p40、CK5/6、NapsinA联合CT对晚期非小细胞肺癌的分型诊断效能

目的:本研究旨在探讨p40、细胞角蛋白5/6（cytokeratin 5/6,CK5/6）、天冬氨酸蛋白酶A（aspartic acid protease A,NapsinA）在非小细胞肺癌组织中的表达情况，及其联合肺部电子计算机断层扫描（computed tomography,CT）对非小细胞肺癌诊断及分型的价值。方法:回顾性分析2017年04月至2019年03月本院收治的91例经皮肺穿刺活检或支气管镜检确诊的不可手术的非小细胞肺癌患者的病例资料，采用χ2检验比较p40、CK5/6和NapsinA表达情况，分析其与CT影像表现间的关系，ROC曲线分析其联合诊断效能。结果:p40的表达与病变部位有关（P＜0.05）；CK5/6的表达与病变部位、胸腔积液有关（P＜0.05）；NapsinA的表达与病变部位有关（P＜0.05）。p40、CK5/6、CT对鳞癌诊断的灵敏度分别为96.00%、88.00%、79.17%，特异度分别为90.24%、90.24%、76.74%，准确度分别为93.41%、89.01%、78.02%；NapsinA、CT对腺癌诊断的灵敏度、特异度及准确度分别为 85.36%、96.00%及92.22%和72.09%、75.00%及73.62%。p40、CK5/6及CT诊断鳞癌的ROC曲线下面积（AUC）为0.987（P＜0.001），NapsinA及CT诊断腺癌的AUC为0.953（P＜0.001）。结论:p40、CK5/6、NapsinA及CT能够为非小细胞肺癌的病理分型提供精确的数据参考，但联合多个指标有更高的诊断准确度。

Diagnostic efficacy of p40,CK5/6,NapsinA combined with computed tomography in the classification of non-small cell lung cancer

Objective:To investigate the positive expression of protein p40(p40),cytokeratin 5/6(CK5/6)and aspartic acid protease A(NapsinA)in non-small cell lung cancer tissues,and the value of combined computed tomography(CT)in the diagnosis and classification of non-small cell lung cancer.Methods:The data of 91 patients with inoperable non-small cell lung cancer diagnosed by percutaneous lung biopsy or bronchoscope admitted to our hospital from April 2017 to March 2019 were retrospectively analyzed.The relationship between the expressions of p40,CK5/6,NapsinA and CT signs was analysed byχ² test,and the diagnostic performance between the immunohistochemistry results and CT results was analysed by ROC curve.Results:The expression of p40 was related to diseased region of the patients(P<0.05),and the expression of CK5/6 was related to diseased region and pleural effusion of the patients(P<0.05).And the NasinA expression was related to diseased region(P<0.05).The sensitivity of p40,CK5/6 and CT in the diagnosis of squamous cell carcinoma were 96.00%,88.00%,79.17%.The specificity was 90.24%,90.24%,76.74%,and the accuracy was 93.41%,89.01%,78.02%,respectively.The sensitivity,specificity and accuracy of NapsinA and CT in the diagnosis of adenocarcinoma were 85.36%,96.00%and 92.22%,72.09%,75.00%and 73.62%,respectively.The ROC curve area of p40,CK5/6 and CT in diagnosis of squamous cell carcinoma was 0.987(P<0.001),and that of NapsinA and CT in diagnosis of adenocarcinoma was 0.953(P<0.001).Conclusion:p40,CK5/6,NapsinA and CT can provide accurate data reference for pathological classification of non-small cell lung cancer,but combined with multiple indicators has higher diagnostic accuracy.