多因素联合对于肺癌骨转移的诊断价值

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摘要目的探讨多因素联合对于肺癌骨转移的诊断价值。方法纳入2013年1月~2015年12月于唐山市人民医院放化疗科初治的126例肺癌患者，应用酶联免疫吸附试验法检测血清Ⅰ型胶原吡啶交联氨基末端肽（NTx）水平，同时检测血清碱性磷酸酶（ALP）水平，收集性别、年龄、体力状态评分（KPS）等一般临床信息。应用ECT结合CT、MRI诊断骨转移。以是否存在骨转移进行分组，应用ROC曲线判断NTx、ALP及KPS对于肺癌骨转移诊断价值，并确定最佳cutoff值，进一步采用Logistic回归模型分析骨转移相关诊断因素，多因素分析结果提示独立预测因子作为联合指标进一步应用ROC曲线分析。结果 126例中骨转移的发生率为34.1％。分组后ROC曲线观察初治肺癌患者血清NTx和ALP水平及KPS评分等对于骨转移的诊断价值关系，确立NTx、ALP和KPS评分用于诊断骨转移的最佳cutoff值分别为21.5 nmol/L、94 U/L和80分，其ROC曲线下面积分别为0.792、0.641和0.644，敏感性和特异性分别为65.1%和84.3%，46.5%和81.9%，74.4%和44.6%，分类后多因素分析显示血清NTx，ALP水平以及KPS评分均为骨转移的独立预测因子（P < 0.05）。联合应用NTx、ALP和KPS评分三指标的ROC曲线下面积为0.861，其敏感性为74.4%，特异性为86.7%。较单一因素，联合指标的诊断效力明显提高。结论血清NTx和ALP水平以及KPS均为肺癌骨转移相关的独立诊断因子，联合应用NTx、ALP和KPS评分三指标的诊断效力明显提高，该结果尚需大样本多中心的研究来证实。

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	吴琼马海洋张明明王志武▲ 王雪臣崔泽军

关键词 ：肺癌, 骨转移瘤, 生物标志物, Ⅰ型胶原吡啶交联氨基末端肽

Abstract：Objective To investigate the diagnostic value of multi-factorial combination in bone metastasis of lung cancer. Methods From January 2013 to December 2015, 126 newly diagnosed lung cancer patients from Department of Chemoradiotherapy in Tangshan People′s Hospital were selected in this study. The serum levels of NTx and ALP were measured and the information of clinical characteristics such as sex, age and the Karnofsky's index of performance status (KPS) score were collected. The bone metastasis was diagnosed by ECT combined with CT and MRI. Patients were grouped according to the presence or absence of bone metastasis. ROC curves were used to examine the diagnostic value of NTx, ALP and KPS and determine the best cutoff value. The correlation between bone metastasis and aforementioned factors was analyzed by logistic regression analysis. The multi-factorial combination which was produced though Logistic regression analysis was valued by ROC test again. Results The rate of bone metastasis was 34.1%. After being grouped, ROC analysis indicated that the optimal cutoff value of NTx, ALP and KPS were 21.5 nmol/L, 94 U/L and 80. The areas under the ROC curve of NTx, ALP and KPS were 0.792, 0.641 and 0.644. The sensitivities were 65.1%, 46.5% and 74.4% and the specificities were 84.3%, 81.9% and 44.6% respectively. Univariate and multivariate analysis showed NTx, ALP and KPS were significantly correlated with bone metastasis（P < 0.05）. Further ROC test demonstrated that the multi-factorial combination got a better diagnostic result (area under the ROC curve 0.861, sensitivity 74.4% and specificities 86.7%). Conclusion Serum NTx, Serum ALP and KPS were independent factors corrected with bone metastasis. Multi-factorial combination has a higher diagnostic result than single factor. Further multi-center studies with large sample should be conducted to confirm the result.

Key words： Lung cancer Bone metastasis Biomarkers Collagen Type Ⅰ collagen pyridinoline cross-linked N-telo peptides

基金资助:河北省医学科学研究重点课题计划（20181209）。

通讯作者: ▲通讯作者

引用本文:

吴琼马海洋张明明王志武▲ 王雪臣崔泽军. 多因素联合对于肺癌骨转移的诊断价值[J]. 中国医药导报, 2018, 15(16): 55-58.
WU Qiong MA Haiying ZHANG Mingming WANG Zhiwu▲ WANG Xuechen CUI Zejun. Diagnostic value of multi-factorial combination for bone metastasis of lung cancer. 中国医药导报, 2018, 15(16): 55-58.

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