肺磨玻璃结节患者浸润性病变及间变性淋巴瘤激酶基因突变的影响因素分析

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Abstract Objective To analyze the influencing factors of infiltrative lesion and anaplastic lymphoma kinase (ALK)gene mutation in patients with lung ground glass nodule (GGN). Methods A total of 80 lung GGN patients suspected with ALK gene mutation admitted to oncology department of our hospital from January 2015 to January 2018 were selected as the research objects, including 30 cases with pre-infiltration lesions and 50 cases with infiltration lesions, 36 patients in normal ALK gene group, 44 patients in the gene mutation group.The pathological results were used as the gold standard to analyze the differences between the pathological status of patients with pre-infiltration lesions and infiltration lesions, as well as ALK gene mutations, and to study the influencing factors of GGN invasion and ALK gene mutations. Results There were statistically significant differences in morphology (hair prick sign, lobular sign, pleural indentation or stretch sign, bronchial inflation sign or vacuole sign), size, relative CT value, CT value, volume and mass between pre-infiltration lesions and infiltration lesions (P＜0.05).Logistic regression analysis showed that GGN mass(β=2.190, OR=8.935, 95%CI：7.446-10.722), volume (β=1.781, OR=5.936, 95%CI：4.841-7.278), CT value (β=1.709,OR=5.523,95%CI：4.694-6.499),relative CT value(β=1.684,OR=5.387, 95%CI：3.690-7.864), size (β=1.762, OR=5.824,95%CI：5.264-6.324),hair prick sign(β=1.594,OR=4.923,95%CI：4.184-5.793),lobular sign(β=1.665,OR=5.286,95%CI：4.153-6.727), pleural indentation or stretch sign (β=1.606, OR=4.983, 95%CI：4.413-5.627), bronchial inflation sign or vacuole sign (β=1.794, OR=6.013, 95%CI：5.191-6.966) were influencing factors of infiltrative lesions (P＜0.05).The ROC curve showed that the sensitivity of lesions ≥0.276 g to diagnose GGN infiltration was 80.0% (24/30),the specificity was 94.0% (47/50), and the area under the ROC curve was 0.872.There were statistically significant differences in GGN size, volume, mass, and invasion between the gene mutation group and the normal gene group (P＜0.05).Logistic regression analysis showed that mass (β=2.059, OR=7.838, 95%CI：5.380-11.419), volume (β=1.936, OR=6.931, 95%CI：5.036-9.540), size (β=1.781, OR=5.936, 95%CI：4.450-7.918), and invasion (β=1.635, OR=5.129, 95%CI：4.031-6.528) were the influencing factors of ALK gene mutation (P＜0.05).The optimal cut-off values for ALK gene mutations diagnosed by GGN mass, volume and size were 0.256 g, 565.6 mm3 and 10.4 mm, respectively, and the areas under the ROC curve were 0.803, 0.781 and 0.755. Conclusion The mutation of ALK gene is an important factor affecting the invasion of GGN.High-resolution CT (HRCT) signs are of great value in the prediction of the invasion of GGN and the mutation of ALK gene.

Key words： Lung ground glass nodule Lung adenocarcinoma Invasive High-resolution CT Anaplastic lymphoma kinase Diagnosis Influencing factors

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LIU Ning. Influencing factors analysis of infiltrative lesion and anaplastic lymphoma kinase gene mutation in patients with lung ground glass nodule[J]. 中国当代医药, 2020, 27(15): 15-19.

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http://dangdaiyiyao.com/EN/ OR http://dangdaiyiyao.com/EN/Y2020/V27/I15/15

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