ECT联合血清FGF23、Angptl-2对肺癌患者骨转移的诊断价值

doi:10.3760/cma.j.cn371439-20250901-00129

摘要/Abstract

摘要：

目的探究发射计算机断层显像（ECT）联合血清成纤维细胞生长因子23（FGF23）、血管生成素样蛋白2（Angptl-2）对肺癌患者骨转移的诊断价值。方法选取2023年6月至2025年6月西安交通大学第一附属医院收治的127例肺癌疑似骨转移患者为研究对象。ELISA法检测血清FGF23、Angptl-2水平；采用Bayesian log-binomial回归模型分析评估FGF23、Angptl-2水平对肺癌患者发生骨转移的影响；受试者操作特征（ROC）曲线评估血清FGF23、Angptl-2水平对肺癌患者骨转移的诊断效能；四格表法分析ECT联合血清FGF23、Angptl-2水平对肺癌患者骨转移的诊断价值。结果以骨活检病理结果为金标准，127例肺癌疑似骨转移患者中发生骨转移53例，无骨转移74例。骨转移患者血清FGF23、Angptl-2水平分别为（123.46±22.18）pg/ml、（32.46±5.13）ng/ml，无骨转移患者分别为（98.37±16.21）pg/ml、（26.52±4.15）ng/ml，与无骨转移患者相比，骨转移患者血清FGF23、Angptl-2水平均较高，差异均有统计学意义（t=7.37，P<0.001；t=7.20，P<0.001）。血清FGF23、Angptl-2高水平患者发生骨转移的风险分别是低水平患者的2.96倍、2.66倍。ROC曲线分析显示，血清FGF23、Angptl-2水平诊断肺癌患者骨转移的曲线下面积（AUC）分别为0.77、0.81，敏感性分别为69.81%、66.04%，特异性分别为82.43%、87.84%，准确性分别为77.17%、78.74%。ECT诊断肺癌患者骨转移的敏感性为79.25%，特异性为83.78%，准确性为81.89%。ECT联合血清FGF23、Angptl-2诊断肺癌患者骨转移的敏感性为98.11%，特异性为81.08%，准确性为88.19%，联合诊断的敏感性均高于血清FGF23、Angptl-2、ECT各自诊断（χ²=15.76，P<0.001；χ²=18.53，P<0.001；χ²=9.40，P=0.002），联合诊断的准确性均高于血清FGF23、Angptl-2各自诊断（χ²=5.39，P=0.020；χ²=4.11，P=0.043）。结论肺癌骨转移患者血清FGF23、Angptl-2水平均较高，ECT联合血清FGF23、Angptl-2水平较各指标单独检测对肺癌患者骨转移的诊断价值更高。

关键词: 肺肿瘤, 肿瘤转移, 成纤维细胞生长因子, 血管生成素样蛋白质类, 放射性核素骨显像

Abstract:

Objective To explore the diagnostic value of emission computed tomography （ECT） combined with serum fibroblast growth factor 23 （FGF23） and angiopoietin-like protein 2 （Angptl-2） for bone metastasis in lung cancer patients. Methods A total of 127 patients suspected of having bone metastasis from lung cancer at First Affiliated Hospital of Xi'an Jiaotong University from June 2023 to June 2025 were included as the study subjects. ELISA method was used to measure the levels of serum FGF23 and Angptl-2. The Bayesian log-binomial regression model was used to evaluate the effects of the levels of FGF23 and Angptl-2 on bone metastasis in lung cancer patients. Receiver operator characteristic （ROC） curve was used to analyze the diagnostic efficacy of serum FGF23 and Angptl-2 levels for bone metastasis in lung cancer patients； Four grid table method was used to analyze the diagnostic value of ECT combined with serum FGF23 and Angptl-2 levels for bone metastasis in lung cancer patients. Results Taking the pathological results of bone biopsy as the gold standard， among 127 patients with suspected bone metastasis of lung cancer， 53 cases had bone metastasis and 74 cases didn't have bone metastasis. The levels of serum FGF23 and Angptl-2 in patients with bone metastasis were （123.46±22.18） pg/ml and （32.46±5.13） ng/ml， respectively， while those in patients without bone metastasis were （98.37±16.21） pg/ml and （26.52±4.15） ng/ml， respectively. Compared with patients without bone metastasis， the levels of serum FGF23 and Angptl-2 in patients with bone metastasis were both relatively higher， with statistically significant differences （t=7.37， P<0.001； t=7.20， P<0.001）. The risk of bone metastasis in patients with high levels of serum FGF23 and Angptl-2 was 2.96 times and 2.66 times that of patients with low levels， respectively. The ROC curve analysis showed that， the area under the curve （AUC） of serum FGF23 and Angptl-2 levels in diagnosing bone metastasis in lung cancer patients was 0.77 and 0.81， respectively， the sensitivities were 69.81% and 66.04%， respectively， the specificities were 82.43% and 87.84%， respectively， and the accuracies were 77.17% and 78.74%， respectively. The sensitivity of ECT in diagnosing bone metastasis in lung cancer patients was 79.25%， the specificity was 83.78%， and the accuracy was 81.89%. The sensitivity of ECT combined with serum FGF23 and Angptl-2 in diagnosing bone metastasis in lung cancer patients was 98.11%， the specificity was 81.08%， and the accuracy was 88.19%. The sensitivity of combined diagnosis was higher than that of serum FGF23， Angptl-2 and ECT alone （χ²=15.76， P<0.001； χ²=18.53， P<0.001； χ²=9.40， P=0.002）， and the accuracy of combined diagnosis was higher than that of serum FGF23 and Angptl-2 alone （χ²=5.39， P=0.020； χ²=4.11， P=0.043）. Conclusions Patients with lung cancer bone metastasis have higher levels of serum FGF23 and Angptl-2. ECT combined with serum FGF23 and Angptl-2 levels has a higher diagnostic value for bone metastasis in lung cancer patients compared to the individual detection of each indicator.

Key words: Lung neoplasms, Neoplasm metastasis, Fibroblast growth factors, Angiopoietin-like proteins, Radionuclide bone imaging

白洁, 耿倩倩. ECT联合血清FGF23、Angptl-2对肺癌患者骨转移的诊断价值[J]. 国际肿瘤学杂志, 2025, 52(12): 758-763.

Bai Jie, Geng Qianqian. Diagnostic value of ECT combined with serum FGF23 and Angptl-2 for bone metastasis in lung cancer patients[J]. Journal of International Oncology, 2025, 52(12): 758-763.

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临床资料	骨转移患者（n=53）	无骨转移患者（n=74）	t/χ²值	P值
年龄（岁）	63.25±7.29	62.84±7.13	0.32	0.752
性别
男	31	45	0.07	0.793
女	22	29	0.07	0.793
吸烟史
有	22	27	0.33	0.566
无	31	47	0.33	0.566
肿瘤部位
右肺	33	49	0.21	0.646
左肺	20	25	0.21	0.646
TNM分期
Ⅲ期	14	28	1.82	0.177
Ⅳ期	39	46	1.82	0.177
病理分型
腺癌	22	33	1.49	0.685
鳞状细胞癌	20	29
小细胞癌	6	10
其他	5	2

指标	RR值	95%CI	P值
FGF23（高水平/低水平）	2.96	1.73~5.09	<0.001
Angptl-2（高水平/低水平）	2.66	1.61~4.39	<0.001

变量	AUC	截断值	95%CI	敏感性（%）	特异性（%）	准确性（%）	约登指数
FGF23	0.77	116.59 pg/ml	0.69~0.84	69.81	82.43	77.17	0.52
Angptl-2	0.81	30.60 ng/ml	0.73~0.88	66.04	87.84	78.74	0.54

诊断方法	敏感性	特异性	准确性
FGF23	69.81（37/53）^a	82.43（61/74）	77.17（98/127）^a
Angptl-2	66.04（35/53）^a	87.84（65/74）	78.74（100/127）^a
ECT	79.25（42/53）^a	83.78（62/74）	81.89（104/127）
三者联合	98.11（52/53）	81.08（60/74）	88.19（112/127）