【摘要】：目的利用腫瘤標(biāo)志物建立預(yù)測(cè)孤立性肺結(jié)節(jié)(SPN)惡性概率的數(shù)學(xué)模型,并評(píng)價(jià)其臨床價(jià)值。方法選取250例SPN患者,考察其年齡、性別、吸煙史、癥狀、結(jié)節(jié)最大徑、結(jié)節(jié)部位、病理,以及血清癌胚抗原(CEA)、細(xì)胞角蛋白19片段抗原(CYFRA21-1)、神經(jīng)元特異性烯醇化酶(NSE)水平,采用二分類Logistic回歸法作影響因素篩選,并建立Logistic回歸模型。繪制受試者工作特征曲線(ROC)并計(jì)算曲線下面積(AUC)以評(píng)價(jià)模型準(zhǔn)確性,并與梅奧模型比較以評(píng)價(jià)模型的臨床價(jià)值。結(jié)果 CEA(P=0.002,OR=5.921,95%CI=1.968~17.819),CYFRA21-1(P=0.046,OR=2.500,95%CI=1.018~6.142),癥狀(P=0.010,OR=2.384,95%CI=1.234~4.607),結(jié)節(jié)最大徑(P=0.001,OR=2.331,95%CI=1.441~3.773)與SPN的良惡性有關(guān);由此建立預(yù)測(cè)模型:P=ex/(1+ex),X=-1.991+0.869×癥狀+0.846×結(jié)節(jié)最大徑+1.779×CEA+0.916×CYFRA21-1;采用Hosmer-Lemeshow檢驗(yàn)?zāi)Ｐ偷臄M合度較好(P=0.691);當(dāng)截點(diǎn)為0.636時(shí),靈敏度為63.5%,特異度為71.2%;預(yù)測(cè)模型(AUC:0.734±0.033)與指南推薦的梅奧模型(AUC:0.792±0.047)進(jìn)行比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 CEA、CYFRA21-1、癥狀和結(jié)節(jié)最大徑為惡性SPN的獨(dú)立危險(xiǎn)因素;由此建立的Logistic回歸模型準(zhǔn)確性較高,有較好的臨床價(jià)值。
[Abstract]:Objective to establish a mathematical model to predict the malignant probability of solitary pulmonary nodules (SPN) by using tumor markers and to evaluate its clinical value. Methods the age, sex, smoking history, symptoms, maximum diameter of nodules, location and pathology of nodules, and serum carcinoembryonic antigen (CEA),) cytokeratin 19 fragment antigen (CYFRA21-1) were studied in 250 patients with SPN. The level of neuron-specific enolase (NSE) was screened by two-class Logistic regression and the Logistic regression model was established. To evaluate the accuracy of the model by drawing the operating characteristic curve (ROC) and calculating the area under the curve (AUC), and comparing with Mayo model to evaluate the clinical value of the model. Results CEA (P0. 002) 5.921 ~ 95CII = 1. 968 ~ 17. 819), CYFRA21-1 (P0. 046) ~ 2.500 ~ 95 ~ 95 CI = 1.018 ~ 6. 142), symptoms (P ~ 0. 010 OR2. 384 ~ 95), nodule maximum diameter (P ~ 0. 001, P ~ 0. 001), nodule diameter (P ~ 0. 001, P ~ 0. 001), symptom (P ~ 0. 010 ~ 0. 010 OR2. 384 ~ 95 CI = 1. 234 ~ 4.607). OR=2.331,95%CI=1.441~3.773) is associated with benign and malignant SPN. The prediction model was established as follows: P=ex/ (1 ex), XML-1.991 0.869 脳 symptom 0.846 脳 CEA 0.916 脳 CYFRA21-1;) fitted well with Hosmer-Lemeshow test model (P0. 691); When the cut-off point was 0.636, the sensitivity was 63.5 and the specificity was 71.2; The predictive model (AUC:0.734 鹵0.033) was compared with the Mayo model (AUC:0.792 鹵0.047) recommended by the guidelines. The difference was not statistically significant (P0.05). Conclusion CEA,CYFRA21-1, symptoms and the maximum diameter of nodules are independent risk factors for malignant SPN, and the Logistic regression model established from this model has high accuracy and good clinical value.
【作者單位】： 濱州醫(yī)學(xué)院煙臺(tái)附屬醫(yī)院呼吸內(nèi)科;濱州醫(yī)學(xué)院煙臺(tái)附屬醫(yī)院統(tǒng)計(jì)室;煙臺(tái)毓璜頂醫(yī)院血管外科;大連醫(yī)科大學(xué)附屬第二醫(yī)院呼吸內(nèi)科;
【分類號(hào)】：R734.2

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李慎江;肖湘生;劉士遠(yuǎn);李惠民;李成洲;張沉石;;惡性孤立性肺結(jié)節(jié)血流模式與結(jié)節(jié)大小的關(guān)系探討[J];中國(guó)肺癌雜志;2008年01期

2 章智榮;毛友生;;孤立性肺結(jié)節(jié)病變的診斷與處理策略[J];中國(guó)肺癌雜志;2013年09期

3 談高 ,郝麗萍 ,張晉昕 ,李占軍 ,杜中立 ,章作銓 ,洪國(guó)斌 ,彭秀斌 ,李坤煒 ,羅永輝;肺外腫瘤與合并孤立性肺結(jié)節(jié)發(fā)生率關(guān)系初探[J];影像診斷與介入放射學(xué);2003年02期

4 吳一龍;蔣國(guó)j;廖美琳;周清華;陸舜;王俊;王長(zhǎng)利;傅渝;程穎;赫捷;張力;楊學(xué)寧;許林;黃誠(chéng);湯鵬;毛偉敏;周彩存;宋啟斌;周清;;孤立性肺結(jié)節(jié)的處理[J];循證醫(yī)學(xué);2009年04期

5 周友俊;鄧智勇;劉長(zhǎng)江;李高峰;向旭東;賈莉;劉超;;~(99m)Tc-MIBI-SPECT與定位CT融合顯像診斷孤立性肺結(jié)節(jié)的價(jià)值[J];昆明醫(yī)科大學(xué)學(xué)報(bào);2014年01期

6 羅清泉;;老年孤立性肺結(jié)節(jié)臨床處理選擇[J];實(shí)用老年醫(yī)學(xué);2014年08期

7 王俊;;老年孤立性肺結(jié)節(jié)診斷的進(jìn)展[J];實(shí)用老年醫(yī)學(xué);2014年08期

8 公長(zhǎng)春;肖喜剛;;64排螺旋CT掃描對(duì)惡性孤立性肺結(jié)節(jié)的影像診斷[J];牡丹江醫(yī)學(xué)院學(xué)報(bào);2008年02期

9 高春民;左傳田;李守波;錢立宇;譚軍濤;;孤立性肺結(jié)節(jié)電視輔助胸腔鏡手術(shù)的臨床研究[J];中國(guó)癌癥防治雜志;2010年02期

10 廖栩鶴;王榮福;范巖;張建華;王彥福;康磊;;孤立性肺結(jié)節(jié)—周圍型腺癌1例[J];腫瘤學(xué)雜志;2011年11期

相關(guān)會(huì)議論文 前6條

1 余苔痕;吳恩福;鄭祥武;姜億一;葉彩兒;;惡性孤立性肺結(jié)節(jié)螺旋CT診斷[A];2007年浙江省放射學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2007年

2 王昕s，

本文編號(hào)：2409773