64排CT联合NSE、ProGRP在肺癌鉴别诊断及TNM分期中的应用

Application of 64-detector-row CT combined with NSE and ProGRP in differential diagnosis and TNM staging of lung cancer

摘要:

目的 分析64排螺旋CT联合神经元特异性烯醇酶（NSE）、促胃秘素释放肽前体（ProGRP）在肺癌鉴别诊断及TNM分期中的应用。方法 选取2017年5月—2021年10月于滁州市第一人民医院影像科检查的130例高度疑似肺癌患者，均接受64排螺旋CT检查及血清NSE及ProGRP水平检测。以病理组织学诊断结果作为金标准，比较肺癌、良性肺部疾病患者CT灌注参数、血清NSE、ProGRP水平，ROC曲线分析CT参数联合血清NSE、ProGRP水平诊断肺癌的诊断效能；比较不同TNM分期肺癌患者的CT灌注参数、血清NSE、ProGRP水平，比较CT，血清NSE、ProGRP水平单一及联合诊断肺癌TNM分期的符合率。结果 肺癌组与良性组BF比较，差异无统计学意义（P >0.05），肺癌组BV、PS、MTT较良性组参数值大（P <0.05）。肺癌组术前血清NSE、ProGRP水平较良性组高（P <0.05）。ROC曲线分析结果显示，BV、PS、MTT、NSE、ProGRP及各指标联合诊断肺癌发生的AUC分别为0.865（95% CI：0.775，0.955）、0.861（95% CI：0.766，0.956）、0.770（95% CI：0.602，0.937）、0.875（95% CI：0.737，0.962）、0.901（95% CI：0.843，0.982）、0.958（95% CI：0.916，0.999）。不同TNM组BF比较，差异无统计学意义（P >0.05），Ⅳ期组BV、PS、MTT高于其他组（P <0.05）。Ⅳ期组血清NSE、ProGRP水平高于其他组（P <0.05）。各联合诊断肺癌的符合率最高，Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期分别为91.67%、88.89%、100.00%、100.00%。结论 64排螺旋CT联合血清NSE、ProGRP水平可有效鉴别诊断肺癌，提高TNM分期诊断符合率。

Abstract:

Objective To analyze the value of 64-detector-row CT combined with neuron-specific enolase (NSE) and progastrin-releasing peptide (ProGRP) in the differential diagnosis and TNM staging of lung cancer.Methods A total of 130 patients with highly suspected lung cancer who were present in the Department of Imaging of the Chuzhou First People's Hospital from May 2017 to October 2021 were included. All the patients underwent 64-detector-row spiral CT and the serum levels of NSE and ProGRP were detected. The histopathological diagnosis was set as the gold standard. The CT perfusion parameters and serum levels of NSE and ProGRP were compared between patients with lung cancer and those with benign pulmonary diseases. The receiver operating characteristic (ROC) curve was applied to analyze the diagnostic efficacy of CT perfusion parameters and serum levels of NSE and ProGRP for lung cancer. The CT perfusion parameters and serum levels of NSE and ProGRP were compared among lung cancer patients with different TNM stages. The diagnostic coincidence rate of TNM stages of lung cancer via CT perfusion parameters, serum levels of NSE and ProGRP and their combination was analyzed.Results There was no difference in BF between the lung cancer group and the benign pulmonary diseases group (P >0.05), while BV, PS and MTT were higher in the lung cancer group than those in the benign pulmonary diseases group (P < 0.05). The preoperative serum levels of NSE and ProGRP were higher in the lung cancer group than in the benign pulmonary diseases group (P < 0.05). The ROC curve analysis showed that the areas under the ROC curves (AUCs) of BV, PS, MTT, NSE, ProGRP and their combination for diagnosing lung cancer were 0.865 (95% CI: 0.775, 0.955), 0.861 (95% CI: 0.766, 0.956), 0.770 (95% CI: 0.602, 0.937), 0.875 (95% CI: 0.737, 0.962), 0.901 (95% CI: 0.843, 0.982), and 0.958 (95% CI: 0.916, 0.999), respectively. There was no difference in BF among patients with different TNM stages (P >0.05), while BV, PS and MTT were higher in patients with stage Ⅳ lung cancer than in others (P < 0.05). Besides, the serum levels of NSE and ProGRP were also higher in patients with stage Ⅳ lung cancer than in others (P < 0.05). The diagnostic coincidence rates of TNM stages of lung cancer via the combined detection were the highest, and were 91.67%, 88.89%, 100.00% and 100.00%, respectively for stage Ⅰ to Ⅳ.Conclusions The 64-detector-row spiral CT perfusion parameters combined with serum levels of NSE and ProGRP are effective in diagnosing lung cancer, and they improve the diagnostic coincidence rate of TNM stages of lung cancer.