气管镜窄带成像技术联合血清赖氨酸氧化酶样蛋白4和过氧化物酶3诊断支气管肺癌的临床价值

Clinical diagnostic value of bronchoscopic narrow-band imaging combined with serum LOXL4 and PRDX3 for bronchogenic carcinoma

摘要:

目的 探讨气管镜窄带成像技术（NBI）联合血清赖氨酸氧化酶样蛋白4（LOXL4）、过氧化物酶3（PRDX3）诊断支气管肺癌的临床价值。方法 选取2024年1月－2025年2月该院收治的107例支气管肺癌患者为支气管肺癌组，同期95例良性肺部病变患者为良性肺部病变组。所有患者采用电子支气管镜实施气管镜NBI，采用酶联免疫吸附试验（ELISA），检测血清LOXL4和PRDX3水平；采用Kappa检验，分析该诊断方法与病理诊断的一致性；绘制受试者操作特征曲线（ROC curve），分析气管镜NBI、LOXL4、PRDX3单独和三者联合诊断支气管肺癌的效能。结果 气管镜NBI诊断支气管肺癌的Kappa值为0.759，与病理诊断的一致性较高（P < 0.05）。相较于良性肺部病变组，支气管肺癌组血清LOXL4水平较低，PRDX3水平较高（P < 0.05）。气管镜NBI、LOXL4、PRDX3单独和三者联合诊断支气管肺癌的曲线下面积（AUC）分别为：0.951、0.769、0.813和0.988，三者联合诊断的AUC明显高于其他指标单独诊断（Z = 2.290，Z = 6.343，Z = 5.720，P < 0.05）。敏感度分别为：96.26%、76.64%、74.77%和96.32%，特异度分别为：78.95%、74.74%、75.79%和96.87%，LOXL4、PRDX3及三者联合的诊断阈值分别为：6.54 ng/mL、151.54 ng/mL和0.89。不同病理分型支气管肺癌患者血清LOXL4和PRDX3水平比较，差异均无统计学意义（P > 0.05）。气管镜NBI鉴别诊断支气管肺癌病理分型的Kappa值为0.092，与病理诊断的一致性较低（P > 0.05）。结论 气管镜NBI诊断支气管肺癌的价值较高，联合血清LOXL4和PRDX3，能进一步提高诊断效能。

Abstract:

Objective To explore the diagnostic value of bronchoscopic narrow-band imaging (NBI) combined with serum lysine oxidase like protein 4 (LOXL4) and peroxiredoxin 3 (PRDX3) for bronchogenic carcinoma.Methods From January 2024 to February 2025, 107 patients with bronchogenic carcinoma admitted to hospital were considered as the bronchogenic carcinoma group. During the same period, 95 patients with benign lung diseases were considered as the benign lung disease group. All patients underwent NBI examination using electronic bronchoscopy. The enzyme-linked immunosorbent assay (ELISA) method was used to detect serum LOXL4 and PRDX3. The Kappa test was used to explore the consistency between this new diagnostic method and pathological diagnosis. The receiver operating characteristic curve (ROC curve) was used to explore the efficacy of bronchoscopic NBI, LOXL4, and PRDX3 alone and in combination models for the diagnosis of bronchogenic carcinoma.Results The Kappa value of bronchoscopic NBI for the diagnosis of bronchogenic carcinoma was 0.759, which showed high consistency with the pathological diagnosis (P < 0.05). Compared with the benign lung disease group, the bronchogenic carcinoma group had lower serum LOXL4 and higher PRDX3 (P < 0.05). The area under the curve (AUC) values for the diagnosis of bronchogenic carcinoma using bronchoscopic NBI, LOXL4, and PRDX3 alone and in combination models were 0.951, 0.769, 0.813, and 0.988, respectively. The AUC for the combined model was higher than those for other indicators alone (Z = 2.290, Z = 6.343, Z = 5.720, P < 0.05). The sensitivities were 96.26%, 76.64%, 74.77%, 96.32%, and the specificities were 78.95%, 74.74%, 75.79%, 96.87%, respectively. The diagnostic thresholds for LOXL4, PRDX3, and the combined model were 6.54 ng/mL, 151.54 ng/mL, and 0.89, respectively. There was no statistically prominent difference in serum LOXL4 and PRDX3 among patients with different pathological subtypes of bronchogenic carcinoma (P > 0.05). The Kappa value of bronchoscopic NBI for differential diagnosis of the pathological classification of bronchogenic carcinoma was 0.092, which had low consistency with the pathological diagnosis (P > 0.05).Conclusion Bronchoscopic NBI has high diagnostic value for bronchogenic carcinoma, and the diagnostic efficiency is further improved when it is combined with serum LOXL4 and PRDX3.