| 赵 波,李京京,刘永利,王景诗,张晶晶,董旭鹏.CT征象联合血清外泌体CDH5鉴别直径5~30 mm磨玻璃样肺腺癌浸润的价值[J].,2024,(16):3128-3133 |
| CT征象联合血清外泌体CDH5鉴别直径5~30 mm磨玻璃样肺腺癌浸润的价值 |
| The Value of CT Signs Combined with Serum Exosomal CDH5 in Identifying 5~30 mm Diameter Ground-glass Lung Adenocarcinoma Infiltration |
| 投稿时间：2024-01-30 修订日期：2024-02-26 |
| DOI：10.13241/j.cnki.pmb.2024.16.025 |
| 中文关键词: 肺腺癌 CT征象 外泌体 CDH5 浸润 |
| 英文关键词: Lung adenocarcinoma CT signs Exosomes CDH5 Infiltration |
| 基金项目:河北省卫生健康委医学科学研究课题计划项目（20201312）；河北省秦皇岛市科技计划项目（201502A121） |
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| 中文摘要: |
| 摘要 目的：探究CT征象联合血清外泌体钙粘蛋白5（CDH5）鉴别直径5~30 mm磨玻璃样肺腺癌浸润的价值。方法：选取104例CT表现为磨玻璃样肺腺癌（腺体前驱病变和腺癌）患者和20例良性肺结节患者作为研究对象。用蛋白质免疫印迹法检测外泌体CDH5水平。比较肺腺癌和良性肺结节患者外泌体CDH5水平；比较肺腺癌非浸润和浸润患者的CT征象和外泌体CDH5水平差异。用Logistic回归分析肺腺癌浸润的风险因素。用受试者工作特征（ROC）曲线、平均绝对误差和决策曲线分析（DCA）评价模型价值。结果：肺腺癌患者血清外泌体CDH5水平低于良性肺结节患者（P＜0.05）。肺腺癌中非浸润性病变67例，浸润性病变37例。浸润性病变患者的混合磨玻璃结节、毛刺征、血管集束征和瘤肺界面不清晰占比均高于非浸润性病变患者，外泌体CDH5水平低于非浸润性病变患者（P＜0.05）。Logistic回归分析结果显示混合磨玻璃结节、毛刺征和瘤肺界面不清晰均是肺腺癌未浸润的危险因素，外泌体CDH5≥0.31是肺腺癌未浸润的保护因素（P＜0.05）。模型B（由结节类型、毛刺征、瘤肺界面和外泌体CDH5构成）鉴别肺腺癌浸润的ROC曲线下面积高于模型A（由结节类型、毛刺征和瘤肺界面构成，P＜0.05）。模型B的平均绝对误差值低于模型A。风险阈值在0~0.08，模型A的净收益高于模型B；风险阈值在0.08~1.00，模型B的净收益高于模型A。结论：混合磨玻璃结节、毛刺征、瘤肺界面不清晰和外泌体CDH5均与肺腺癌浸润有关，由上述因素构成的模型可辅助评估5~30 mm磨玻璃样肺腺癌是否浸润。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the value of CT signs combined with serum exosomal cadherin 5 (CDH5) in identifying 5~30 mm diameter ground-glass lung adenocarcinoma infiltration. Methods: 104 patients with lung adenocarcinomas (glandular precursor lesions and adenocarcinoma) showing ground glass on CT and 20 patients with benign lung nodules were selected as study subjects. Exosomal CDH5 levels were detected by western blotting. Exosomal CDH5 levels were compared between patients with lung adenocarcinomas and benign lung nodules. CT signs and differences in exosomal CDH5 levels were compared between patients with non-infiltrating and infiltrating lung adenocarcinomas. Risk factors for lung adenocarcinoma infiltration were analyzed by logistic regression. The risk models values were analyzed by receiver operating characteristic (ROC) curves, mean absolute error, and decision curve analysis (DCA). Results: Serum exosomal CDH5 levels were lower in patients with lung adenocarcinoma than in patients with benign lung nodules (P<0.05). There were 67 cases of non-infiltrative lesions and 37 cases of infiltrative lesions in lung adenocarcinomas. The percentage of mixed ground-glass nodules, burr signs, vascular cluster signs, and the unclear tumor-pulmonary interface were higher in patients with infiltrative lesions than in patients with non-infiltrative lesions, and the level of exosomal CDH5 was lower than that in patients with non-infiltrative lesions(P<0.05). Logistic regression analysis showed that mixed ground-glass nodules, burr signs, and the unclear tumor-pulmonary interface were all risk factors for lung adenocarcinoma without infiltration, and exosomal CDH5≥0.31 was a protective factor for lung adenocarcinoma without infiltration (P<0.05). The area under the ROC curve for identifying lung adenocarcinoma infiltration was higher in model B (consisting of nodule type, burr sign, tumor-pulmonary interface, and exosomal CDH5) than in model A (consisting of nodule type, burr sign, and tumor-pulmonary interface, P<0.05). The mean absolute error value of model B was lower than that of model A. The net benefit of model A was higher than that of model B for risk thresholds ranging from 0 to 0.08, and that of model B was higher than that of model A for risk thresholds ranging from 0.08 to 1.00. Conclusion: Mixed ground-glass nodules, burr signs, the unclear tumor-pulmonary interface, and exosomal CDH5 were all associated with lung adenocarcinoma infiltration. The model consisting of these factors can assist in assessing whether 5~30 mm ground-glass lung adenocarcinoma is infiltrating. |
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