CT联合血清SMRP早期诊断大鼠恶性胸膜间皮瘤的研究  

CT combined with serum SMRP in early diagnosis of malignant pleural mesothelioma in rats

作　　者：江杰[1] 谢晓洁[1] 吴莉[1] 赵雯[1] 赵迅冉 韩丹[1] JIANG Jie;XIE Xiao-jie;WU Li(Deparment of Medical Imaging,First Affiliated Hospital,Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科,昆明650032

出　　处：《放射学实践》2021年第2期152-157,共6页Radiologic Practice

基　　金：国家自然科学基金(81460264、81960310);云南省科技厅-昆明医科大学应用基础研究联合专项(2014FA013、2018FE001-041);云南省高层次卫生健康技术人才培养专项经费资助(H-2018007)。

摘　　要：目的:探讨CT联合血清可溶性间皮素相关蛋白(SMRP)在提高早期诊断恶性胸膜间皮瘤(MPM)中的价值,为早期诊断MPM提供实验依据及理论基础。方法:采用右侧胸腔注射青石棉纤维混悬液诱发大鼠MPM,对大鼠行胸腹部CT平扫及增强扫描,对病变进行CT分期,并比较CT对MPM不同分期的诊断价值。分析不同分期MPM的SMRP表达情况。分析CT联合SMRP早期诊断MPM的效能。结果:72例MPM中,CT诊断MPM 50例(69.4%),非MPM 5例(6.9%),未发现病变17例(23.7%)。基于CT鉴别MPM的受试者操作特征(ROC)曲线下面积(AUC)为0.65,敏感度为64.5%,特异度为71.2%。对T1、T2、T3、T4期诊断敏感度分别为35.7%、43.5%、89.3%、100.0%,特异度分别为44.4%、57.2%、90.0%、100%,AUC分别为0.68、0.82、0.95、1.00;对N、M分期诊断敏感度分别为72.5%、100.0%,特异度分别为75.0%、95.0%,AUC分别为0.82、0.85。MPM不同分期的血清SMRP表达差异具有统计学意义(P<0.05)。随着分期增高,SMRP表达量增加。CT检查联合血清SMRP检测诊断MPM的T分期,根据ROC曲线分析,AUC为0.97,敏感度为90.5%,特异度为92.5%;诊断N分期的AUC为0.96,敏感度为87.5%,特异度为92.5%;诊断M分期的AUC为0.95,敏感度为100%,特异度为98%,明显高于单独CT检查(Z分别为4.86、3.05、2.74,P<0.05)。结论:CT检查联合SMRP检测可用于MPM的早期诊断,可明显提高对早期MPM的诊断效能。Objective:To explore the diagnostic value of CT combined with serum soluble mesothelin-related protein(SMRP)in the early diagnosis of malignant pleural mesothelioma(MPM),providing both experimental and theoretical basis for early diagnosis of MPM.Methods:The MPM rat model was created by injecting crocidolite suspension from the right second intercostal into the pleural cavity.None-enhanced and enhanced CT imaging were performed and the CT stages of MPM were evaluated.The diagnostic value of CT for staging evaluation was analyzed.The expression of SMRP in different MPM stages were also analyzed.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of CT combined with SMRP in early diagnosis of MPM.Results:72 MPM subjects were enrolled in this study.Fifty cases(69.4%)were diagnosed as MPM,5 cases(6.9%)were diagnosed as non-MPM by CT and 17 cases(23.7%)found no lesions.The area under the curve(AUC),the sensitivity and specificity of CT in differentiating MPM were 0.65,64.5%and 71.2%,respectively.For staging T1,T2,T3 and T4,the sensitivity were 35.7%、43.5%、89.3%、100.0%,the specificity were 44.4%、57.2%、90.0%、100%,and the AUC were 0.68,0.82,0.95,1.00,respectively.For staging N and M,the sensitivity and specificity were 72.5%,100.0%and 75.0%,95.0%,and the AUC were 0.82,0.85,respectively.The expression level of SMRP in different MPM stages showed statistical differences(P<0.05).The expression level of SMRP raised as the MPM stage increased.The area under the curve(AUC)of diagnostic value of CT combined with SMRP for T stage,N stage and M stage was 0.97,0.96 and 0.95,the sensitivity were 90.5%,87.5%and 100%,and the specificity were 92.5%,92.5%,and 98%,respectively.The diagnostic performance of combination model was higher than that of CT for differentiating T,N and M stages(Z were 4.86,3.05,2.74,respectively,P<0.05).Conclusion:Combination of CT and SMRP can facilitate the early diagnosis of MPM with higher diagnostic performance.

关 键 词：恶性胸膜间皮瘤 体层摄影术 X线计算机 间皮素 可溶性间皮素相关蛋白 

分 类 号：R814.42[医药卫生—影像医学与核医学] R730.262.7[医药卫生—放射医学]