MSCT联合癌症因子对肺结核合并肺癌的诊断效能分析

The analysis of diagnostic efficacy of MSCT combined with cancer factors for pulmonary tuberculosis combined with lung cancer

目的 分析MSCT联合多效蛋白(protein,PTN)、癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白19片段(Cytokeratin 19 fragment,CYFRA21-1)对肺结核合并肺癌的诊断效能。方法 选取76例肺结核出现疑似软组织肿块患者,以病理金标准确诊单纯肺结核患者40例作为A组,肺结核合并肺癌患者36例作为B组,选取同期健康志愿者40例为C组,三组均采用MSCT联合PTN、CEA、CYFRA21-1进行诊断,对不同组间癌症因子水平、CT特征进行比较,分析B组内不同肺癌类型患者癌症因子水平,采用受试者工作特征曲线(ROC)分析模型预测价值。结果 1)B组患者PTN、CEA、CYFRA21-1水平显著高于A组与C组,差异有统计学意义(P<0.05);2)小细胞肺癌患者PTN水平显著高于腺癌与鳞癌,差异有统计学意义(P<0.05),CEA、CYFRA21-1水平显著低于腺癌与鳞癌,且腺癌患者CEA水平明显更高,差异均有统计学意义(P<0.05);3)B组空泡征、钙化影、分叶征、毛刺征、卫星灶、胸膜凹陷征与空洞征例数均高于A组,组间比较差异有统计学意义(P<0.05);4)ROC曲线结果显示,预测模型最佳临界值为0.089,ROC曲线下面积(AUC)为0.614(0.651~0.732)、0.671(0.686~0.811)、0.891(0.787~0.993)(P<0.05)。结论 MSCT联合PTN、CEA、CYFRA21-1在肺结核合并肺癌诊断效能高,CT特征及痰液肿瘤标志物水平组间差异显著。

Objective To analyze the diagnostic efficacy of 64 Philips CT combined with pleiotropic protein(PTN),carcino‐embryonic antigen(CEA),and cytokeratin 19 fragment(CYFRA21-1)in tuberculosis and lung cancer.Methods 76 tubercu‐losis patients with suspected soft tissue mass were selected for observation.40 patients with simple tuberculosis by the pathologi‐cal gold standard patients were infor group A,36 patients with tuberculosis with lung cancer were in group B,40 healthy volun‐teers were in group C.Patients in the three groups were diagnosed by means of the combination of MSCT with PTN,CEA,CYFRA21-1.The cancer factors,CT characteristics were compared between different groups.The different lung cancer factors of patients in group B were analyzed and the predict value of the model was also evaluated by ROC curve analysis.Results 1)The PTN,CEA,and CYFRA21-1 levels in group B were significantly higher than those in groups A and C(P<0.05);2)PTN levels in small cell lung cancer were significantly higher than adenocarcinoma and squamous carcinoma(P<0.05),but,CEA and CYFRA21-1 levels in small cell lung cancer were significantly lower than adenocarcinoma and squamous carcinoma,adeno‐carcinoma patients had significantly higher CEA levels(P<0.05);3)The number of vacuolation,calcification,foliation,burr,satellite focus,pleural depression and cavity sign were higher than group A,with statistically significant difference between groups(P<0.05);and 4)The ROC curve results showed that the optimal cut-off value of the prediction model was 0.089 and the area under the ROC curve(area under curve,AUC)was 0.614(0.651~0.732),0.671(0.686~0.811)and 0.891(0.787~0.993)(P<0.05).Conclusion MSCT combined with PTN、CEA and CYFRA21-1 has high diagnostic efficiency in tuberculosis and lung cancer,with significant differences between CT characteristics and sputum tumor marker levels.