能谱CT联合肿瘤标志物在诊断肺癌病理分型中的应用价值  

Application value of spectral CT and tumor markers in pathological subtyping of lung cancer

作　　者：苏相茹 李猛[2] 韩妞妞 吴嘉倩 陈亚明[2] SU Xiangru;LI Meng;HAN Niuniu;WU Jiaqian;CHEN Yaming(Graduate School,Bengbu Medical University,Bengbu 233000,China;Department of Imaging,General Hospital of North Coal and Power Group,Suzhou 234000,China.)

机构地区：[1]蚌埠医科大学研究生院,安徽蚌埠233000 [2]皖北煤电集团总医院影像科,安徽宿州234000

出　　处：《中国中西医结合影像学杂志》2025年第2期161-167,共7页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：宿州市卫生健康科研项目(szwj2022a071)。

摘　　要：目的:探讨能谱CT成像、肿瘤标志物水平及两者联合在鉴别肺癌病理分型中的应用价值。方法:回顾性收集104例肺癌患者的能谱CT、肿瘤标志物资料,按病理类型将104例分为腺癌组38例,鳞癌组35例,小细胞肺癌组31例,对比3组能谱CT成像参数及肿瘤标志物,包括标准化碘浓度(NIC)、标准化原子序数(nZ_(eff))、能谱曲线斜率(K_(1)、K_(2)、K_(3))、神经元特异性烯醇化酶(NSE)、鳞状细胞癌相关抗原(SCC)、细胞角蛋白19片段(CYFRA21-1)及癌胚抗原(CEA)。结果:动脉期3组的NIC及K_(3)差异无统计学意义(均P>0.05),nZ_(eff)及K_(1)、K_(2)差异均有统计学意义(均P<0.05)。静脉期3组的K_(2)、K_(3)差异均无统计学意义(均P>0.05),NIC、nZ_(eff)及K_(1)差异均有统计学意义(均P<0.05)。腺癌组的CEA水平高于其他2组,小细胞肺癌组的NSE水平高于其他2组,鳞癌组的SCC、CYFRA21-1水平高于其他2组,差异均有统计学意义(均P<0.05)。能谱CT参数联合4种肿瘤标志物诊断腺癌、鳞癌及小细胞肺癌的AUC分别为0.981、0.963和0.969,均大于两者单独应用。结论:能谱CT成像参数及肿瘤标志物在肺癌病理分型中均有一定应用价值,两者联合诊断的AUC均大于两者单独应用,推荐两者联合使用。Objective:To evaluate the diagnostic performance of spectral CT parameters,serum tumor markers,and their combined use in differentiating pathological subtypes of lung cancer.Methods:This retrospective study enrolled 104 patients with lung cancer,and they were categorized into adenocarcinoma(38 cases),squamous cell carcinoma(35 cases),and small cell carcinoma(31 cases)groups.Spectral CT parameters,including normalized iodine concentration(NIC),normalized effective atomic number(nZ_(eff)),spectral curve slopes(K_(1),K_(2),K_(3)),and tumor markers(NSE,SCC,CYFRA21-1,CEA)were compared.Results:In the arterial phase,no significant differences were observed in NIC or K3(both P>0.05),while nZ_(eff),K1 and K2 showed significant intergroup variations(all P<0.05).During the venous phase,K_(2) or K_(3) exhibited no statistical differences(both P>0.05),whereas NIC,nZ_(eff) and K_(1) demonstrated significant differences(all P<0.05).Adenocarcinoma showed elevated CEA levels,small cell carcinoma exhibited higher NSE levels,while squamous cell carcinoma displayed increased SCC and CYFRA21-1 concentrations compared to other subtypes(all P<0.05).The combined model integrating spectral CT parameters with four tumor markers achieved superior diagnostic performance,yielded AUC of 0.981 for adenocarcinoma,0.963 for squamous cell carcinoma,0.969 for small cell carcinoma,outperforming individual parameter analyses.Conclusions:Spectral CT parameters and tumor markers demonstrate complementary value in lung cancer subtyping,with their combination yielding optimal diagnostic accuracy.Integrated clinical application of both modalities is strongly recommended.

关 键 词：肺肿瘤 肿瘤标记物 病理类型 体层摄影术 X线计算机 能谱成像 

分 类 号：R73[医药卫生—肿瘤]