【摘要】：目的探討SPECT骨顯像和腫瘤標(biāo)志物(CEA、CA125、CYFRA21-1)聯(lián)合檢測對非小細(xì)胞肺癌(Non-small-cell lung cancer,NSCLC)患者骨轉(zhuǎn)移診斷的臨床應(yīng)用價值。方法回顧性分析本院2014年1月至2016年6月185例首診且經(jīng)病理或細(xì)胞學(xué)檢查確診為NSCLC患者的SPECT骨顯像及血清腫瘤標(biāo)志物(CEA、CA125、CYFRA21-1)檢測結(jié)果,計算各項檢查單檢及聯(lián)合檢查診斷骨轉(zhuǎn)移效能。參照Soloway分級標(biāo)準(zhǔn)將NSCLC骨轉(zhuǎn)移患者的SPECT骨顯像結(jié)果分為4級,分別為EOD0:全身骨顯像未見異常;EOD1:骨轉(zhuǎn)移灶1~2個;EOD2:骨轉(zhuǎn)移灶3~5個;EOD3:骨轉(zhuǎn)移灶大于5個。應(yīng)用Spearman相關(guān)分析評價SPECT骨顯像分級與CEA、CA125、CYFRA21-1水平的相關(guān)性。結(jié)果185例NSCLC患者中78例發(fā)生骨轉(zhuǎn)移,骨轉(zhuǎn)移發(fā)生率為42.16%(78/187);SPECT骨顯像診斷NSCLC骨轉(zhuǎn)移的靈敏度、特異性分別為91.02%(71/78)、85.98%(92/107)。NSCLC骨轉(zhuǎn)移組CEA、CA125及CYFRA21-1水平高于NSCLC無骨轉(zhuǎn)移組,差異有統(tǒng)計學(xué)意義(P0.05);78例NSCLC骨轉(zhuǎn)移患者中,EOD0 8.98%(7/78),EOD1 50%(39/78),EOD2 21.79%(17/78),EOD319.23%(15/78)。Spearman相關(guān)分析結(jié)果顯示,SPECT骨顯像分級與CEA、CA125及CYFRA21-1水平存在相關(guān)性(rs=0.579、0.274、0.327,P均0.05)。SPECT骨顯像與腫瘤標(biāo)志物聯(lián)檢預(yù)測NSCLC骨轉(zhuǎn)移診斷效能高于各項單檢效能(AUC=0.922),靈敏度及特異性均提高(分別為97.44%、86.00%)。結(jié)論SPECT骨顯像對診斷NSCLC骨轉(zhuǎn)移的診斷效能較高,適宜作為NSCLC骨轉(zhuǎn)移的首選篩查方法,在臨床中具有重要應(yīng)用價值。SPECT骨顯像聯(lián)合CEA、CA125、CYFRA21-1檢測比單檢有助于提高NSCLC骨轉(zhuǎn)移灶檢出率,臨床實用性更強。
[Abstract]:Objective to evaluate the clinical value of SPECT bone imaging combined with tumor marker (CEA,CA125,CYFRA21-1) in the diagnosis of bone metastasis in patients with non-small cell lung cancer (Non-small-cell lung cancer,NSCLC). Methods from January 2014 to June 2016, the results of SPECT bone imaging and serum tumor markers (CEA,CA125,CYFRA21-1) in 185 patients with NSCLC diagnosed by pathology or cytology were retrospectively analyzed. The efficacy of single examination and combined examination in the diagnosis of bone metastasis was calculated. The results of SPECT bone imaging in patients with bone metastasis of NSCLC were divided into 4 grades according to the Soloway grading standard. The results were as follows: no abnormality in EOD0: bone imaging, 1 ~ 2 bone metastases in EOD1:, 3 ~ 5 bone metastases in EOD2:, and more than 5 bone metastases in EOD3:. Spearman correlation analysis was used to evaluate the correlation between SPECT bone imaging grade and CEA,CA125,CYFRA21-1 level. Results among the 185 patients with NSCLC, 78 had bone metastasis, the incidence of bone metastasis was 42.16% (78 / 187). The sensitivity of SPECT bone scintigraphy in the diagnosis of bone metastasis in NSCLC was 91.02% (71 / 78), and the CEA,CA125 and CYFRA21-1 levels in 85.98% (92 / 107). NSCLC bone metastasis group were higher than those in NSCLC without bone metastasis group. The difference was statistically significant (P0.05). Among 78 patients with NSCLC bone metastasis, EOD0 8.98% (7 / 78), EOD1 50% (39 / 78), EOD2 21.79% (17 / 78), EOD319.23% (15 / 78). Spearman correlation analysis showed that SPECT bone imaging grade was correlated with CEA,. There was a correlation between CA125 and CYFRA21-1 levels (rs=0.579,0.274,0.327,P 0.05). SPECT bone scintigraphy combined with tumor markers to predict the diagnostic efficacy of NSCLC bone metastasis was higher than that of single detection efficiency (AUC=0.922). The sensitivity and specificity were improved (97.44%, 86.00%, respectively). Conclusion SPECT bone imaging is effective in the diagnosis of bone metastasis of NSCLC, and it is the first choice of NSCLC bone metastasis screening method. SPECT bone imaging combined with CEA,CA125, is of great value in clinical application. CYFRA21-1 is helpful to improve the detection rate of bone metastases in NSCLC, and its clinical practicability is stronger.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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