P63、NapsinA、CK7、TTF-1联合SCC-Ag检测对于肺腺癌与鳞癌的鉴别诊断效能分析  

An Analysis of the Efficacy of Immunohistochemistry in the Diagnosis of Lung Adenocarcinoma and Squamous Cell Carcinoma

作　　者：魏杰 王志国[2] 梁鑫[3] 王琼琼 WEI Jie;WANG Zhi-guo;LIANG Xing;WANG Qiong-qiong(Department of Clinical Laboratory,Shanghai Meishan Hospital,Nanjing 210039,China;Department of Clinical Laboratory,Jiangsu Provincial Integrated Traditional Chinese and Western Medicine Hospital,Nanjing 210028;Department of Clinical Laboratory,Jiangsu Province Traditional Chinese Medicine Hospital,Nanjing 210029,China;Department of Nuclear Medicine,Nanjing First Hospital,Nanjing 210006,China)

机构地区：[1]南京梅山医院检验科,江苏南京210039 [2]江苏省中西医结合医院检验科,江苏南京210028 [3]江苏省中医院检验科,江苏南京210029 [4]南京市第一医院核医学科,江苏南京210006

出　　处：《标记免疫分析与临床》2018年第9期1313-1317,共5页Labeled Immunoassays and Clinical Medicine

摘　　要：目的分析免疫组化(IHC)指标对于肺腺癌与肺鳞癌鉴别诊断的价值。方法回顾性分析本院2015年1月至2016年12月间明确诊断的114例肺腺癌及87例肺鳞癌患者的病理及生化检测资料。统计IHC指标:肺鳞癌特异性蛋白P63(P63)、新天冬氨酸蛋白酶A(NapsinA)、细胞角蛋白7(CK7)和甲状腺转录因子-1(TTF-1)的阳性率,以及全部血清鳞状细胞癌相关抗原(SCC-Ag)检测结果;计算各项指标对于肺腺癌与肺鳞癌鉴别诊断的效能:鉴别符合率、灵敏度、特异性、阳性预测值、阴性预测值;以ROC曲线评估各项指标的鉴别诊断价值并绘制ROC曲线图;对比肺腺癌与肺鳞癌患者血清SCC-Ag表达水平的差异,并以ROC曲线计算SCC-Ag鉴别肺腺癌与肺鳞癌的最佳诊断值(约登指数);分析各项指标鉴别诊断结果与确诊结果间的一致性。结果肺腺癌患者血清SCC-Ag与肺鳞癌患者差异具有统计学意义,P <0.05;最佳鉴别诊断值为3.715 ng/mL。IHC指标中TTF-1鉴别诊断符合率最高为91.67%,以本组数据计算所得约登指标为阳性标准,SCC-Ag鉴别诊断符合率为97. 01%。SCC-Ag具有较高鉴别诊断价值,IHC指标均具有中等鉴别诊断价值,P<0.05。TTF-1、NapsinA、P63鉴别诊断结果与确诊结果具有中等一致性,P<0.05;CK7鉴别诊断结果与确诊结果间具有一致性,P<0.05;SCC-Ag鉴别诊断结果与确诊结果具有较高一致性,P <0.05。结论各项免疫组化指标联合血清鳞状细胞癌相关抗原能够为肺腺癌与肺鳞癌的正确鉴别提供较为准确的参考,对于肺腺癌与肺鳞癌的鉴别诊断具有较高诊断效能。Objective To analyze the value of immunohistochemistry （IHC）in the diagnosis of lung adenocarcinoma and squamous cell carcinoma. Methods A retrospective analysis of patients inour hospital from January 2015 to December 2016 was conducted,using 114 cases of lung cancer and 87cases of squamous cell carcinoma diagnosed with pathological and biochemical tests. Statistical indexes were obtained, including ： IHC lung squamous cell carcinoma specific protein P63 （P63）and aspartic protease A（NapsinA） ,cell keratin 7（CK7） thyroid transcription factor -1 （TTF-1）positive rate, and all the serum squamous cell carcinoma antigen （ SCC- Ag） test results. We then calculatedthe effectiveness index of diagnosis of lung adenocarcinoma and lung squamous cell carcinoma, including：the screening coincidence rate, sensitivity, specificity, positive predictive value, and negative predictive value. ROC curve was used to evaluate all the screening diagnosis indexes; We also compared lung adenocarcinoma and lung squamous cell carcinoma patients by serum SCC- Ag expression level, and used ROC curve to identify optimal diagnostic cutoff values of SCC-Ag screeninglung adenocarcinoma and lung squamous cell carcinoma （Uden index ）; The consistency between the diagnostic results was then analyzed. Results The serum SCC-Ag of patients with lung adenocarcinoma was significantlydifferent from that of patients with squamous cell carcinoma （ P 〈 0. 05 ）, and the optimal diagnostic value was 3. 715ng/mL. The highest rate was 91.67% with TTF-1 screening for diagnosis IHC index. Using positive standard index of Youden, the diagnostic coincidence rate of SCC-Ag screening was 97.01%. SCC-Ag had a high diagnostic value, and the IHC indexes had a middle screening diagnosis value, P 〈 0. 05. TTF-1, NapsinA, and P63 had a medium consistency with confirmed diagnosis, CK7 had a consistency with confirmed diagnosisP 〈 0.05 ; high consistency was found for SCC- Ag screening diagnosis, P 〈 0. 05. Conclusion Immunohistoche

关 键 词：免疫组化 非小细胞肺癌 肺腺癌 肺鳞癌 

分 类 号：R734.2[医药卫生—肿瘤]