摘要
目的探讨低剂量CT结合Ras相关区域家族蛋白1A(RASSF1A)、矮小同源盒基因2(SHOX2)甲基化在肺癌早期预测中的应用价值。方法选取2021年1月~2023年1月我院90例拟行肺结节手术患者,根据手术病理学分为肺良性结节组和肺癌组。2组均于术前行低剂量CT检查、SHOX2、RASSF1A甲基化检测,采用Kappa指数分析上述检查结果与手术病理学一致性,分析低剂量CT、SHOX2、RASSF1A甲基化与血清肿瘤标志物[癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、鳞状细胞癌抗原(SCC-Ag)、细胞角蛋白19片段(CYFRA21)]对肺癌诊断效能,采用Spearman低剂量CT检查、SHOX2、RASSF1A甲基化与临床病理特征相关性。结果低剂量CT、SHOX2、RASSF1甲基化及三者联合分别确定40例、43例、46例、58例肺癌,三者联合与手术病理学诊断肺癌效能一致性Kappa值为0.951;三者联合诊断肺癌敏感度96.67%、准确度97.78%均高于三者单一诊断效能(P<0.05);肺癌患者血清CEA、SCC、NSE、CYFRA21水平均高于肺良性结节患者(P<0.05);低剂量CT联合SHOX2、RASSF1甲基化诊断肺癌效能的AUC为0.983,近似于四种血清肿瘤标志物诊断肺癌效能的AUC 0.933;不同肿瘤直径、临床分期、组织学分化肺癌患者低剂量CT检出率及SHOX2、RASSF1A甲基化阳性率比较差异有统计学意义(P<0.05);肺癌患者低剂量CT检出率、SHOX2及RASSF1A甲基化阳性率与肿瘤直径、临床分期呈正相关,与组织学分化呈负相关(P<0.05)。结论低剂量CT联合SHOX2及RASSF1A甲基化可用于肺癌早期预警中,临床可通过其进行早期诊断、评估病情进展程度,以针对性展开后续治疗,改善预后。
Objective To investigate the application value of low dose CT combined with methylation of Ras related region family protein 1A(RASSF1A)and dwarf homeobox gene 2(SHOX2)in early prediction of lung cancer.Methods 90 patients with pulmonary nodule operation in our hospital from January 2021 to January 2023 were selected and divided into benign pulmonary nodule group and lung cancer group according to surgical pathology.Low-dose CT examination and methylation detection of SHOX2 and RASSF1A were performed in both groups before surgery.Kappa index was used to analyze the consistency between the above examination results and surgical pathology.To analyze the diagnostic efficacy of low-dose CT,SHOX2,RASSF1A methylation and serum tumor markers(CEA),neuron-specific enolase(NSE),squamous cell carcinoma antigen(SCC-Ag),and cytokeratin 19 fragment(CYFRA21))in lung cancer.Spearman low-dose CT examination,SHOX2 and RASSF1A methylation were correlated with clinicopathologic features.Results 40 cases,43 cases,46 cases and 58 cases of lung cancer were identified by low dose CT,SHOX2,RASSF1 methylation and their combination,respectively.The consistency of the efficacy of the combination of CT,Shox2 and RassF1 in the diagnosis of lung cancer was 0.951 Kappa value.The sensitivity of 96.67%and accuracy of 97.78%were higher than the single diagnostic efficacy of the three methods(P<0.05).The levels of CEA,SCC,NSE and CYFRA21 in lung cancer patients were higher than those in benign pulmonary nodules(P<0.05).The AUC of low dose CT combined with SHOX2 and RASSF1 methylation in the diagnosis of lung cancer was 0.983,which was similar to the AUC of 0.933 of the four serum tumor markers.There were significant differences in the detection rate of low-dose CT and methylation positive rate of SHOX2 and RASSF1A among patients with different tumor diameter,clinical stage and histological differentiation(P<0.05).The detection rate of low-dose CT,the positive rate of methylation of SHOX2 and RASSF1A in lung cancer patients were positively correlated with tumor diameter and clinical stage,but negatively correlated with histological differentiation(P<0.05).Conclusion Low-dose CT combined with SHOX2 and RASSF1A methylation can be used for early warning of lung cancer,which can be used for early diagnosis and evaluation of the progression of the disease,so as to carry out targeted follow-up treatment and improve the prognosis.
作者
李志娟
董红
田涛
于哲
李晓敏
LI Zhi-juan;DONG Hong;TIAN Tao;YU Zhe;LI Xiao-min(Department of Respiratory and Critical Care Medicine,General Hospital of North ChinaPetroleum Administration Bureau,Cangzhou 062550,Hebei Province,China 2.Department of Orthopedics,General Hospital of North China Petroleum AdministrationBureau,Cangzhou 062550,Hebei Province,China 3.Department of Thoracic Surgery,General Hospital of North China Petroleum AdministrationBureau,Cangzhou 062550,Hebei Province,China 4.Department of Pathology,General Hospital of North China Petroleum Administration Bureau,Cangzhou 062550,Hebei Province,China)
出处
《中国CT和MRI杂志》
2024年第2期73-76,共4页
Chinese Journal of CT and MRI
基金
2021年度河北省医学科学研究课题计划(20210235)。
