细针穿刺洗脱液多项指标检测在良恶性颈部结节鉴定中的意义  

Significance of multiple indexes of fine needle aspiration eluent in the identification of benign and malignant cervical nodules

作　　者：苏莉[1] 黄诚刚[1] 戴一菲[1] 牛文强[1] 刘汉忠[2] 陈小艳[1] Su Li;Huang Chenggang;Dai Yifei;Niu Wenqiang;Liu Hanzhong;Chen Xiaoyan(Department of Nuclear Medicine,the Center Hospital of Xiaogan City,Hubei Xiaogan 432000,China;Department of Pathology,the Center Hospital of Xiaogan City,Hubei Xiaogan 432000,China)

机构地区：[1]湖北省孝感市中心医院核医学科,432000 [2]湖北省孝感市中心医院病理科,432000

出　　处：《中国医师进修杂志》2021年第5期421-425,共5页Chinese Journal of Postgraduates of Medicine

基　　金：湖北省卫生和计划生育委员会基金(WJ2015MB304)。

摘　　要：目的评估细针穿刺洗脱液中癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)、细胞角质蛋白19片段(Cyfra211)、甲状腺球蛋白(TG)、铁蛋白(Fer)和降钙素原(PCT)在鉴别良恶性颈部结节中的应用价值,以期筛选最优鉴别诊断模型。方法选择2017年8月至2019年8月在湖北省孝感市中心医院行细针穿刺细胞学检查的单发颈部结节患者396例,采用电化学发光分析法测定穿刺洗脱液CEA、SCC-Ag、Cyfra211、TG、Fer和PCT水平,以细胞病理学诊断为"金标准",通过受试者工作特征(ROC)曲线分析穿刺洗脱液各指标单项检测以及联合检测的诊断效能。结果396例患者中,恶性结节101例,良性结节295例。恶性结节患者穿刺洗脱液CEA、SCC-Ag、Cyfra211、TG和Fer明显高于良性结节患者[(27.73±10.63)μg/L比(16.81±8.18)μg/L、(1.59±0.74)μg/L比(1.09±0.83)μg/L、(3.31±1.48)μg/L比(1.66±0.59)μg/L、(144.96±38.93)μg/L比(95.03±47.23)μg/L和(191.18±80.13)μg/L比(137.87±63.22)μg/L],PCT明显低于良性结节患者[(0.61±0.24)μg/L比(1.01±0.52)μg/L],差异有统计学意义(P<0.01)。ROC曲线分析结果表明,单项诊断性能较高指标为CEA、Cyfra211和TG(曲线下面积>0.7,约登指数>0.5);CEA、Cyfra211和TG联合检测的曲线下面积明显高于任何指标两两联合检测(P<0.05)。结论细针穿刺洗脱液CEA、Cyfra211和TG联合检测可有效鉴别良恶性颈部结节。Objective To explore the identification value of carcinoembryonic antigen(CEA),squamous cell carcinoma antigen(SCC-Ag),cytokeratin 19 fragment(Cyfra211),thyroglobulin(TG),ferritin(Fer)and procalcitonin(PCT)in fine needle aspiration eluent in benign and malignant cervical nodules,and acquire the optimal diagnostic model.Methods Three hundred and ninety-six single cervical nodule patients who underwent fine needle aspiration biopsy from August 2017 to August 2019 in the Center Hospital of Xiaogan City of Hubei Province were selected.The fine needle aspiration eluent levels of CEA,SCC-Ag,Cyfra211,TG,Fer and PCT were detected by electrogenerated chemiluminescence method.The results of cytopathological diagnosis were regard as"gold standard",and the diagnostic efficiency of single and combined indexes in fine needle aspiration eluent were analyzed by receiver operating characteristic(ROC)curve.Results Among the 396 patients,malignant nodules was in 101 cases,and benign nodules was in 295 cases.The fine needle aspiration eluent levels of CEA,SCC-Ag,Cyfra211,TG and Fer in patients with malignant nodules were significantly higher than those in patients with benign nodules:(27.73±10.63)μg/L vs.(16.81±8.18)μg/L,(1.59±0.74)μg/L vs.(1.09±0.83)μg/L,(3.31±1.48)μg/L vs.(1.66±0.59)μg/L,(144.96±38.93)μg/L vs.(95.03±47.23)μg/L and(191.18±80.13)μg/L vs.(137.87±63.22)μg/L,the PCT was significantly lower than that in patients with benign nodules:(0.61±0.24)μg/L vs.(1.01±0.52)μg/L,and there were statistical differences(P<0.01).The ROC curve analysis result showed that the CEA,Cyfra211 and TG had super diagnostic value(area under curve>0.7,Youden index>0.5);the area under curve of CEA,Cyfra211 combined with TG was significantly higher than other combined detection of 2 indexes(P<0.05).Conclusions The combined detection of CEA,Cyfra211 and TG in fine needle aspiration eluent can effectively distinguish the benign and malignant cervical nodules.

关 键 词：颈 活组织检查 针吸 诊断 鉴别 结节 洗脱液 

分 类 号：R739.91[医药卫生—肿瘤]