摘要
目的探讨低剂量螺旋CT（LDCT）在肺癌筛查中的应用价值。方法前瞻性人组2011年6月至2012年12月于复旦大学附属中山医院体检中心行胸部LDCT检查的无症状人群，总结肺结节和肺癌的检出率，比较吸烟相关的肺癌高、中、低危人群组中LDCT筛查的价值差异。并探讨是否能通过血清肿瘤标志物降低LDCT筛查的假阳性。结果2251名体检人群中，222名（9．9％）胸部LDCT结果显示至少1个I〉4mm的非钙化结节。随访发现诊断为肺癌者2例，1例手术切除。与吸烟相关的肺癌高、中、低危组中肺结节检出率分别为8．8％、9．5％和10．1％；3组间数据差异均无统计学意义（均P=0．864）。年龄≥55岁者肺结节检出率显著高于年龄〈55岁者（12．7％比9．1％，P=0．034）。女性为磨玻璃样影或磨玻璃样结节的高危因素（P=0．015）。肺癌肿瘤标志物癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、角质蛋白19片段（Cyfra211）和鳞癌细胞抗原（SCC）的单独或联合检测未能预测肺结节检出率（均P〉0．05）。结论低剂量螺旋CT在肺癌筛查中具有较高的应用价值。
Objective To explore the application value of low-dose spiral computed tomography （LDCT） in lung cancer screening. Methods A total of 2251 asymptomatic subjects undergoing chest LDCT scan at Center of Physical Examination, Affiliated Zhongshan Hospital, Fudan University between June 2011 and December 2012 were prospectively enrolled. The incidence rates of lung nodule and lung cancer were analyzed to compare the value of LDCT screening in subjects with smoking-related high, medium and low risks of lung cancer. The value of serum tumor biomarker in the reduction of false positive of LDCT was also discussed. Results Among all subjects, 9. 9% （222/2251） displayed at least 1 non-calcified nodule with a diameter ≥4 mm. Two subjects were diagnosed with lung cancer and 1 of them received surgical resection. Other subjects with lung nodules were followed. There was no statistical difference in the incidence rates of lung nodule between the high, medium and low-risk groups of lung cancer associated with smoking （ 8.8%, 9.5 % and 10. 1% , P = 0. 864 ）. The incidence rates of lung nodule in subjects I〉 55 years old were higher than that of those 〈 55 years old （ 12. 7% vs 9. 1%, P = 0. 034）. Female gender had a high risk of ground glass opacity （GGO） or ground glass nodule （GGN） （P =0. 015）. The independent or combined increase of serum tumor biomarkers of carcinoembryonic antigen （CEA） , neuron specific enolase （ NSE）, cytokeratin fragment 21-1 （Cyfra211 ） and squamous cell carcinoma antigen （SCC） might not predicate the incidence of lung nodule. Conclusion LDCT screening is highly valuable in lung cancer screening.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第38期3011-3014,共4页
National Medical Journal of China
基金
上海市重点学科建设项目（B115）
