血清 ALP、CT监测肺癌骨转移的临床意义

摘要

目的：通过对肺癌患者血清碱性磷酸酶( ALP)、降钙素( CT)水平的测定,分析肺癌骨转移患者血清ALP、CT水平的变化,并评价其监测肺癌骨转移的临床意义。方法：对80例经病理或穿刺活检证实为肺癌的患者行99m锝-亚甲基二磷酸盐(99mTc-MDP)全身骨显像,根据骨转移诊断标准将肺癌患者分为未骨转移组(48例)和骨转移组(32例),并对80例肺癌患者及30例肺部良性疾病患者进行血清ALP、CT水平测定,比较各组患者间血清ALP、CT水平的变化,并通过受试者工作特征曲线( Receiver operator characteristic curve,ROC曲线)及联合检测来评价其监测肺癌骨转移的临床意义。结果：肺癌组患者血清ALP、CT水平明显高于肺部良性病变组(P<0.01)；肺癌骨转移组患者血清ALP、CT水平明显高于未骨转移组(P<0.01)；患者血清ALP、CT的曲线下面积(Area under the ROC curves,AUC)分别为0.715、0.760,患者血清ALP的敏感性为69.400%,特异性为79.600%,血清CT的敏感性为61.900%,特异性为84.600%；通过联合检测可将敏感度提高至85.000%,特异度提高至93.333%。结论：血清ALP、CT可作为肺癌骨转移的初筛及监测方法。%Objective:To analyze change of serum alkaline phosphatase ( ALP) and calcitonin ( CT) levels in patients with bone metastases of lung cancer and evaluate clinical significance of ALP and CT in monitoring bone metastases by measuring the levels of serum ALP and CT. Methods:80 lung cancer patients confirmed by pathology or needle biopsy were underwent 99mTc-MDP whole body bone images, and divided into non-bone metastasis group (48 persons) and bone metastasis group (32 persons) according to the criteria for the diagnosis of bone metastases. The levels of ALP and CT of 80 patients with lung cancer and 30 patients with benign lung diseases were detected and compared. The clinical significance of ALP and CT in monitoring bone metastases was evaluated by receiver operating characteristic curve ( ROC) and the joint detection. Results:The levels of ALP and CT in lung cancer group were much high-er than those in benign lung disease group (P<0. 01);and the levels in bone metastasis group were much higher than those in non-bone metastasis (P<0. 01). The area under the ROC curves of ALP and CT was 0. 715 and 0. 760. The sensitivity and specificity of ALP were 69. 400% and 79. 600%, respectively; and those of CT were 61. 900% and 84. 600%, respectively. The sensitivity and specificity can be promoted to 85. 000% and 93. 333% by the joint detection, respectively. Conclusions:ALP and CT can be used for lung cancer screening and a monitoring method of bone metastases.