本文關(guān)鍵詞： 肺腫瘤 小細胞肺癌 免疫組織化學(xué)　出處：《中國全科醫(yī)學(xué)》2017年S2期 　論文類型：期刊論文

【摘要】：目的分析比較清遠地區(qū)肺腺癌和小細胞肺癌(SCLC)患者的胸部CT征象及免疫組化特征。方法回顧性研究2013年1月—2016年8月清遠市人民醫(yī)院64例肺癌患者,其中腺癌34例,SCLC 30例,比較兩組血常規(guī)、血生化、腫瘤標志物、CT征象及免疫組化指標。結(jié)果兩組患者年齡、吸煙指數(shù)、病程比較,差異無統(tǒng)計學(xué)意義(P0.05),但性別比較,差異有統(tǒng)計學(xué)意義(P0.05),兩組患者主要癥狀方面如咳嗽、咯血、胸痛、體質(zhì)量下降比較,差異無統(tǒng)計學(xué)意義(P0.05)。兩組患者血常規(guī)指標白細胞計數(shù)(WBC)、淋巴細胞計數(shù)(LYMPH)、血小板計數(shù)(PLT)、血紅蛋白(Hb)、中性粒細胞與淋巴細胞比值(NLR)、血小板與淋巴細胞比值(PLR)比較,差異均無統(tǒng)計學(xué)意義(P0.05);血生化指標紅細胞沉降率(ESR)、堿性磷酸酶(ALP)、乳酸脫氫酶(LDH)、類風(fēng)濕因子(RF)比較,差異無統(tǒng)計學(xué)意義(P0.05),但C反應(yīng)蛋白(CRP)比較,差異有統(tǒng)計學(xué)意義(P0.05);腫瘤標志物癌胚抗原(CEA)、細胞角蛋白21片段(Cyfra21-1)、神經(jīng)元烯醇化酶(NSE)比較,差異有統(tǒng)計學(xué)意義(P0.05)。兩組患者CT征象中腫瘤部位和內(nèi)外部結(jié)構(gòu)比較,差異有統(tǒng)計學(xué)意義(P0.05),腺癌組腫瘤多發(fā)生于右上葉,SCLC組好發(fā)于左上葉和右下葉;腺癌內(nèi)部結(jié)構(gòu)主要表現(xiàn)為空泡征和胸膜凹陷征,SCLC表現(xiàn)為空洞征。兩組腫瘤大小、形狀、邊緣形態(tài)及中央型肺癌特征比較,差異無統(tǒng)計學(xué)意義(P0.05)。兩組常見的CT征象如腫瘤形狀、邊緣形態(tài)、內(nèi)外部結(jié)構(gòu)和中央型肺癌特征均與免疫組化常用指標如CK、CK7、Ki-67、P63、CD56、Syn、TTF-1無相關(guān)性(P0.05)。結(jié)論肺腺癌CT征象主要表現(xiàn)為空泡征和胸膜凹陷征,而SCLC可表現(xiàn)為空洞征,血CEA、Cyfra21-1、NSE、CRP具有一定鑒別價值,但仍需支氣管鏡或肺活檢確診。
[Abstract]:Objective to analyze and compare the CT features and immunohistochemical features of lung adenocarcinoma and small cell lung cancer (SCLC) in Qingyuan area. Methods 64 patients with lung cancer were studied retrospectively from January 2013 to August 2016, including 34 cases of adenocarcinoma and 30 cases of SCLC. Results there was no significant difference in age, smoking index and course of disease between the two groups, but there was no significant difference between the two groups (P 0.05). The difference was statistically significant (P 0.05). The main symptoms of the two groups were cough, hemoptysis, chest pain and body mass decline. There was no significant difference between the two groups in blood routine indexes: WBCU, LYMPHN, PLT, HBC, NLRN, PLR, and PLR were compared between the two groups, and the ratio of neutrophil to lymphocyte was higher than that of the control group (P < 0.05), but the difference was not significant (P < 0.05), and there was no significant difference between the two groups. There was no significant difference in erythrocyte sedimentation rate (ESRR), alkaline phosphatase (ALPN), lactate dehydrogenase (LDH), rheumatoid factor (RFRFs), but there was no significant difference in RBC sedimentation rate (ESRR), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and rheumatoid factor (RFRFs), but there was no significant difference in C-reactive protein (CRP). The difference was statistically significant (P 0.05), the tumor marker carcinoembryonic antigen (CEA), cytokeratin 21 fragment (Cyfra21-1) and neuronal enolase (NSE) were significantly different between the two groups. The difference was statistically significant (P 0.05). Most tumors occurred in the upper right lobe and the lower right lobe in the adenocarcinoma group, and the internal structure of the adenocarcinoma was mainly characterized by vacuole sign and pleural depression sign, and the size and shape of the tumor in the two groups. There was no significant difference in the features of peripheral and central lung cancer (P 0.05). The common CT features of the two groups were tumor shape, edge shape, and so on. Both the internal and external structures and the characteristics of central lung cancer were correlated with the commonly used immunohistochemical indexes such as CK7, Ki-6i, P63TTF-1. Conclusion the CT signs of lung adenocarcinoma are mainly vacuole sign and pleural depression sign, while SCLC can show cavities sign. The serum CEACyfra21-1NSEE CRP has some differential value. But it still needs bronchoscopy or lung biopsy.
【作者單位】： 廣東省清遠市人民醫(yī)院呼吸內(nèi)科二病區(qū);
【分類號】：R730.44;R734.2

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