血清miRNAs和低剂量CT鉴别肺结节性质效果的研究

Effect of serum miRNAs and low-dose CT in identifying the type of pulmonary nodules

目的研究miR-210、miR-1290和miR-19a在肺结节患者血清中的表达差异以及联合低剂量CT(LDCT)提高鉴别良恶性肺结节诊断效能的可行性。方法随机纳入2022-09-01-2023-03-31就诊于中国人民解放军联勤保障部队第九六〇医院的77例肺结节患者为研究对象,所有患者均进行LDCT检查,并采用实时荧光定量聚合酶链式反应(qRT-PCR)检测患者血清miR-210、miR-1290和miR-19a的相对表达水平以鉴别肺结节性质,手术或穿刺活检的病理诊断结果为金标准。采用χ^(2)检验分析良恶性肺结节与影像学征象的关系,Mann-Whitney U检验进行组间各miRNAs相对表达的比较,通过绘制ROC曲线,评价3种miRNAs鉴别良恶性肺结节的效果,进一步评价miRNAs联合LDCT扫描结果的鉴别诊断效果。结果LDCT肺扫描检出恶性肺结节61例,良性肺结节16例。miR-210、miR-1290和miR-19a在恶性肺结节患者血清中的表达均高于良性肺结节患者,均P<0.05。ROC曲线显示,miR-210、miR-1290和miR-19a诊断良恶性肺结节的AUC值分别为0.699、0.709和0.697,3种miRNAs联合检测的AUC值为0.768。3种miRNAs联合检测检出恶性肺结节37例,良性肺结节40例。通过病理学组织切片确诊恶性肺结节47例、良性肺结节30例。其中LDCT检出的41例恶性肺结节和10例良性肺结节与病理学诊断结果一致,鉴别肺结节性质的准确率为66.2%。影像学显示,恶性肺结节者的结节密度改变、分叶征、毛刺征、空泡征、胸膜牵拉发生率显著高于良性肺结节者,χ^(2)值分别为13.508、10.100、6.337、18.731和13.766,均P<0.05。3种miRNAs联合检测检出的30例恶性肺结节和23例良性肺结节与病理学诊断结果一致,鉴别肺结节性质的准确率为68.8%。LDCT与3种miRNAs联合检测后,检出的44例恶性肺结节和26例良性肺结节与病理学诊断结果一致,鉴别肺结节性质的灵敏度、特异度和准确率分别为93.6%、86.7%和90.9%。结论LDCT肺扫描联合血清miR-210、miR-1290和miR-19a检测能提高鉴别肺结节性质的准确性,对肺结节良恶性的鉴别诊断具有实际临床意义。

Objective To study the differences in the expression of miR-210,miR-1290 and miR-19a in the serum of pa-tients with pulmonary nodules and the feasibility on combining with low-dose computed tomography(LDCT)to improve the diagnostic efficacy of benign and malignant pulmonary nodules.Methods Totally 77 patients with pulmonary nodules who consulted 960th Hospital of the PLA from September 01,2022 to March 31,2023 for symptomatic specialties were randomly included in the study.All patients underwent LDCT and detected the relative expression levels of serum miR-210,miR-1290 and miR-19a by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)to identify the type of the pulmonary nodules,while surgery or puncture biopsy as the gold standard.The relationship between benign and malignant pulmonary nodules and imaging signs was analyzed using the χ^(2) test.Comparison of the relative expression of each miRNA between groups was performed by using the Mann-Whitney U test.The effect of the three miRNAs in identifying benign and malignant pulmonary nodules was evaluated by plotting ROC curves,and further evaluating the dif-ferential diagnostic effect of miRNAs combined with LDCT scanning results.Results LDCT lung scan detected malig-nant pulmonary nodules in 61 cases and benign pulmonary nodules in 16 cases.The expression of miR-210,miR-1290,and miR-19a in the serum of patients with malignant pulmonary nodules was significantly higher than that of patients with benign pulmonary nodules(all P<0.05).The AUC values for the diagnosis of benign and malignant pulmonary nodules for miR-210,miR-1290,and miR-19a were 0.699,0.709 and 0.697,respectively,and the AUC for the combined detec-tion of the three miRNAs was 0.768.The combination of the three miRNAs detected malignant pulmonary nodules in 37 cases and benign pulmonary nodules in 40 cases.The diagnosis of malignant pulmonary nodules was confirmed in 47 cases and benign pulmonary nodules in 30 cases by pathologic tissue sections.Among them,41 cases of malignant pulmonary nodules and 10 cases of benign pulmonary nodules detected by LDCT were consistent with the pathological diagnosis,and the accuracy of identifying the type of pulmonary nodules was 66.2%.Imaging showed a significantly higher incidence of nodal density changes,lobular sign,burr sign,vacuolar sign,and pleural pulling in those with malignant lung nodules than in those with benign lung nodules(χ^(2) values were 13.508,10.100,6.337,18.731 and 13.766,respectively,all P<0.05).The combination of the three miRNAs identified 30 malignant and 23 benign pulmonary nodules,all of which were consistent with the pathological diagnosis.The accuracy of identifying the type of pulmonary nodules was 68.8%.The combination of LDCT and the three miRNAs identified 44 malignant and 26 benign pulmonary nodules,all of which were consistent with the pathological diagnosis.The sensitivity,specificity,and accuracy of determining the type of pul-monary nodules increased to 93.6%,86.7%,and 90.9%,respectively.Conclusion LDCT lung scan combined with ser-um miR-210,miR-1290 and miR-19a detection improves the accuracy of identifying the type of pulmonary nodules and has practical clinical significance in the differential diagnosis of benign and malignant pulmonary nodules.