肺泡灌洗液RASSF1A及SHOX2甲基化联合径向超声特征对肺结节性质鉴别诊断的意义  

Significance of RASSF1A and SHOX2 methylation in bronchoalveolar lavage fluid combined with radial ultrasonic features in differentiating the property of pulmonary nodules

作　　者：刘锦程 王斌 张雯 张明周 刘禹 叶东樊 黄赞胜 邱凌霄 卿斌 王创业 王南博 王苹 郭宇航 周培花 程秋霞 徐智 Liu Jincheng;Wang Bin;Zhang Wen;Zhang Mingzhou;Liu Yu;Ye Dongfan;Huang Zansheng;Qiu Lingxiao;Qing Bin;Wang Chuangye;Wang Nanbo;Wang Ping;Guo Yuhang;Zhou Peihua;Cheng Qiuxia;Xu Zhi(Department of Respiratory and Critical Care Medical Center,The Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Chongqing Key Laboratory for Precise Diagnosis,Treatment,Prevention and Control of Major Respiratory Diseases,Chongqing 400037,China)

机构地区：[1]陆军(第三)军医大学第二附属医院呼吸与危重症医学中心,重庆400037 [2]重大呼吸疾病精准诊疗与防控重庆市重点实验室,重庆400037

出　　处：《中华肺部疾病杂志（电子版）》2024年第4期505-511,共7页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：重庆市技术创新与应用发展专项重点项目(CSTC2021jscx-gksb-N0029)。

摘　　要：目的分析检测肺泡灌洗液中大鼠肉瘤(rat sarcoma,Ras)相关区域家族1A基因(Ras association family 1 isoform A,RASSF1A)和矮小同源盒基因2(short stature homeobox 2,SHOX2)甲基化联合径向超声特征对肺结节性质鉴别诊断的意义。方法选择2022年9月至2024年3月我院收治的肺结节患者90例,经组织病理学确诊恶性肺结节54例为观察组,良性肺结节36例为对照组,收集肺泡灌洗液进行细胞学检查及RASSF1A、SHOX2基因甲基化检测,比较两组甲基化阳性率,分析肺泡灌洗液甲基化检测对肺结节性质的灵敏度和特异性,采用Logistic回归分析从临床特征、径向超声特征及甲基化指标中筛选预测因子,构建恶性肺结节预测模型。结果观察组RASSF1A阳性22例(40.74%)高于对照组1例(2.78%)(P<0.01)、SHOX2阳性25例(46.30%)高于对照组2例(5.56%)(P<0.01)、RASSF1A及SHOX2两者阳性14例(25.93%)高于对照组1例(2.78%)(P<0.05)、RASSF1A或SHOX2阳性33例(61.11%)高于对照组2例(5.56%)(P<0.01);RASSF1A或SHOX2阳性诊断恶性肺结节的灵敏度61.11%、特异性94.44%。RASSF1A或SHOX2阳性33例(61.11%)高于肺泡灌洗液细胞学阳性17例(31.48%)(P<0.05);RASSF1A或SHOX2阳性联合肺泡灌洗液细胞学阳性率72.22%;观察组径向超声特征中边缘连续比率81.40%、内部回声不均匀比率83.72%及低回声影比率72.09%高于对照组40.00%、40.00%、45.71%(P<0.05);多因素Logistic回归分析显示,两基因甲基化、径向超声特征边缘连续及内部回声不均匀为预测恶性肺结节的危险因素,绘制受试者工作特征曲线下面积(area under the curve,AUC)为0.886。结论RASSF1A联合SHOX2甲基化检测肺泡灌洗液用于恶性肺结节诊断具有价值,RASSF1A及SHOX2甲基化联合径向超声特征对肺结节性质鉴别诊断有临床意义。Objective To analyse the significance of methylation test of Ras association family 1 isoform A(RASSF1A)and short stature homeobox 2(SHOX2)in bronchoalveolar lavage fluid(BALF)combined with radial ultrasonic features in the differential diagnosis between malignant and benign pulmonary nodules.Methods Ninety patients with pulmonary nodules admitted to our hospital from September 2022 to March 2024 were selected,54 cases of malignant pulmonary nodules diagnosed by histopathology were in the observation group,and 36 cases of benign pulmonary nodules were in the control group,and BALF was collected for cytological examination and methylation detection of the RASSF1A and SHOX2 genes to compare the methylation positivity rate of the two groups and analyse the sensitivity and specificity of pulmonary nodules.Logistic regression analysis was used to screen some clinical characteristics,radial ultrasonic features and methylation indexes as predictors to construct a prediction model of pulmonary nodules.Results In the observation group,22 cases(40.74%)of RASSF1A positivity were higher than 1 case(2.78%)in the control group(P<0.01);25 cases(46.30%)of SHOX2 positivity were higher than 2 cases(5.56%)in the control group(P<0.01);14 cases(25.93%)of both RASSF1A and SHOX2 positivity were higher than 1 case(2.78%)in the control group(P<0.05);33 cases(61.11%)of RASSF1A or SHOX2 positivity were higher than 2 cases(5.56%)in the control group(P<0.01);The sensitivity for diagnosing malignant lung nodules was 61.11%and the specificity was 94.44%for the positivity of RASSF1A or SHOX2.33 cases(61.11%)of RASSF1A or SHOX2 positivity were significantly higher than 17 cases(31.48%)of BALF cytology positivity(P<0.05);Radial ultrasound characteristics of the observation group in the ratio of the continuous margins of 81.40%,the ratio of the uneven internal echo of 83.72%and the ratio of hypoechogenic shadows of 72.09%were higher than that of the control group of 40.00%,40.00%,45.71%(P<0.05);Multifactorial logistic regression analysis showed th

关 键 词：肺结节 肺泡灌洗液 大鼠肉瘤相关区域家族1A基因甲基化 矮小同源盒基因甲基化 径向超声特征 

分 类 号：R563[医药卫生—呼吸系统]