非小细胞肺癌CT灌注参数与EGFR基因突变的关系

发布时间：2018-03-16 00:13

本文选题：非小细胞肺癌　切入点：CT灌注　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过非小细胞肺癌的CT灌注参数来初步推断患者EGFR基因的突变情况,以便早期、合理地为患者找到个体化、最优化的治疗策略。方法:从2015.10到2017.3,收集山西省肿瘤医院可疑“胸部占位”并行CT灌注检查,患者经病理证实为非小细胞肺癌,且均进行了EGFR基因突变的检测,有效病例共30例。然后根据患者的EGFR基因是否存在突变,将30例肺癌患者分为EGFR突变组和野生组,其中突变组患者有13例(13/30,43%),男8例,女5例;野生组患者17例(17/30,57%),男11例,女3例。然后分别计算肺癌患者病灶的CT灌注值:血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)。对突变组及野生组病例的肺癌病灶的BF、BV、MTT、PS进行比较。将所得数据采用两独立样本t检验进行统计学分析,对有统计学意义的灌注参数再继续做ROC曲线分析,以评价其预测EGFR突变的判别能力,最后得出诊断的最佳阈值及相对应的灵敏度与特异度。结果:1.在30例非小细胞肺癌患者中,EGFR突变组有13例,占本次研究的43%,其中腺癌9例,鳞癌4例;EGFR野生组有17例,占本次研究的57%,其中腺癌7例,鳞癌10例。2.EGFR突变组的灌注参数BF(t=2.514,P=0.021)、BV(t=0.467,P=0.646)、PS(t=-0.656,P=0.520)均高于野生组,而MTT(t=1.162,P=0.260)则野生组较高;突变组与野生组的BV、PS及MTT的组间差异均无统计学意义(P0.05),BF值有统计学意义(P0.05)。3.对EGFR突变组与野生组的BF值进行ROC曲线分析,可得出当BF值达到46.747ml·100ml-1·min-1时可以判断非小细胞肺癌的EGFR基因发生了突变,其灵敏度和特异度分别为80%、72.7%。结论:CT灌注检查在初步推断NSCLC患者的EGFR基因突变情况方面具有一定的临床价值:(1)EGFR突变组的灌注参数BF、BV、PS均高于野生组(2)BF值的测量可用来初步判断NSCLC患者的基因突变情况。
[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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R730.44

【参考文献】