双能量CT参数联合血清Ⅰ型前胶原N端前肽和Ⅰ型胶原羧基端肽β特殊序列鉴别诊断脊柱肺癌骨转移瘤和骨髓瘤的价值

Value of dual energy CT parameters combined with serum procollagenⅠN-terminal propeptide and beta C-terminal cross-linked telopeptide of typeⅠcollagen in differential diagnosis of spinal bone metastasis from lung cancer and myeloma

目的分析双能量CT参数联合血清Ⅰ型前胶原N端前肽(PⅠNP)和Ⅰ型胶原羧基端肽β特殊序列(β-CTX)鉴别诊断脊柱肺癌骨转移瘤和骨髓瘤的价值。方法回顾性分析晋城市人民医院2019年10月至2021年3月54例脊柱肺癌骨转移瘤和50例骨髓瘤患者的临床资料。患者入院当天行双能量CT检查,记录40~80 keV(能量间隔为10 keV)能量水平下的CT值;治疗前采用化学免疫发光法检测血清PⅠNP和β-CTX水平。以病理学检查结果为"金标准",比较两组患者双能量CT 40~80 keV能谱曲线CT值及血清PⅠNP和β-CTX水平。采用受试者工作特征(ROC)曲线分析双能量CT 40~80 keV能谱曲线CT值、PⅠNP和β-CTX单独及联合对疾病的鉴别诊断价值。结果脊柱肺癌骨转移瘤患者双能量CT 40~80 keV能谱曲线CT值和血清PⅠNP、β-CTx均明显高于骨髓瘤患者[79.86(61.20,116.32)HU比58.29(46.92,64.03)HU、64.48(50.27,90.08)HU比45.78(38.59,56.75)HU、57.35(43.31,78.04)HU比43.62(36.91,54.06)HU、52.05(42.98,75.79)HU比41.26(32.84,51.76)HU、45.52(38.55,63.59)HU比36.68(28.72,49.83)HU、66.35(31.15,81.97)μg/L比31.38(27.76,34.50)μg/L和0.61(0.48,0.67)μg/L比0.49(0.47,0.52)μg/L],差异有统计学意义(P<0.05或P<0.01)。ROC曲线分析结果显示,双能量CT 40~80 keV能谱曲线CT值联合对脊柱肺癌骨转移瘤与骨髓瘤鉴别诊断的灵敏度高于单个能谱曲线CT值(83.33%比59.26%、61.11%、62.96%、64.81%和66.67%),曲线下面积(AUC)也高于单个能谱曲线CT值(0.882比0.798、0.811、0.817、0.801和0.773),差异有统计学意义(P<0.01或<0.05);血清PⅠNP联合β-CTX对脊柱肺癌骨转移瘤与骨髓瘤的鉴别诊断灵敏度高于单个血清指标(81.48%比57.41%和62.96%),AUC也高于单个血清指标(0.829比0.753和0.729),差异有统计学意义(P<0.01或<0.05);全部指标联合对脊柱肺癌骨转移瘤与骨髓瘤的鉴别诊断灵敏度高于单纯双能量CT 40~80 keV能谱曲线CT值联合和PⅠNP联合β-CTX(98.15%比83.33%和81.48%),AUC也高于单纯双能量CT 40~80 keV能谱曲线CT值联合和PⅠNP联合β-CTX(0.976比0.882和0.829),差异有统计学意义(P<0.01);各指标单独和联合的特异度比较差异无统计学意义(P>0.05)。结论脊柱肺癌骨转移瘤相较于骨髓瘤双能量CT 40~80 keV能谱曲线CT值、血清PⅠNP和β-CTX水平均明显升高,且上述指标联合对二者有理想的鉴别诊断价值。

Objective To analyze the value of dual energy CT parameters combined with serum procollagenⅠN-terminal propeptide(PⅠNP)and beta C-terminal cross-linked telopeptide of typeⅠcollagen(β-CTX)in differential diagnosis of spinal bone metastasis from lung cancer and myeloma.Methods The clinical data of 54 patients with spinal bone metastasis from lung cancer and 50 patients with myeloma in Jincheng People′s Hospital from October 2019 to March 2021 were analyzed retrospectively.All patients were examined by dual energy CT on the day of admission,and the CT values at the energy levels of 40 to 80 keV(energy interval of 10 keV)were recorded.The serum PⅠNP andβ-CTX levels were detected by chemiluminescent assay before treatment.The pathological examination results were taken as gold standard,and the CT values at the energy levels of 40 to 80 keV by dual energy CT and serum PⅠNP andβ-CTX levels were compared between 2 groups.Receiver operating characteristic(ROC)curve was used to analyze the differential diagnosis value of the CT values at the energy levels of 40 to 80 keV,serum PⅠNP andβ-CTX levels alone and combination.Results The CT values at the energy levels of 40 to 80 keV by dual energy CT and serum PⅠNP andβ-CTX levels in patients with spinal bone metastasis from lung cancer were significantly higher than those in patients with myeloma:79.86(61.20,116.32)HU vs.58.29(46.92,64.03)HU,64.48(50.27,90.08)HU vs.45.78(38.59,56.75)HU,57.35(43.31,78.04)HU vs.43.62(36.91,54.06)HU,52.05(42.98,75.79)HU vs.41.26(32.84,51.76)HU,45.52(38.55,63.59)HU vs.36.68(28.72,49.83)HU,66.35(31.15,81.97)μg/L vs.31.38(27.76,34.50)μg/L and 0.61(0.48,0.67)μg/L vs.0.49(0.47,0.52)μg/L,and there were statistical differences(P<0.05 or<0.01).ROC curve analysis result showed that the sensitivity of the combination of the CT values at the energy levels of 40 to 80 keV by dual energy CT was higher than those alone(83.33%vs.59.26%,61.11%,62.96%,64.81%and 66.67),the area under the curve(AUC)was also higher than those alone(0.882 vs.0.798,0.811,0.817,0.801 and 0.773),and there were statistical differences(P<0.01 or<0.05);the sensitivity of the combination of serum PⅠNP andβ-CTX levels was higher than those alone(81.48%vs.57.41%and 62.96%),the AUC was higher than those alone(0.829 vs.0.753 and 0.729),and there were statistical differences(P<0.01 or<0.05);the sensitivity of all indexes combined in the differential diagnosis of spinal bone metastasis from lung cancer and myeloma was higher than those of the combination of the CT values at the energy levels of 40 to 80 keV by dual energy CT,the combination of serum PⅠNP andβ-CTX levels(98.15%vs.83.33%and 81.48%),the same as AUC(0.976 vs.0.882 and 0.829),and there were statistical differences(P<0.01);there were no significant differences in the specificity of each index alone and combination(P>0.05).Conclusions Compared with myeloma,the CT values at the energy levels of 40 to 80 keV by dual energy CT,serum PⅠNP andβ-CTX levels in patients with spinal bone metastasis from lung cancer are increased,and the combination of the above indexes has ideal value in differential diagnosis of the two diseases.