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目的探讨低剂量螺旋CT联合肿瘤标志物对社区肺癌高危人群的筛查效果。方法选取2016年1月至2017年1月间在常州市金坛区中医医院体检的1 388例社区肺癌高危人群,采用随机数表法分为试验组(632例)和对照组(756例)。试验组患者采用低剂量螺旋CT(LDCT)联合血清肿瘤标志物筛查,对照组患者采用胸部X线(CXR)筛查,比较两组体检者初筛阳性率和肺癌确诊率。根据筛查结果将试验组分为确诊肺癌组、初筛阳性但排除肺癌组和初筛阴性组,比较三组体检者癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原199(CA199)、人多效蛋白(PTN)、神经元特异性烯醇化酶(NSE)和细胞角质蛋白(Cyfra21-1)等肿瘤标志物水平,对试验组患者性别、年龄、吸烟指数、肺癌家族史、肺病病史和职业有害因素接触史等进行单因素和多因素Logistic回归分析,探讨LDCT初筛阳性的高危因素。结果试验组体检者初筛阳性率和确诊肺癌率,均显著高于对照组,差异均有统计学意义(均P<0.05)。确诊肺癌组的CEA、PTN、NSE和Cyfra21-1水平均显著高于初筛阳性但排除肺癌组和初筛阴性组,差异均有统计学意义(均P<0.05)。三组体检者CA125和CA199水平比较,差异无统计学意义(P>0.05)。多因素Logistic分析显示:年龄>50岁、吸烟指数>400支/年和有职业有害因素接触史等,为初筛阳性的高危因素。结论 LDCT可明显提高初筛阳性率,且与CEA、PTN、NSE和Cyfra21-1等肿瘤标志物检测联合,可进一步提高肺癌确诊率,具有高危险因素的人群应定期行肺癌早期筛查。
Objective To investigate the screening effect of low-dose spiral CT combined with tumor markers on high risk population of community lung cancer. Methods A total of 1 388 community-based high-risk population of community-based lung cancer at the Jintan District Chinese Medicine Hospital of Changzhou from January 2016 to January 2017 were selected and randomized into the experimental group (632 cases) and the control group (756 cases) . The patients in the test group were screened by low-dose spiral CT (LDCT) combined with serum tumor markers. The control group was screened by chest X-ray (CXR). The positive rate of primary screening and the diagnosis of lung cancer were compared between the two groups. According to the screening results, the experimental group was divided into the group of diagnosed lung cancer, the primary screening positive but excluding the lung cancer group and the primary screening negative group. The CEA, carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), human pleiotropic protein (PTN), neuron-specific enolase (NSE) and cytokeratin (Cyfra21-1) History, the history of lung disease and occupational harmful factors such as contact history of single factor and multivariate Logistic regression analysis to explore the positive risk factors of LDCT screening. Results The positive rates of positive screening and lung cancer diagnosis in the test group were significantly higher than those in the control group (all P <0.05). The levels of CEA, PTN, NSE and Cyfra21-1 in the diagnosed lung cancer group were significantly higher than those of the primary screening positive lung cancer group but negative in the lung cancer screening group and the primary screening negative group (all P <0.05). There was no significant difference in CA125 and CA199 levels between the three groups (P> 0.05). Multivariate Logistic analysis showed that: age> 50 years old, smoking index> 400 / year and history of exposure to occupational harmful factors, screening for the positive risk factors. Conclusions LDCT can significantly increase the positive rate of primary screening, and combined with the detection of tumor markers such as CEA, PTN, NSE and Cyfra21-1 can further improve the diagnosis rate of lung cancer. Patients with high risk should be screened regularly for lung cancer.