低剂量螺旋CT结合血浆DAPK、MGMT甲基化检测在肺癌早期筛查诊断中的应用价值

Application value of low-dose spiral CT combined with plasma DAPK and MGMT methylation detection in early screening and diagnosis of lung cancer

目的探讨低剂量螺旋CT结合血浆死亡相关蛋白激酶(DAPK)、O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)甲基化检测在肺癌早期筛查诊断中的应用价值。方法选取2022年6月至2022年12月宿迁市第一人民医院收治的92例疑似肺癌患者,以病理诊断为金标准,均行低剂量螺旋CT检查,并采用甲基化特异性PCR法检测患者血浆中DAPK、MGMT基因启动子区甲基化状态,分析低剂量螺旋CT结合血浆DAPK、MGMT甲基化检测在肺癌早期筛查诊断中的价值。结果92例疑似肺癌患者,病理检查结果显示,共有54例阳性患者,包括35例鳞癌,17例腺癌和2例小细胞癌,38例阴性患者中,包括19例肺结核,12例肺炎,6例肺脓肿和1例间质性肺病;低剂量螺旋CT检查诊断出肺癌54例,其中,47例阳性与病理诊断一致,31例阴性与病理诊断一致,经Kappa一致性检验,Kappa=0.686,P<0.05,2种诊断方法的一致性一般;血浆DAPK、MGMT甲基化检测诊断出肺癌55例,其中,44例阳性与病理诊断一致,27例阴性与病理诊断一致,经Kappa一致性检验,Kappa=0.474,P<0.05,2种诊断方法的一致性一般;低剂量螺旋CT结合血浆DAPK、MGMT甲基化检测诊断出肺癌53例,其中,50例阳性与病理诊断一致,35例阴性与病理诊断一致,经Kappa一致性检验,Kappa=0.844,P<0.05,2种诊断方法的一致性较好;低剂量螺旋CT结合血浆DAPK、MGMT甲基化检测以及联合诊断的灵敏度分别为87.04%,81.48%和92.59%,特异度分别为81.58%,71.05%和92.11%,约登指数分别为0.686,0.525和0.847,联合诊断的价值更高。结论低剂量螺旋CT结合血浆DAPK、MGMT甲基化检测诊断用于肺癌诊断与病理诊断一致性较高,用于肺癌患者早期筛查诊断具有重要参考价值。

Objective To explore the application value of low-dose spiral CT combined with plasma death-associated protein kinase(DAPK)and O6-methylguanine-DNA methyltransferase(MGMT)methylation detection in early screening and diagnosis of lung cancer.Methods 92 patients with suspected lung cancer admitted to the hospital from June 2022 to December 2022 were selected.With pathological diagnosis as the gold standard,low-dose spiral CT was performed,and methylation status of DAPK and MGMT gene promoter region in the plasma of patients was detected by methylation-specific PCR.The value of low-dose spiral CT combined with plasma DAPK and MGMT methylation detection in early screening and diagnosis of lung cancer was analyzed.Results Among 92 suspected lung cancer patients,pathological examination showed that there were 54 positive patients,including 35 cases of squamous cell carcinoma,17 cases of adenocarcinoma and 2 cases of small cell carcinoma,and 38 negative patients,including 19 cases of tuberculosis,12 cases of pneumonia,6 cases of lung abscess and 1 case of interstitial lung disease.54 cases of lung cancer were diagnosed by low-dose spiral CT,of which 47 cases were positive and consistent with pathological diagnosis,and 31 cases were negative and consistent with pathological diagnosis.The Kappa consistency test showed that Kappa=0.686,P<0.05,and the two diagnostic methods were generally consistent.55 cases of lung cancer were diagnosed by plasma DAPK and MGMT methylation detection,of which 44 cases were positive and consistent with pathological diagnosis,and 27 cases were negative and consistent with pathological diagnosis.The Kappa consistency test showed that Kappa=0.474,P<0.05,and the two diagnostic methods were generally consistent.53 cases of lung cancer were diagnosed by low-dose spiral CT combined with plasma DAPK and MGMT methylation detection,of which 50 cases were positive and 35 cases were negative and consistent with pathological diagnosis.The Kappa consistency test showed that Kappa=0.844,P<0.05,and the consistency of the two diagnostic methods was good.The sensitivity of low-dose spiral CT combined with plasma DAPK,MGMT methylation detection,and combined diagnosis were 87.04%,81.48%,and 92.59%respectively;the specificity was 81.58%,71.05%,and 92.11%respectively;and the Yoden index was 0.686,0.525,and 0.847 respectively.The value of combined diagnosis was higher.Conclusions Low-dose spiral CT combined with plasma DAPK and MGMT methylation detection for diagnosis of lung cancer has high consistency with pathological diagnosis,and it has important reference value for early screening and diagnosis of lung cancer patients.