广西医学

目的探讨肺癌相关自身抗体（TAAbs）联合血清肿瘤标志物及CT影像学指标在磨玻璃结节（GGN）良恶性鉴别及恶性GGN侵袭性评估中的应用价值。方法回顾性分析213例GGN患者的临床资料，其中良性GGN 68例（良性组）、恶性GGN 145例（恶性组）。检测患者血清7种TAAbs［肿瘤蛋白p53（p53）、SRY盒转录因子2（SOX2）、G抗原7（GAGE7）、GBU4⁃5、蛋白基因产物9.5、MAGE家族成员A1、CAGE］及癌胚抗原（CEA）水平，测量患者CT影像的结节直径及实性成分比例（CTR）。比较良性组与恶性组7种TAAbs的阳性率、TAAbs阳性率、CEA阳性率、CTR。采用受试者工作特征曲线分析TAAbs、CEA、CTR对鉴别GGN良恶性及诊断恶性GGN侵袭性的效能。结果（1）与良性组相比，恶性组中4种TAAbs（p53、SOX2、GAGE7、GBU4⁃5）的阳性率、TAAbs阳性率、CEA阳性率更高，结节直径及CTR更大。（2）在鉴别良恶性GGN时，单个TAAbs、TAAbs阳性抗体数量、CEA的曲线下面积（AUC）<0.7；CTR的AUC为0.842，大于TAAbs阳性抗体数量、CEA（P<0.05）；联合检测模型（TAAbs阳性抗体数量+CEA+CTR）的AUC为0.860，大于TAAbs阳性抗体数量、CEA（P<0.05），但与CTR比较差异无统计学意义（P>0.05）。（3）在诊断恶性GGN侵袭性时，单个TAAbs的AUC<0.7，TAAbs阳性抗体数量、CEA的AUC分别为0.706、0.748；CTR的AUC为0.879，大于TAAbs阳性抗体数量、CEA（P<0.05）；联合检测模型的AUC为0.922，大于CTR、TAAbs阳性抗体数量、CEA（P<0.05）。结论 TAAbs联合CEA及CT影像学指标对GGN诊断具有一定辅助价值，尤其在恶性GGN侵袭性评估中可提高诊断效能，有助于术前风险分层及临床决策。

Objective To investigate the application values of pulmonary tumor⁃associated autoantibodies (TAAbs) combined with serum tumor markers and CT imaging indices in the differentiation between benign and malignant ground⁃glass nodule (GGN) and in the assessment of malignant GGN invasion. Methods A retrospective analysis was conducted on the clinical data of 213 GGN patients, therein there were 68 cases of benign GGN (the benign group), whereas 145 cases of malignant GGN (the malignant group). Seven TAAbs in terms of tumor protein p53 (p53), SRY⁃box transcription factor 2 (SOX2), G antigen 7 (GAGE7), GBU4-5, protein gene product 9.5, MAGE family member A1, CAGE, and carcinoembryonic antigen (CEA) levels were detected. The nodule diameters and consolidation⁃to⁃tumor ratio (CTR) of CT imaging were measured. The positive rates of 7 TAAbs, TAAbs, and CEA, as well as CTR were compared between the benign group and the malignant group. The receiver operating characteristic curve was used to analyze the efficiency of TAAbs, CEA and CTR in the differentiation of benign and malignant GGN and in the diagnosis of invasion of malignant GGN. Results (1) The positive rates of 4 TAAbs with respect to p53, SOX2, GAGE7, and GBU4⁃5, and the positive rates of TAAbs and CEA in the malignant group were higher than those in the benign group, and the malignant group exhibited larger nodule diameter and CTR. (2) In differentiating benign and malignant GGN, the area under the curve (AUC) of single TAAbs, the number of TAAbs positive antibodies and CEA were less than 0.7; furthermore, AUC of CTR was 0.842, which was greater than that of the number of TAAbs positive antibodies and CEA (P<0.05). AUC of combined detection model (the number of TAAbs positive antibodies+CEA+CTR) was 0.860, which was greater than that of the number of TAAbs positive antibodies and CEA (P<0.05), but there was no statistically significant difference between the combined detection model and CTR (P>0.05). (3) In the diagnosis of malignant GGN invasion, AUC of single TAAbs was less than 0.7, the AUC of the number of TAAbs positive antibodies and CEA were 0.706 and 0.748, respectively. AUC of CTR was 0.879, which was greater than that of the number of TAAbs positive antibodies and CEA (P<0.05). AUC of the combined detection model was 0.922, which was greater than that of CTR, the number of TAAbs positive antibodies and CEA (P<0.05). Conclusion TAAbs combined with CEA and CT imaging indicators has a certain auxiliary value in the diagnosis of GGN, especially in the assessment of malignant GGN invasion, which can improve the diagnostic efficiency and help preoperative risk stratification and clinical decision⁃making.