本文關(guān)鍵詞： 雙入口灌注 肺癌 病理類型 淋巴結(jié) Ki67　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景近年來,隨著環(huán)境污染的加重,肺癌的發(fā)病率及死亡率仍居于所有惡性腫瘤首位。由于其早期臨床癥狀無特異性,發(fā)現(xiàn)時多數(shù)處于中晚期,2/3患者確診時已失去手術(shù)機會,預(yù)后欠佳。因此早發(fā)現(xiàn)、早診斷、早治療對肺癌患者的預(yù)后及生活質(zhì)量的提高有著重要的臨床價值;臨床治療方案的制定及預(yù)后與肺癌的病理類型及準(zhǔn)確分期、分級密切相關(guān)。所以,對腫瘤作出明確的診斷和精確的分級、分期有助于治療方案的選擇,從而可改善患者的生存質(zhì)量、提高生存期。目的探討320排CT雙入口灌注技術(shù)在術(shù)前評估肺癌的病理類型、有無縱隔淋巴結(jié)轉(zhuǎn)移及Ki67陽性表達(dá)率的應(yīng)用價值。材料和方法選取鄭州大學(xué)第一附屬醫(yī)院2015年10月-2016年12月經(jīng)穿刺或術(shù)后病理證實的肺癌患者71例(男39例,女32例),年齡32-70歲,中位年齡56歲。采用東芝320排CT(Aquilion ONE,Toshiba Medical Systems,Otawara,Japan)掃描儀對所有患者進(jìn)行肺部動態(tài)容積灌注掃描,運用雙入口灌注(Dual-input CT perfusion,DI-CTP)模式對圖像進(jìn)行后處理,得到三個灌注參數(shù):體循環(huán)中的支氣管動脈血流量(BAF,bronchial artery flow)、肺循環(huán)中的肺動脈血流量(PAF,pulmonary artery flow)及灌注指數(shù)[PI=PAF/(BAF+PAF),perfusion index];采用方差分析探討腺癌、鱗癌及小細(xì)胞肺癌的DI-CTP參數(shù)的差異;采用獨立樣本t檢驗分析縱隔淋巴結(jié)轉(zhuǎn)移與肺癌原發(fā)灶的DI-CTP參數(shù)的關(guān)系,并運用ROC曲線分析DI-CTP參數(shù)評價肺癌縱隔淋巴結(jié)轉(zhuǎn)移的診斷效能;根據(jù)免疫組化結(jié)果,將Ki67陽性表達(dá)率按弱(10%-25%)、中(26%-50%)、強(50%)分為3組,采用Spearman秩相關(guān)分析對DI-CTP參數(shù)及Ki67陽性表達(dá)率作統(tǒng)計學(xué)處理。結(jié)果1.經(jīng)穿刺或術(shù)后病理證實肺癌共71例,其中腺癌25例,鱗癌22例,小細(xì)胞肺癌18例,其他病理類型肺癌共6例,包括神經(jīng)內(nèi)分泌癌2例、腺鱗癌3例、肉瘤樣癌1例。鱗癌、腺癌及小細(xì)胞肺癌三組的DI-CTP參數(shù)PAF、BAF、PI間的差異無統(tǒng)計學(xué)意義(P0.05)。2.61例患者行淋巴結(jié)清掃術(shù),有淋巴結(jié)轉(zhuǎn)移組(27例)BAF高于無淋巴結(jié)轉(zhuǎn)移組(34例),差異有統(tǒng)計學(xué)意義(t=4.173,P0.001);有淋巴結(jié)轉(zhuǎn)移組PI低于無淋巴結(jié)轉(zhuǎn)移組,差異有統(tǒng)計學(xué)意義(t=-3.378,P=0.001);兩組PAF間的差異無統(tǒng)計學(xué)意義(P0.05)。三個參數(shù)中,BAF的ROC曲線曲線下面積最大,為0.773,當(dāng)以BAF56.42ml·min-1·(100ml)-1作為預(yù)測肺癌縱隔淋巴結(jié)轉(zhuǎn)移的臨界值時,靈敏度為74.1%,特異度為76.5%;PI的ROC曲線下面積為0.739,以PI41.57%作為預(yù)測縱隔淋巴結(jié)轉(zhuǎn)移的臨界值時,靈敏度為82.4%,特異度為66.7%。3.53例患者行Ki67免疫組化檢查,低表達(dá)15例,中表達(dá)15例,高表達(dá)23例;經(jīng)Spearman秩相關(guān)分析得到:BAF與Ki67陽性表達(dá)率呈正相關(guān)(r=0.759,P0.001),PI與Ki67的陽性表達(dá)率呈負(fù)相關(guān)(r=-0.534,P0.001),PAF與Ki67的陽性表達(dá)率無相關(guān)性(P0.05)。結(jié)論肺癌DI-CTP參數(shù)PAF、BAF及PI與肺癌的病理類型無關(guān);肺癌DI-CTP參數(shù)對術(shù)前預(yù)測肺癌是否發(fā)生縱隔淋巴結(jié)轉(zhuǎn)移及Ki67的陽性表達(dá)率的強弱有重要參考價值,從而可為術(shù)前評估肺癌的生物學(xué)行為、術(shù)前分期及治療方案的制定等提供參考。
[Abstract]:Background: in recent years, with the increase of environmental pollution, the incidence and mortality of lung cancer among all malignant tumors is still first. Because of no specific clinical symptoms in its early stage, the majority found at advanced stage, 2/3 patients have lost the chance of operation, the prognosis is poor. Therefore early detection, early diagnosis, early treatment of patients with lung cancer the prognosis and improve the quality of life has important clinical value; pathological type clinical treatment planning and prognosis of lung cancer and tumor staging and grading are closely related. So, make a clear diagnosis and accurate classification of tumor staging, contribute to the choice of treatment, which can improve the quality of life of patients, improve objective to investigate the survival. 320 rows of CT double entrance perfusion technology assessment of pathological types of lung cancer before operation, there is no value of mediastinal lymph node metastasis and the positive expression rate of Ki67 in the selection of materials and methods. 71 patients with lung cancer in October 2015 of the First Affiliated Hospital of Zhengzhou University -2016 12 menstrual biopsy or postoperative pathology cases (male 39 cases, female 32 cases), age 32-70 years, median age was 56 years. The Toshiba 320 slice CT (Aquilion ONE, Toshiba Medical Systems, Otawara, Japan) of the lung perfusion scan of dynamic volume all patients with the scanner, the use of double entrance perfusion (Dual-input CT perfusion, DI-CTP) model for image postprocessing, get three perfusion parameters: bronchial artery blood flow in the systemic circulation (BAF bronchial, artery flow), pulmonary artery blood flow in the pulmonary circulation (PAF pulmonary, artery flow) and perfusion index [PI=PAF/ (BAF+PAF), perfusion index]; by analysis of variance of adenocarcinoma, the differences of DI-CTP parameters of squamous cell carcinoma and small cell lung cancer; independent samples t test was used to analyze the DI-CTP parameter of mediastinal lymph node metastasis and primary tumor. System, and using the ROC curve analysis of diagnostic efficacy evaluation of mediastinal lymph node metastasis DI-CTP parameters; according to the results of immunohistochemistry, the positive expression rate of Ki67 (10%-25%), according to the weak in (26%-50%), strong (50%) divided into 3 groups, using Spearman rank correlation analysis for statistical processing of the DI-CTP parameter and Ki67 positive the expression rate of 1.. The results by biopsy or postoperative pathology confirmed lung cancer were 71 cases, including 25 cases of adenocarcinoma, 22 cases of squamous cell carcinoma, 18 cases of small cell lung cancer and other pathological types of lung cancer were 6 cases, including 2 cases of neuroendocrine carcinoma, 3 cases of adenosquamous carcinoma, 1 cases of sarcomatoid carcinoma. Squamous cell carcinoma, DI-CTP parameters PAF, three groups of adenocarcinoma and small cell lung cancer BAF, there was no significant difference between PI (P0.05).2.61 patients underwent lymph node dissection, lymph node metastasis group (27 cases) BAF higher than the group without lymph node metastasis (34 cases), the difference was statistically significant (t=4.173, P0.001); lymph node metastasis was lower than that without lymph node PI Transfer group, the difference was statistically significant (t=-3.378, P=0.001); there was no significant difference between the two groups of PAF (P0.05). Three parameters, ROC curve area under the BAF curve of the maximum is 0.773, when the BAF56.42ml min-1 (100ml) -1 as a predictor of mediastinal lymph node metastasis of the critical value, the sensitivity was 74.1%, specificity was 76.5%; the area under the PI curve of ROC was 0.739, with PI41.57% as a predictor of mediastinal lymph node metastasis of the critical value, the sensitivity was 82.4%, specificity of 66.7%.3.53 patients underwent Ki67 immunohistochemical examination, 15 cases low expression, the expression of 15 cases, 23 cases of high expression; by Spearman rank correlation analysis: BAF was positively correlated with the positive expression rate of Ki67 (r=0.759, P0.001), the positive expression of PI and Ki67 was negatively correlated (r=-0.534, P0.001), the positive expression of PAF and Ki67 was no significant correlation (P0.05). The lung cancer DI-CTP parameters PAF, BAF and PI and lung cancer pathology the The DI-CTP parameters of lung cancer have important reference value for predicting the mediastinal lymph node metastasis and the positive expression rate of Ki67 before operation, so that it can provide references for preoperative assessment of biological behavior, preoperative staging and treatment plan of lung cancer.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2;R730.44

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本文編號：1503593