SPECT骨显像与血清肿瘤标志物联合检测在诊断非小细胞肺癌骨转移中的应用价值

发布时间：2018-11-10 10:59

【摘要】：目的探讨SPECT骨显像和肿瘤标志物(CEA、CA125、CYFRA21-1)联合检测对非小细胞肺癌(Non-small-cell lung cancer,NSCLC)患者骨转移诊断的临床应用价值。方法回顾性分析本院2014年1月至2016年6月185例首诊且经病理或细胞学检查确诊为NSCLC患者的SPECT骨显像及血清肿瘤标志物(CEA、CA125、CYFRA21-1)检测结果,计算各项检查单检及联合检查诊断骨转移效能。参照Soloway分级标准将NSCLC骨转移患者的SPECT骨显像结果分为4级,分别为EOD0:全身骨显像未见异常;EOD1:骨转移灶1~2个;EOD2:骨转移灶3~5个;EOD3:骨转移灶大于5个。应用Spearman相关分析评价SPECT骨显像分级与CEA、CA125、CYFRA21-1水平的相关性。结果185例NSCLC患者中78例发生骨转移,骨转移发生率为42.16%(78/187);SPECT骨显像诊断NSCLC骨转移的灵敏度、特异性分别为91.02%(71/78)、85.98%(92/107)。NSCLC骨转移组CEA、CA125及CYFRA21-1水平高于NSCLC无骨转移组,差异有统计学意义(P0.05);78例NSCLC骨转移患者中,EOD0 8.98%(7/78),EOD1 50%(39/78),EOD2 21.79%(17/78),EOD319.23%(15/78)。Spearman相关分析结果显示,SPECT骨显像分级与CEA、CA125及CYFRA21-1水平存在相关性(rs=0.579、0.274、0.327,P均0.05)。SPECT骨显像与肿瘤标志物联检预测NSCLC骨转移诊断效能高于各项单检效能(AUC=0.922),灵敏度及特异性均提高(分别为97.44%、86.00%)。结论SPECT骨显像对诊断NSCLC骨转移的诊断效能较高,适宜作为NSCLC骨转移的首选筛查方法,在临床中具有重要应用价值。SPECT骨显像联合CEA、CA125、CYFRA21-1检测比单检有助于提高NSCLC骨转移灶检出率,临床实用性更强。
[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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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