螺旋CT多期扫描联合肿瘤标志物诊断胃癌的价值研究

Clinical value of multi-phase scan of spiral CT combined with tumor markers in the diagnosis of gastric cancer

目的:探讨螺旋CT多期扫描联合肿瘤标志物对胃癌诊断的临床价值。方法:选取2019年9月至2023年9月延安市中医医院收治的80例高度疑似胃癌患者,所有患者均接受螺旋CT多期(动脉期、静脉期、延迟期)扫描,检测肿瘤标志物癌胚抗原(CEA)、糖类抗原724(CA724)和糖类抗原199(CA199),并行病理检查;依据病理检查结果,对比恶性、良性患者螺旋CT多期扫描CT值、肿瘤标志物水平;绘制受试者工作特征(ROC)曲线,分析各参数诊断阈值(cut-off值),并分析螺旋CT多期扫描联合肿瘤标志物对胃癌的诊断价值。结果:80例高度疑似胃癌患者中经病理检查恶性62例,良性18例;恶性患者动脉期CT值、静脉期CT值、延迟期CT值、CEA、CA724及CA199水平均高于良性患者,差异有统计学意义(t=10.322、15.195、19.123、17.115、14.494、14.041,P<0.05);ROC曲线分析发现,螺旋CT检查动脉期CT值、静脉期CT值及延迟期CT值,以及CEA、CA724和CA199单独及联合诊断胃癌的ROC曲线下面积(AUC)均>0.70,有诊断价值,而联合检测诊断价值最高;cut-off值分别为82.275、74.975、50.445 HU、5.970 ng/ml、8.385μg/L及41.315 U/ml时,可获得最佳诊断价值。依据病理检查结果,螺旋CT多期扫描联合肿瘤标志物诊断胃癌的灵敏度为96.77%,特异度为94.44%,准确率为96.25%,且与病理检查结果一致性好(Kappa=0.895)。结论:螺旋CT多期扫描联合肿瘤标志物对胃癌具有较高诊断价值,可作为胃癌诊断的重要辅助方案。

Objective:To explore clinical value of multi-phase scan of spiral computed tomography(CT)combined with tumor markers in the diagnosis of gastric cancer.Methods:A total of 80 patients with highly suspected gastric cancer admitted to hospital from September 2019 to September 2023 were selected.All patients underwent multiphase(arterial phase,venous phase,delayed phase)scan of spiral CT,and the tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724)and carbohydrate antigen 199(CA199)]of them were detected,as well as pathological examination.Based on the results of pathological examination,the CT values of multi-phase scan of spiral CT and tumor marker levels between patients with malignant tumor and patients with benign tumor were compared.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic cut-off values of various parameters,and also analyze the diagnostic value of multi-phase scans of spiral CT combined with tumor markers for gastric cancer.Results:In 80 patients with highly suspected gastric cancer,62 cases were confirmed as malignant tumor by pathological examination.The CT values of arterial phase,venous phase and delayed phase,CEA,CA724 and CA199 levels in patients with malignant tumor were higher than those in patients with benign tumor(P<0.05),respectively,and the differences of them were significant(t=10.322,15.195,19.123,17.115,14.494,14.041,P<0.05).The results of ROC curve indicated that the area under curve(AUC)values of the CT values of arterial phase,venous phase and delayed phase of spiral CT examination,single CEA,single CA724,single CA199 and combination of them were all greater than 0.70 in diagnosing gastric cancer,and all of them had diagnostic value but the diagnostic value of combined detection was highest.The optimal diagnostic value could be obtained when the cut-off values of above indicators were respectively 82.275 HU,74.975 HU,50.445 HU,5.970ng/ml,8.385μg/l and 41.315U/ml.According to the results of pathological examination,the sensitivity,specificity and accuracy of multi-phase scan of spiral CT combined with tumor markers were respectively 96.77%,94.44%and 96.25%in diagnosing gastric cancer,and the consistency between the combined examination and the pathological examination was favorable(Kappa=0.895).Conclusion:The combination of multi-phase scan of spiral CT and tumor markers has higher diagnostic value for gastric cancer,which can be used as important auxiliary scheme for the diagnosis of gastric cancer.