能谱CT定量参数联合NLR、CAR检测对非小细胞肺癌根治术后复发转移的预测价值  

Value of quantitative parameters of energy spectrum CT combined with NLR and CAR detection in predicting recurrence and metastasis of non-small cell lung cancer after radical surgery

作　　者：张自超 吴志刚 万洪晓[4] 杜嘉慧[3] ZHANG Zi-chao;WU Zhi-gang;WAN Hong-xiao(Surgical Teaching and Research Office,Linyi Health School,Shandong 276000,China)

机构地区：[1]山东省临沂卫生学校外科教研室,山东276000 [2]山东省临沂卫生学校预防医学教研室,山东276000 [3]临沂市人民医院胸外科,山东276000 [4]临沂市人民医院医学影像科,山东276000

出　　处：《放射学实践》2024年第5期641-646,共6页Radiologic Practice

摘　　要：目的:探讨能谱CT定量参数联合NLR、CAR检测对非小细胞肺癌(NSCLC)根治术后复发转移的预测价值。方法:选择2018年1月至2021年6月于我院就诊并接受根治性切除术的114例NSCLC患者作为研究对象,术前对患者行胸部平扫及双期增强扫描,记录平扫有效原子序数(Eff-Z)、病灶处动脉期标准化碘浓度(NICVP)和静脉期标准化碘浓度(NICAP)、碘浓度差值(ICD)。术前采用全自动血细胞分析仪检测中性粒细胞、淋巴细胞计数,采用免疫比浊法测定血清C反应蛋白水平,溴甲酚绿法测定血清白蛋白水平,计算并记录中性粒细胞/淋巴细胞比值(NLR)、C反应蛋白水平/白蛋白比值(CAR)。患者术后门诊随访2年,观察是否发生复发转移。结果:术后复发转移与未复发转移NSCLC患者的性别、年龄、BMI、家族肿瘤史、吸烟史和病理类型比较差异均无统计学意义(P均>0.05);术后复发转移组患者中临床分期为Ⅱ期和有淋巴结转移的比例显著高于术后无复发转移组(P<0.05)。术后复发转移患者的Eff-Z、NICVP、NICAP、ICD均低于未复发转移组(P<0.05),NLR、CAR均高于未复发转移组(P<0.05)。多因素Logistic回归分析结果显示,TNM分期、淋巴结转移、Eff-Z、NICAP、NLR、CAR水平是NSCLC患者术后复发转移的独立影响因素(P<0.05)。建立Logistic回归方程如下:Logit(P)=-0.179+1.211×TNM分期+1.161×淋巴结转移+(-0.209)×Eff-Z+(-0.368)×NICAP+0.842×NLR+0.934×CAR。ROC曲线分析结果显示,建立的模型预测NSCLC患者术后复发转移的曲线下面积为0.958(95%CI:0.920~0.997,P<0.001),敏感度和特异度分别为92.0%和85.4%,优于各指标的单独预测效能。结论:联合应用临床病理特征、能谱CT定量参数及NLR、CAR检测对非小细胞肺癌根治术后复发转移的预测效能较好,具有一定临床应用价值。Objective:To investigate the value of quantitative parameters of energy spectrum CT combined with NLR and CAR detection in predicting recurrence and metastasis of non-small cell lung cancer(NSCLC)after radical surgery.Methods:A total of 114 patients with NSCLC who received radical resection in our hospital from January 2018 to June 2021 were selected as the study subjects.Preoperative chest plain scan and double-phase enhanced scan were performed on the patients,and the effective atomic number(Eff-Z),standardized iodine concentration(NICVP)at arterial stage,standardized iodine concentration(NICAP)at venous stage and iodine concentration difference(ICD)were recorded.Neutrophil and lymphocyte counts were detected by automatic blood cell analyzer,serum C-reactive protein levels were determined by immunoturbidimetry,serum albumin levels were determined by bromocresol green method,neutrophil/lymphocyte ratio(NLR)and C-reactive protein/albumin ratio(CAR)were calculated and recorded.The patients were followed up for 2 years to observe whether recurrence and metastasis occurred.Results:There was no significant difference in gender,age,BMI,family tumor history,smoking history and pathological types between NSCLC patients with and without postoperative recurrence and metastasis(P>0.05).The proportion of patients with stageⅡand lymph node metastasis in the recurrent and metastatic group was significantly higher than that in the non-recurrent and non-metastatic group(P<0.05).The Eff-Z,NICVP,NICAP and ICD of patients with postoperative recurrence and metastasis were significantly lower than those without recurrence and metastasis(P<0.05),while NLR and CAR were significantly higher than those without recurrence and metastasis(P<0.05).Multivariate Logistic regression analysis showed that TNM stage,lymph node metastasis,Eff-Z,NICAP,NLR and CAR levels were independent influencing factors for postoperative recurrence and metastasis in NSCLC patients(P<0.05).The Logistic regression equation was established as follows:Logit(P)=-0.

关 键 词：非小细胞肺癌 能谱CT 体层摄影术 X线计算机 中性粒细胞/淋巴细胞比值 C反应蛋白水平/白蛋白比值 复发转移 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]