孤立性肺结节患者血清CEA、NSE、Cyfra21-1水平与结节直径的关系及联合高分辨率CT的诊断价值研究

The Relationship between Serum CEA, NSE and Cyfra21-1 Levels and Nodule Diameter in Patients with Solitary Pulmonary Nodules and the Diagnostic Value of Combined High-resolution CT

目的:研究孤立性肺结节(SPN)患者血清癌胚抗原(CEA)、神经特异性烯醇化酶(NSE)、细胞角蛋白19片段(Cyfra21-1)水平与结节直径的关系及联合高分辨率CT的诊断价值。方法:将医院从2017年3月2020年3月期间收治的SPN患者154例纳入研究。根据术后病理检查结果分为恶性结节组104例和良性结节组50例。对所有患者均进行高分辨率CT胸部增强扫描,并比较不同结节患者的CT影像征象表现。此外,检测并比较不同结节患者的血清CEA、NSE、Cyfra21-1水平,分析血清CEA、NSE、Cyfra21-1与结节直径的关系。通过受试者工作特征(ROC)曲线分析血清CEA、NSE、Cyfra21-1水平联合高分辨率CT诊断SPN良恶性的效能。结果:肺恶性结节患者胸部CT影像征象表现为毛刺征、深分叶征、胸膜凹陷征、血管集数征、棘突征人数占比均高于良性结节,而钙化征人数占比低于良性结节(均P<0.05)。肺恶性结节患者的血清CEA、NSE、Cyfra21-1水平均明显高于良性结节患者(均P<0.05)。结节最大直径>2.0 cm的SPN患者血清CEA明显高于结节最大直径1.02.0 cm患者,而结节最大直径1.02.0 cm患者血清CEA明显高于结节最大直径<1.0c m患者(均P<0.05);且经Spearman相关性分析显示,血清CEA水平与SPN患者结节直径呈正相关,而血清NSE、Cyfra21-1水平与SPN患者结节直径无相关性。经ROC曲线分析可得,血清CEA、NSE、Cyfra21-1联合高分辨率CT诊断SPN良恶性的曲线下面积、灵敏度、特异度均明显高于上述各项血清学指标和高分辨率CT单独诊断。结论:SPN患者血清CEA水平与结节直径呈正相关,而血清NSE、Cyfra21-1水平与结节直径无明显相关,血清CEA、NSE、Cyfra21-1联合高分辨率CT诊断SPN良恶性的价值较高。

Objective: To study the relationship between serum carcinoembryonic antigen(CEA), neurospecific purified enzyme(NSE) and cytokeratin 19 fragment(Cyfra21-1) levels and nodule diameter in patients with Solitary Pulmonary Nodules(SPN) and the diagnostic value of combined high-resolution CT. Methods: 154 patients with SPN who were admitted to the hospital from March 2017 to March 2020 were included in the study. According to the results of postoperative pathological examination, the patients were divided into malignant nodules group with 104 cases and benign nodules group with 50 cases. All patients underwent high-resolution CT chest enhanced scan, and CT imaging manifestations of different tuberculous patients were compared. In addition, serum CEA, NSE and Cyfra21-1 levels of patients with different nodules were detected and compared, and the relationship between serum CEA, NSE and Cyfra21-1 and the nodule diameter were analyzed. Serum CEA, NSE, CYFRA21-1 levels and the effectiveness of high-resolution CT in the diagnosis of benign and malignant SPN were analyzed by receiver operating characteristic(ROC) curves. Results: The proportion of patients with malignant pulmonary nodules showing burr sign, deep lobulation sign, pleural depression sign, vascular collection sign and spinous process sign on chest CT imaging were higher than those of benign nodules, while the proportion of calcification sign was lower than that of benign nodules(all P<0.05). The serum CEA, NSE and Cyfra21-1 levels of patients with malignant pulmonary nodules were significantly higher than those of patients with benign nodules(all P<0.05). Serum CEA of patients with the nodule maximum diameter>2.0 cm was significantly higher than that of patients with the nodule maximum diameter 1.0~2.0 cm, while serum CEA of patients with the nodule maximum diameter 1.0~2.0 cm was significantly higher than that of patients with the nodule maximum diameter <1.0 cm(all P<0.05). Spearman correlation analysis showed that serum CEA level was positively correlated with nodule diameter in SPN patients,while serum NSE, Cyfra21-1 levels were not correlated with nodule diameter in SPN patients. The ROC curve analysis showed that the area under the curve, sensitivity and specificity of serum CEA, NSE and Cyfra21-1 combined with high-resolution CT in the diagnosis of benign and malignant SPN were significantly higher than those of the above serological indexes and high-resolution CT alone.Conclusion: Serum CEA level of SPN patients is positively correlated with nodule diameter, while Serum NSE and Cyfra21-1 levels are not significantly correlated with nodule diameter. The value of serum CEA, NSE and Cyfra21-1 combined with high-resolution CT in the diagnosis of benign and malignant SPN is relatively high.