CAJ | 학술논문

目的评价痰液细胞图像分析对锡矿接尘工人肺癌的筛检试验,分析影响锡矿肺癌高危人群发病的危险因素.方法 1998年用单纯随机抽样的方法选取广西某锡矿队列中45岁以上的男性接尘矿工345人为研究对象,采用全自动细胞图像分析法用经验指标(痰液)对研究对象进行肺癌筛检,其后追访该人群至2006年.以临床确诊为金标准,用筛检试验方法评价痰液细胞图像分析对锡矿接尘工人肺癌的筛检效能及最佳工作点.结果追访期间,共确诊11例肺癌病例;除年龄和职业接触外,吸烟是锡矿高龄接尘工人肺癌发病的危险因素(P=0.0384),调整混杂因素后,高吸烟组的相对危险度为18.21(2.15～154.39).细胞图像分析法经验筛检指标的灵敏度、特异度和正确指数分别为27.3%、83.5%、10.8%;经拟合受试者工作特征(ROC)曲线,C2.5(DNA指数介于1.25～2.50之间所占百分比)以1.70%为最佳工作点,痰液细胞图像系统检测的灵敏度、特异度、一致率、阳性预测值、阴性预测值和正确指数分别为72.7%、62.3%、62.6%、6.0%、98.6%、35.0%.结论吸烟是高龄接尘工人肺癌的危险因素;使用痰液细胞图像分析法,将指标C2.5的筛检值调整为1.70%,有助于早期发现锡矿高危人群中的可疑肺癌患者.
목적 평개담액세포도상분석대석광접진공인폐암적사검시험,분석영향석광폐암고위인군발병적위험인소.방법 1998년용단순수궤추양적방법선취엄서모석광대렬중45세이상적남성접진광공345인위연구대상,채용전자동세포도상분석법용경험지표(담액)대연구대상진행폐암사검,기후추방해인군지2006년.이림상학진위금표준,용사검시험방법평개담액세포도상분석대석광접진공인폐암적사검효능급최가공작점.결과 추방기간,공학진11례폐암병례;제년령화직업접촉외,흡연시석광고령접진공인폐암발병적위험인소(P=0.0384),조정혼잡인소후,고흡연조적상대위험도위18.21(2.15～154.39).세포도상분석법경험사검지표적령민도、특이도화정학지수분별위27.3%、83.5%、10.8%;경의합수시자공작특정(ROC)곡선,C2.5(DNA지수개우1.25～2.50지간소점백분비)이1.70%위최가공작점,담액세포도상계통검측적령민도、특이도、일치솔、양성예측치、음성예측치화정학지수분별위72.7%、62.3%、62.6%、6.0%、98.6%、35.0%.결론 흡연시고령접진공인폐암적위험인소;사용담액세포도상분석법,장지표C2.5적사검치조정위1.70%,유조우조기발현석광고위인군중적가의폐암환자.
Objective To evaluate efficacy of sputum imaging cytometry in early diagnosis on lung cancer among tin miners exposed to dust and analyze possible risk factors related to lung cancer among tin miners.Methods From a cohort of tin miners in Guangxi Province,a total of 345 male tin miners higher than 45 years old and with high exposure to crystalline silica dust were randomly selected as the objects.Imaging cytometry was used to implement the sputum analysis for the screening on lung cancer according to the experience diagnostic standard.All objects were then followed up to the end of 2006.Clinical diagnosis of lung cancer was used as the golden standard to evaluate the efficacy of screening.Results From 1998 to 2006,11 new cases were diagnosed as clinical lung cancer.Except of age and exposure to occupational hazards,smoking status (P=0.0384) and mean smoking dose (P=0.0078) were significantly associated with lung cancer,and the adjusted odds ratio of high level to the low was 18.21(2.15～154.39).The sensitivity,specificity and Youden's index of the sputum imaging cytometry for the experience diagnosis were 27.3%.83.9% and 11.2% respectively.According to the ROC curve analysis,area under ROC Curve (AUC) of C2.5 (the percentage when the DNA index ranged from 1.25 to 2.50) was 0.647 (0.525～0.768),with the optimal operating point (OOP) of 1.70%.Sensitivity,specificity,agreement rate,positive predictive val-ue,negative predictive value and Youden's index for predicting lung cancers in highexposure tin miners were found to be 72.7%.62.3%.62.6%.6.0%.98.6% and 35.0% respectively.Conclusion Smoking is confirmed as an important risk factor of lung cancer in tin miners.The diagnostic efficiency can be improved if the diag-nostic point of C2.5 is adjusted to 1.70%.