.029,P<0.05);③关于血清CEA,CA125指标,腺癌组患者分别为(81.25±15.86)ng/mL、(165.34±18.32)U/mL,鳞癌组为(5.19±2.35)ng/mL、(113.63±13.25)U/mL,小细胞癌组为(6.56±1.49)ng/mL、(107.03±12.74)U/mL,腺癌明显高于鳞癌和小细胞癌,差异有统计学意义(P<0.05);关于CYFRA21-1指标,腺癌(21.58±4.85)ng/mL、鳞癌(23.82±4.11)ng/mL显著高于小细胞癌(5.91±1.35)ng/mL,差异有统计学意义(P<0.05);关于NSE指标,腺癌(20.31±4.34)ng/mL、鳞癌(18.69±4.05)ng/mL与小细胞癌(58.61±13.46)ng/mL相比明显较低,差异有统计学意义(P<0.05);④血清肿瘤标志物CEA诊断尘肺合并肺癌的灵敏度、特异性、准确性为别为55.9%、52.7%、54.2%;CA125诊断尘肺合并肺癌的灵敏度、特异性、准确性为别为54.4%、64.9%、59.9%;NSE诊断尘肺合并肺癌的灵敏度、特异性、准确性为别为77.9%、67.6%、72.5%;CYFRA21-1诊断尘肺合并肺癌的灵敏度、特异性、准确性为别为77.9%、66.2%、71.8%;CEA、CA125、NSE、CYFRA21-1四种肿瘤标志物联合检测的灵敏度、特异性、准确性分别为80.9%、79.7%、80.3%,均高于四项肿瘤标志物单独检测,差异有统计学意义(χ^(2)=3.964,P=0.031)。多层螺旋CT与CEA、CA125、NSE、CYFRA21-1四项肿瘤标志物联合检测诊断尘肺合并肺癌的灵敏度、特异性、准确性分别为91.2%、91.9%、91.5%,显著高于单一项目的单独检测,差异有统计学意义(P<0.05)。结论在尘肺合并肺癌患者诊断过程中,可以采用血清肿瘤标志物与多层螺旋CT扫描联合的方法,能够在一定程度上有效提升临床诊断的准确性,使用价值显著,值得推荐。

Objective To analyze the clinical effects of multi-slice spiral CT and tumor markers CEA,CA125,NSE,CYFRA21-1 in the diagnosis of patients with pneumoconiosis and lung cancer.Methods A total of 68 patients with confirmed pneumoconiosis and lung cancer admitted to the hospital from January 2014 to January 2019 were convenient selected.The patients were subjected to multi-slice spiral CT combined with tumor marker detection,and the serum tumor markers were detected within one week,and the differences and interrelationships of the two types were analyzed.Results 1.36 cases of central pneumoconiosis with lung cancer and 32 cases of peripheral pneumoconiosis with lung cancer.There were 32 cases of adenocarcinoma,26 cases of squamous cell carcinoma,and 10 cases of small cell carcinoma.2.In the pneumoconiosis and lung cancer group,the CEA index was(23.49±16.37)ng/mL,the CA125 index was(28.40±13.33)U/mL,the NSE index was(25.63±16.28)ng/mL,and the CYFRA21-1 index was(17.23±7.91)ng/mL,the indicators of patients in the benign lung disease group were(2.43±1.32)ng/mL,(22.35±6.78)U/mL,(11.96±4.09)ng/mL,(2.26±1.36)ng/mL,the pneumoconiosis with lung cancer group was significantly higher,and the difference was statistically significant(t=11.031,3.450,6.989,16.029,P<0.05);3.Regarding serum CEA and CA125 indicators,the adenocarcinoma group was respectively(81.25±15.86)ng/mL,(165.34±18.32)U/mL,(5.19±2.35)ng/mL,(113.63±13.25)U/mL in the squamous cell carcinoma group,and(6.56±1.49)ng/mL,(107.03±12.74)U/mL,adenocarcinoma was significantly higher than squamous cell carcinoma and small cell carcinoma,the difference was statistically significant(P<0.05);about CYFRA21-1 index,adenocarcinoma(21.58±4.85)ng/mL,squamous cell carcinoma(23.82±4.11)ng/mL were significantly higher than small cell carcinoma(5.91±1.35)ng/mL,the difference was statistically significant(P<0.05);regarding the NSE index,adenocarcinoma(20.31±4.34)ng/mL and squamous cell carcinoma(18.3±4.05)ng/mL were significantly lower than small cell carcinoma(58.61±13.46)ng/mL,and the difference was statistically significant(P<0.05);4.Serum tumor markers the sensitivity,specificity,and accuracy of CEA in the diagnosis of pneumoconiosis with lung cancer were 55.9%,52.7%and 54.2%;the sensitivity,specificity,and accuracy of CA125 in the diagnosis of pneumoconiosis with lung cancer were 54.4%,64.9%and 59.9%.The sensitivity,specificity,and accuracy of NSE in the diagnosis of pneumoconiosis with lung cancer were 77.9%,67.6%,72.5%;the sensitivity,specificity,and accuracy of CYFRA21-1 in the diagnosis of pneumoconiosis with lung cancer were 77.9%,66.2%,71.8%;the sensitivity,specificity,and accuracy of the combined detection of CEA,CA125,NSE,and CYFRA21-1 were 80.9%,79.7%and 80.3%,respectively,which were higher than those of the four tumor markers alone.The difference was statistically significant(χ^(2)=3.964,P=0.031).The sensitivity,specificity,and accuracy of combined detection of multi-slice spiral CT with CEA,CA125,NSE,and CYFRA21-1 four tumor markers in the diagnosis of pneumoconiosis with lung cancer were 91.2%,91.9%and 91.5%,which were significantly higher than that of a single item When tested individually,the difference was statistically significant(P<0.05).Conclusion In the diagnosis process of patients with pneumoconiosis and lung cancer,the combined method of serum tumor markers and multi-slice spiral CT scanning can be used,which can effectively improve the accuracy of clinical diagnosis to a certain extent.The use value is significant and it is worth recommending.