肺腺癌和小细胞肺癌患者胸部CT征象及免疫组化特征分析

发布时间：2018-02-23 02:22

本文关键词： 肺肿瘤小细胞肺癌免疫组织化学　出处：《中国全科医学》2017年S2期 　论文类型：期刊论文

【摘要】：目的分析比较清远地区肺腺癌和小细胞肺癌(SCLC)患者的胸部CT征象及免疫组化特征。方法回顾性研究2013年1月—2016年8月清远市人民医院64例肺癌患者,其中腺癌34例,SCLC 30例,比较两组血常规、血生化、肿瘤标志物、CT征象及免疫组化指标。结果两组患者年龄、吸烟指数、病程比较,差异无统计学意义(P0.05),但性别比较,差异有统计学意义(P0.05),两组患者主要症状方面如咳嗽、咯血、胸痛、体质量下降比较,差异无统计学意义(P0.05)。两组患者血常规指标白细胞计数(WBC)、淋巴细胞计数(LYMPH)、血小板计数(PLT)、血红蛋白(Hb)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)比较,差异均无统计学意义(P0.05);血生化指标红细胞沉降率(ESR)、碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、类风湿因子(RF)比较,差异无统计学意义(P0.05),但C反应蛋白(CRP)比较,差异有统计学意义(P0.05);肿瘤标志物癌胚抗原(CEA)、细胞角蛋白21片段(Cyfra21-1)、神经元烯醇化酶(NSE)比较,差异有统计学意义(P0.05)。两组患者CT征象中肿瘤部位和内外部结构比较,差异有统计学意义(P0.05),腺癌组肿瘤多发生于右上叶,SCLC组好发于左上叶和右下叶;腺癌内部结构主要表现为空泡征和胸膜凹陷征,SCLC表现为空洞征。两组肿瘤大小、形状、边缘形态及中央型肺癌特征比较,差异无统计学意义(P0.05)。两组常见的CT征象如肿瘤形状、边缘形态、内外部结构和中央型肺癌特征均与免疫组化常用指标如CK、CK7、Ki-67、P63、CD56、Syn、TTF-1无相关性(P0.05)。结论肺腺癌CT征象主要表现为空泡征和胸膜凹陷征,而SCLC可表现为空洞征,血CEA、Cyfra21-1、NSE、CRP具有一定鉴别价值,但仍需支气管镜或肺活检确诊。
[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.
【作者单位】：广东省清远市人民医院呼吸内科二病区;
【分类号】：R730.44;R734.2

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