發(fā)布時(shí)間：2018-03-16 00:13

  本文選題：非小細(xì)胞肺癌　切入點(diǎn)：CT灌注　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:通過(guò)非小細(xì)胞肺癌的CT灌注參數(shù)來(lái)初步推斷患者EGFR基因的突變情況,以便早期、合理地為患者找到個(gè)體化、最優(yōu)化的治療策略。方法:從2015.10到2017.3,收集山西省腫瘤醫(yī)院可疑“胸部占位”并行CT灌注檢查,患者經(jīng)病理證實(shí)為非小細(xì)胞肺癌,且均進(jìn)行了EGFR基因突變的檢測(cè),有效病例共30例。然后根據(jù)患者的EGFR基因是否存在突變,將30例肺癌患者分為EGFR突變組和野生組,其中突變組患者有13例(13/30,43%),男8例,女5例;野生組患者17例(17/30,57%),男11例,女3例。然后分別計(jì)算肺癌患者病灶的CT灌注值:血流量(BF)、血容量(BV)、平均通過(guò)時(shí)間(MTT)、表面通透性(PS)。對(duì)突變組及野生組病例的肺癌病灶的BF、BV、MTT、PS進(jìn)行比較。將所得數(shù)據(jù)采用兩獨(dú)立樣本t檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析,對(duì)有統(tǒng)計(jì)學(xué)意義的灌注參數(shù)再繼續(xù)做ROC曲線分析,以評(píng)價(jià)其預(yù)測(cè)EGFR突變的判別能力,最后得出診斷的最佳閾值及相對(duì)應(yīng)的靈敏度與特異度。結(jié)果:1.在30例非小細(xì)胞肺癌患者中,EGFR突變組有13例,占本次研究的43%,其中腺癌9例,鱗癌4例;EGFR野生組有17例,占本次研究的57%,其中腺癌7例,鱗癌10例。2.EGFR突變組的灌注參數(shù)BF(t=2.514,P=0.021)、BV(t=0.467,P=0.646)、PS(t=-0.656,P=0.520)均高于野生組,而MTT(t=1.162,P=0.260)則野生組較高;突變組與野生組的BV、PS及MTT的組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),BF值有統(tǒng)計(jì)學(xué)意義(P0.05)。3.對(duì)EGFR突變組與野生組的BF值進(jìn)行ROC曲線分析,可得出當(dāng)BF值達(dá)到46.747ml·100ml-1·min-1時(shí)可以判斷非小細(xì)胞肺癌的EGFR基因發(fā)生了突變,其靈敏度和特異度分別為80%、72.7%。結(jié)論:CT灌注檢查在初步推斷NSCLC患者的EGFR基因突變情況方面具有一定的臨床價(jià)值:(1)EGFR突變組的灌注參數(shù)BF、BV、PS均高于野生組(2)BF值的測(cè)量可用來(lái)初步判斷NSCLC患者的基因突變情況。
[Abstract]:Objective: to infer the mutation of EGFR gene in patients with non-small cell lung cancer (NSCLC) by CT perfusion parameters so as to find individuation in early and reasonable way. Methods: from May 10 to July 3, the suspected "chest occupying" and CT perfusion examination were performed in Shanxi Cancer Hospital. The patients were pathologically proved to be non-small cell lung cancer, and the mutation of EGFR gene was detected. There were 30 effective cases. Then, according to the mutation of EGFR gene, 30 patients with lung cancer were divided into EGFR mutation group and wild group. The CT perfusion values of lung cancer lesions were calculated respectively: blood flow volume (BFF), blood volume (BV), mean transit time (MTT), surface permeability of lung cancer. The BFBV / MTTPS of lung cancer lesions in mutant group and wild group were compared. Two independent samples t-test were used for statistical analysis. To evaluate the discriminant ability of predicting EGFR mutation, we continue to do ROC curve analysis on the statistically significant perfusion parameters. Finally, the optimal diagnostic threshold and the corresponding sensitivity and specificity were obtained. Results: 1.There were 13 cases of EGFR mutation in 30 patients with non-small cell lung cancer, accounting for 43 cases of this study, including 9 cases of adenocarcinoma and 17 cases of wild EGFR group of 4 cases of squamous cell carcinoma. There were 7 cases of adenocarcinoma and 10 cases of EGFR mutation in this study. The perfusion parameters of BFT ~ (2. 514) ~ (0. 021) were higher than that of wild group (P = 0. 467), but MTTt ~ (1. 162) P0. 260) were higher in wild group than in wild group. There was no significant difference in BF between mutant group and wild group (P 0.05). The BF value of EGFR mutation group and wild group was analyzed by ROC curve. It can be concluded that when BF value reaches 46.747ml 路100ml -1 路min-1, the mutation of EGFR gene in non-small cell lung cancer can be judged. The sensitivity and specificity were 72.70.Conclusion the ratio of EGFR gene mutation in NSCLC patients is significantly higher than that in wild group. Conclusion the perfusion parameters of EGFR gene mutation in NSCLC patients are higher than those in wild patients. The gene mutation in NSCLC patients was preliminarily judged.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R734.2;R730.44

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