Clinical Implications of Serum LDH，CysC，and PWR Level Detection in Lung Cancer Patients
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摘要:
目的 探究肺癌患者血清乳酸脱氢酶（LDH）、半胱氨酸蛋白酶抑制剂C（CysC）、血小板/白细胞比值（PWR）水平检测意义。 方法 2023年1月至2023年6月选取常州市第四人民医院72例肺癌患者设为观察组，另选取同期肺部良性病变患者72例设为对照组，比较2组LDH、CysC、PWR及各项肿瘤标志物[癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角蛋白片段19（CYFRA21-1）]，分析LDH、PWR、CysC与各项肿瘤标志物的相关性；比较不同病理特征肺癌患者LDH、CysC、PWR水平，分析肺癌患者LDH、PWR、CysC水平与病理特征的相关性，评价LDH、CysC、PWR结合CEA、CYFRA21-1、NSE对肺癌的诊断价值。 结果 观察组PWR低于对照组，LDH、CysC、CEA、CYFRA21-1及NSE高于对照组（P < 0.05）。肺癌患者PWR与肿瘤标志物CEA、CYFRA21-1、NSE呈负相关（ P < 0.05），LDH、CysC与肿瘤标志物CEA、CYFRA21-1、NSE呈正相关（ P < 0.05）。病理类型方面：肺腺癌与肺鳞癌患者LDH、CysC、PWR比较，差异无统计学意义（ P > 0.05）；临床分期方面：Ⅰ～Ⅱ期患者PWR高于Ⅲ～Ⅳ期患者，LDH、CysC低于Ⅲ～Ⅳ期患者（ P < 0.05）；有无淋巴结转移方面：无淋巴结转移患者PWR高于有淋巴结转移患者，LDH、CysC低于有淋巴结转移患者（ P < 0.05）。肺癌患者LDH、PWR、CysC与病理类型无关（ P > 0.05），PWR与临床分期、淋巴结转移呈负相关（ P < 0.05），LDH、CysC与临床分期、淋巴结转移呈正相关（ P < 0.05）。（ROC）曲线显示，LDH、CysC、PWR联合诊断肺癌的曲线下面积（AUC）值为0.910，CEA、CYFRA21-1及NSE联合诊断AUC值为0.923，进一步采用LDH、CysC、PWR结合CEA、CYFRA21-1、NSE诊断AUC值最高，为0.940，敏感度、特异度分别为93.06%、87.33%。 结论 肺癌患者PWR下降，LDH、CysC水平升高，且其水平与肿瘤标志物、临床分期及淋巴结转移密切相关，可辅助肿瘤标志物对肺癌进行诊断，以期提高早期肺癌诊断率。 -
关键词:
- 肺癌 /
- 乳酸脱氢酶 /
- 半胱氨酸蛋白酶抑制剂C /
- 血小板/白细胞比值
Abstract:Objective To investigate the clinical implications of lung function index, serum lactate dehydrogenase（LDH）, cysteine protease inhibitor C（CysC） and platelet/white blood cell ratio（PWR） in patients with lung cancer. Methods From January 2023 to June 2023, 72 patients with lung cancer in the Fourth People's Hospital of Changzhou were selected as the observation group, and 72 patients with benign lung diseases during the same period were selected as the control group. LDH, CysC, PWR and tumor markers [carcinoembryonic antigen（CEA）, neuron-specific enolase（NSE）, cytokeratin fragment 19（CYFRA21-1）] were compared between the two groups, and the correlation between LDH, PWR, CysC and tumor markers was analyzed. The levels of LDH, CysC and PWR in patients with lung cancer with different pathological characteristics were compared, and the correlation between the levels of LDH, PWR, CysC and pathological characteristics in patients with lung cancer was analyzed. The diagnostic value of LDH, CysC, PWR combined with CEA, CYFRA21-1 and NSE in lung cancer was evaluated. Results The PWR of the observation group was lower than that of the control group, and the LDH, CysC, CEA, CYFRA21-1 and NSE were higher than those of the control group（P < 0.05）. PWR was negatively correlated with tumor markers CEA, CYFRA21-1 and NSE（ P < 0.05）, LDH and CysC were positively correlated with tumor markers CEA, CYFRA21-1 and NSE（ P < 0.05）. There was no significant difference in LDH, CysC and PWR between lung adenocarcinoma and lung squamous cell carcinoma（ P > 0.05）. In terms of clinical stage, PWR of stage Ⅰ- Ⅱ patients was higher than that of stage Ⅲ-Ⅳ patients, LDH and CysC were lower than those of stage Ⅲ-Ⅳ patients（ P < 0.05）. In terms of lymph node metastasis, the PWR of patients without lymph node metastasis was higher than that of patients with lymph node metastasis, and LDH and CysC were lower than those of patients with lymph node metastasis（ P < 0.05）. LDH, PWR and CysC in lung cancer patients were not correlated with pathological type（ P > 0.05）, PWR was negatively correlated with clinical stage and lymph node metastasis（ P < 0.05）, LDH and CysC were positively correlated with clinical stage and lymph node metastasis（ P < 0.05）. The ROC curve showed that the area under the curve（AUC） value of the combination of LDH, CysC and PWR in the diagnosis of lung cancer was 0.910, and the AUC value of the combination of CEA, CYFRA21-1 and NSE was 0.923. Further use of LDH, CysC, PWR combined with CEA, CYFRA21-1, NSE diagnostic AUC value was the highest, 0.940, the sensitivity and specificity were 93.06% and 87.33%, respectively. Conclusion The PWR of lung cancer patients is decreased, and the levels of LDH and CysC are increased, and their levels are closely related to tumor markers, clinical stage and lymph node metastasis, which can assist tumor markers in the diagnosis of lung cancer, in order to improve the diagnosis rate of early lung cancer. -
图 1 LDH、CysC、PWR及肿瘤标志物诊断肺癌的ROC曲线
A：LDH、CysC、PWR诊断；B：肿瘤标志物诊断；C：联合诊断。
Figure 1. ROC curve of lung function index，LDH，CysC，PWR and tumor markers in the diagnosis of lung cancer
表 1 2组一般资料比较[n/（ $\bar x \pm s $）]
Table 1. Comparison of general information of the two groups[n/（ $\bar x \pm s $）]
组别 n 性别（男/女） 年龄（岁） 体质量指数（kg/m2） 观察组 72 47/25 58.76±7.27 21.59±1.24 对照组 72 43/29 57.83±8.46 21.34±1.17 t/χ2 0.474 0.707 1.224 P 0.491 0.480 0.215 
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表 2 2组LDH、CysC、PWR比较（ $ \bar x \pm s $）
Table 2. Comparison of LDH，CysC，PWR between two groups （ $ \bar x \pm s$）
组别 n LDH（U/L） CysC（mg/L） PWR 观察组 72 180.72±44.16 0.86±0.09 32.60±8.43 对照组 72 95.37±23.25 0.65±0.07 37.41±5.06 t 14.511 15.628 4.151 P <0.001* <0.001* <0.001* *P<0.05。
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表 3 2组各项肿瘤标志物比较（ $ \bar x \pm s $）
Table 3. Comparison of various tumor markers between two groups （ $ \bar x \pm s $）
组别 n CEA（ng/mL） CYFRA21-1（ng/mL） NSE（ng/mL） 观察组 72 4.17±1.24 5.04±1.45 15.43±3.58 对照组 72 2.18±0.85 2.46±0.94 8.52±2.77 t 11.232 12.669 12.953 P <0.001* <0.001* <0.001* *P<0.05。
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表 4 LDH、CysC、PWR与各项肿瘤标志物的相关性分析
Table 4. Correlation analysis of LDH，CysC，PWR with various tumor markers
指标 CEA CYFRA21-1 NSE LDH r 0.602 0.637 0.620 P <0.001* <0.001* <0.001* CysC r 0.614 0.625 0.618 P <0.001* <0.001* <0.001* PWR r −0.507 −0.501 −0.517 P <0.001* <0.001* <0.001* *P<0.05。
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表 5 不同病理特征患者LDH、CysC、PWR水平比较（ $\bar x \pm s $）
Table 5. Comparison of LDH，CysC，and PWR levels in patients with different pathologic features （ $ \bar x \pm s$）
病理特征 n LDH（U/L） CysC（mg/L） PWR 病理类型 肺腺癌 55 180.49±45.27 0.86±0.07 32.74±8.14 肺鳞癌 17 181.46±40.13 0.86±0.10 32.15±7.98 t 0.079 0.000 0.262 P 0.937 1.000 0.794 临床分期 Ⅰ～Ⅱ期 48 175.41±25.16 0.82±0.08 34.88±9.25 Ⅲ～Ⅳ期 24 191.34±28.37 0.94±0.14 28.04±6.07 t 2.214 4.456 2.857 P 0.030* <0.001* 0.006* 淋巴结转移 有 19 209.47±50.12 1.05±0.12 26.19±6.98 无 53 170.41±32.06 0.79±0.08 34.90±9.12 t 3.020 8.356 4.172 P 0.004* <0.001* 0.025* *P<0.05。
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表 6 肺癌患者LDH、CysC、PWR水平与病理特征的相关性
Table 6. Correlation of LDH，CysC，and PWR levels with pathologic features in lung cancer patients
指标 病理类型 临床分期 淋巴结转移 LDH r 0.114 0.604 0.611 P 1.569 <0.001* <0.001* CysC r 0.129 0.598 0.634 P 1.710 <0.001* <0.001* PWR r 0.094 -0.579 -0.621 P 1.409 <0.001* <0.001* *P<0.05。
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表 7 LDH、CysC、PWR结合肿瘤标志物对肺癌的诊断价值
Table 7. Diagnostic value of LDH，CysC，and PWR combined with tumor markers in lung cancer
指标 AUC（95%CI） Z统计 截断值 敏感度（%） 特异度（%） P LDH（U/L） 0.842（0.772～0.897） 10.141 180.81 65.28 83.06 <0.001* CysC（mg/L） 0.772（0.695～0.838） 6.991 0.82 65.28 77.78 <0.001* PWR 0.727（0.647～0.798） 5.331 40.24 83.33 55.56 <0.001* 3项联合诊断
0.917（0.860～0.957） 16.759 / 83.92 89.28 <0.001* CEA（ng/mL） 0.751（0.672～0.819） 6.165 4.03 62.50 83.33 <0.001* CYFRA21-1（ng/mL） 0.742（0.662～0.811） 5.792 4.35 66.67 77.78 <0.001* NSE（ng/mL） 0.821（0.749～0.880） 9.030 15.00 68.06 87.50 <0.001* 3项联合诊断 0.923（0.867～0.961） 17.951 / 84.72 90.28 <0.001* 6项联合诊断 0.940（0.888～0.973） 24.267 / 93.06 87.33 <0.001* *P<0.05。
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