CT影像特征联合血清肿瘤标志物对老年肺结核合并肺癌的诊断研究

Diagnostic study of CT Imaging Features Combined with Serum Tumor Markers in Elderly Patients with Pulmonary Tuberculosis and Lung Cancer

目的:研究CT影像特征联合血清肿瘤标志物对老年肺结核合并肺癌的诊断价值。方法:以2017年1月—2019年1月天门市中医医院诊治的38例老年肺结核合并肺癌患者为研究组,同期入院确诊为单纯肺结核的30例作为对照组,比较两组肿块、分叶征、毛刺征、空洞及胸腔积液情况及肿瘤标志物水平;分析不同肺结核合并不同肺癌类型患者肿瘤标志物[糖类癌抗原199(carbohydrate careionid antigen 199,CA199)、癌胚抗原(carcinoembryonic antigen,CEA)、糖类癌抗原(carbohydrate cancer antigen,CA125)、神经元特异性烯醇化酶(neuron speeific enolase,NSE)及细胞角蛋白片段(cytokeratin fragment,CYFRA21-1)]水平。结果:研究组肿块、空洞、毛刺征、分叶征、胸腔积液比例均高于对照组,差异均有统计学意义(P<0.05)。研究组CA199、NSE、CA125、CEA、CYFBA21-1均高于对照组,差异均有统计学意义(P<0.05)。小细胞肺癌患者NSE水平高于鳞癌患者和腺癌患者,差异均有统计学意义(P<0.05);不同癌症类型患者CA199、CA125、CEA、CYFBA21-1比较,差异均无统计学意义(P>0.05)。联合检测的敏感度为98.2%、特异度为98.3%,优于单个指标,AUC=0.983。结论:CT量表指标联合血清肿瘤标志物对肺结核合并肺癌诊断具有较高的特异度、敏感度。

Objective:To study the diagnostic value of CT imaging features combined with serum tumor markers in elderly patients with pulmonary tuberculosis and lung cancer.Method:A total of 38 elderly patients with pulmonary tuberculosis and lung cancer who diagnosed and treated in Tianmen Hospital of Traditional Chinese Medicine from January 2017 to January 2019 were taken as the study group,and 30 patients with simple pulmonary tuberculosis who diagnosed in hospital at the same time were taken as the control group.The tumor mass,lobulated sign,hair prick sign,cavity and pleural effusion and the level of tumor markers in two groups were compared,To analyze the levels of tumor markers[carbohydrate careionid antigen 199,(CA199),carcinoembryonic antigen(CEA),carbohydrate cancer antigen(CA125),neuron speeific enolase(NSE)and eytokeratin fragment(CYFRA21-1)]in patients with different types of pulmonary tuberculosis and lung cancer were analyzed.Result:The proportion of mass,cavity,hair prick sign,lobulation sign and pleural effusion in the study group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The levels of CA199,NSE,CA125,CEA,CYFBA21-1 in the study group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The NSE level in patients with small cell lung cancer was significantly higher than those in patients with squamous cell carcinoma and adenocarcinoma(P<0.05);but there were no significant differences in the levels of CA199,CA125,CEA,CYFBA21-1 tumor markers among different cancer types(P>0.05).The sensitivity and specificity of the combined test were 98.2%and 98.3%respectively,which were better than those of single index,AUC=0.983.Conclusion:CT scale indexes combined with tumor markers have high specificity and sensitivity in the diagnosis of pulmonary tuberculosis and lung cancer.