窄带成像技术电子喉镜联合血清CK18、PD-L1对喉癌的诊断价值

The diagnostic value of electronic laryngoscope narrow-band imaging mode combined with serum CK18 and PD-L1 for laryngeal cancer

摘要:

目的 探究窄带成像技术(NBI)电子喉镜联合血清细胞角蛋白18(CK18)、程序性死亡配体-1(PD-L1)对喉癌的诊断价值。方法 选取2021年6月—2024年6月就诊的喉部病变患者93例作为研究对象，对所有患者喉镜取样后进行病理学检查，根据病理学检查结果将其分为良性组(32例)与恶性组(61例)；比较良性组与恶性组患者一般临床资料及血清CK18、PD-L1差异性，采用Pearson法对恶性组血清CK18、PD-L1进行相关性分析；比较病理检查结果与NBI电子喉镜检查结果差异性；采用ROC曲线分析NBI电子喉镜联合血清CK18、PD-L1水平对早期喉癌的诊断价值。结果 恶性组患者具有吸烟史人数占比、血清降钙素原、C反应蛋白、白细胞计数、CK18、PD-L1水平显著高于良性组患者(P<0.05)，且恶性组患者血清CK18、PD-L1水平呈正相关(r=0.487，P<0.001)；在病理检查结果中发现93例喉部病变患者中61例为喉癌，检出率为65.59%；NBI电子喉镜检查中59例为喉癌，检出率为62.34%；两种不同检查方式一致性较高，Kappa值为0.697(P<0.05)；血清CK18、PD-L1表达水平、NBI电子喉镜检查及三者联合诊断喉癌的曲线下面积(AUC)分别为0.828、0.845、0.856、0.973，联合诊断喉癌优于单独诊断(Z_{CK18-三者联合}=3.273、Z_{PD-L1-三者联合}=3.009、Z_{NBI电子喉镜检查-三者联合}=2.501，P=0.001、P=0.002、P=0.001)。结论 NBI电子喉镜联合血清CK18、PD-L1能对喉癌早期进行有效诊断，为临床治疗提供参考价值。

Abstract:

Objective To explore the diagnostic value of electronic laryngoscope narrow-band imaging (NBI) mode combined with serum cytokeratin 18 (CK18) and programmed death ligand-1 (PD-L1) for laryngeal cancer. Methods A total of 93 patients with laryngeal lesions who visited our hospital between June 2021 and June 2024 were selected as the research subjects. After laryngoscopy sampling, all the patients underwent pathological examination and were divided into the benign group (32 cases) and the malignant group (61 cases) according to the pathological results. The differences in general clinical data and serum CK18 and PD-L1 levels between the benign group and the malignant group were compared. Pearson method was applied to analyze the correlation between serum CK18 and PD-L1 in the malignant group. The differences between pathological results and NBI electronic laryngoscope examination results were compared. Logistic regression was applied to analyze the related factors of the occurrence of early laryngeal cancer, and receiver operator characteristic curve was used to analyze the diagnostic value of NBI electronic laryngoscope combined with serum CK18 and PD-L1 levels for early laryngeal cancer. Results The proportion of patients with a smoking history in the malignant group, as well as the levels of serum procalcitonin, C-reactive protein, white blood cell count, CK18, and PD-L1, were significantly higher than those in the benign group (P<0.05), and the levels of serum CK18 and PD-L1 in the malignant group were positively correlated (r=0.487, P<0.001). In the pathological results, among the 93 patients with laryngeal lesions, 61 were diagnosed with laryngeal cancer, with a detection rate of 65.59%. In the NBI electronic laryngoscopy examination, 59 cases were diagnosed as laryngeal cancer, with a detection rate of 62.34%. The consistency between the two different examination methods was relatively high, with a Kappa value of 0.697 (P<0.05). The area under the curve for the detection of laryngeal cancer by serum CK18 expression level, PD-L1 expression level, NBI electronic laryngoscopy examination, and their combined diagnosis was 0.828, 0.845, 0.856, and 0.973 respectively. The combined diagnosis of laryngeal cancer was superior to individual diagnosis (Z_{CK18-combination}=3.273, Z_{PD-L1-combination}=3.009, Z_{NBI electronic laryngoscope-combination}=2.501, P=0.001, P=0.002, P=0.001). Conclusion The combination of NBI electronic laryngoscope and serum CK18 and PD-L1 can effectively diagnose early laryngeal cancer and provide reference value for clinical practice.