目的 探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法 对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析，将其分为观察组，另选取82例肺部良性肿瘤患者作为对照组，收集其术前CT增强延迟扫描结果，以术后病理诊断结果为金标准，分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值，采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果 CT增强延迟扫描显示观察组患者分叶征（12.50% vs 53.57%）、内部空泡征数量（6.25% vs 39.29%）低于对照组（χ 2 =26.560、24.680，P＜0.05），观察组患者边缘毛刺（56.25% vs 17.86%）、胸部凹陷征（59.38% vs 14.29%）、高于对照组（χ 2 =43.330、64.600，P＜0.05）；82例非小细胞肺癌通过CT增强延迟扫描共确诊79例，CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%（79/82），与病理诊断结果100.00%对比差异无统计学意义（χ 2 =3.060，P=0.080）；82例非小细胞肺癌平均CT增强值为（39.14±7.31），不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义（P＞0.05），不同病理类型［腺癌（43.75±7.15）vs 鳞癌（34.74±6.12）］、细胞分化程度［中、低分化（45.71±7.21）vs 高分化（32.81±5.11）］、临床分期［Ⅰ期（31.03±2.12）vs Ⅱ期（36.61±3.13）vs Ⅲa期（46.32±6.83）］患者、淋巴结转移［是（42.75±4.21）vs 否（35.77±8.13）］CT增强值对比差异有统计学意义（t/F=5.243、8.804、84.828、4.378，P＜0.05）；Spearman相关分析结果显示：病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关（r=0.431，P=0.021；r=0.511，P=0.009；r=0.586，P=0.005；r=0.579，P=0.008，P＜0.05）。结论 CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值，其诊断准确率与病理诊断并无显著差异，且可通过CT增强延迟扫描技术确定患者CT增强值，从而为非小细胞肺癌患者术后病理特征判断提供参考。
Objective To explore the application value of CT enhanced delayed scanning in preoperative diagnosis of non-small cell lung cancer（NSCLC）．Methods A retrospective analysis was conducted on 82 patients with NSCLCwho underwent surgical treatment in a hospital from May 2021 to May 2024．They were included into an observation group and another 82 patients with benign lung tumors were included in the control group．The preoperative CT enhanced delayed scanning results were collected，and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC．And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared，and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC．Results CT enhanced delayed scanning showed that the number of lobular（12.50% vs 53.57%）and internal vacuolar signs（6.25% vs39.29%）in the observation group was significantly lower than that in the control group（χ 2 =26.560，24.680，P＜0.05），while the edge spicules（56.25% vs 17.86%）and chest depression signs（59.38% vs 14.29%）in the observation group were significantly higher than that in the control group（χ 2 =43.330，64.600，P＜0.05）．A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan，and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%（79/82），with no significant difference from the pathological diagnosis result of 100.00%（χ 2 =3.060，P=0.080）．The average CT enhancement value of 82 NSCLC cases was（39.14±7.31）．There was no significant difference in CT enhancement values among patients of different genders，ages，maximum tumor diameter，and lymph node infiltration（P＞0.05）．Patients with different pathological types ［adenocarcinoma（43.75±7.15）vs squamous cell carcinoma（34.74±6.12）］，degree of cell differentiation ［moderate，and low differentiation（45.7±7.21）vs high differentiation（32.81±5.11）］，clinical stage ［I（31.03±2.12）vs II（36.61±3.13）vs IIIa（46.32±6.83）］ and lymph node metastasis ［yes（42.75±4.21），vs no（35.77±8.13）］ CT enhancement had significant difference（t/F=5.243，8.804，84.828，4.378，P＜0.05）．The Spearman correlation analysis results showed that pathological type，degree of cell differentiation，clinical stage，lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients（r=0.431，P=0.021；r=0.511，P=0.009；r=0.586，P=0.005；r=0.579，P=0.008）．Conclusions CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC．Its diagnostic accuracy is not significantly different from pathological diagnosis，and the CT enhanced value of patients can be determined through CT enhanced delayed scanning，providing reference for postoperative pathological feature judgment of NSCLC patients．
目的 评价不同间变性淋巴瘤激酶（ALK）抑制剂联合安罗替尼治疗非小细胞肺癌（NSCLC）的疗效。方法 收集ALK突变阳性NSCLC患者的临床资料，筛选服用ALK抑制剂疗效不佳再加用安罗替尼的病例。根据不同的用药方案分为阿来替尼+安罗替尼，塞瑞替尼+安罗替尼和克唑替尼+安罗替尼三个组别。记录患者联合用药前最近一次的影像学检查结果，并以此为基线按Recist1.1评价疗效，以病情进展、患者死亡、停药、改变治疗方案为终点计算各组患者的无事件生存期（EFS），收集肿瘤标志物、血常规和肝功、心功能、肾功能生化检测等指标数据，统计分析患者联合用药前后各项指标的变化。结果 经筛选，共纳入49例患者的临床数据。阿来替尼+安罗替尼组有23例，疾病控制率（DCR）为86.96%；平均EFS为（10.8±3.6）个月，中位EFS为8.3个月；塞瑞替尼+安罗替尼组有14例，DCR为71.43%；平均EFS为（6.5±2.9）个月，中位EFS为5.6个月；克唑替尼+安罗替尼组有12列，DCR为66.67%；平均EFS为（7.7±3.2）个月，中位EFS为7.2个月。阿来替尼+安罗替尼组的平均EFS长于另外两组（P＜0.05）。各研究组肿瘤标志物仅有CyFra21-1在克唑替尼+安罗替尼组在联合用药后升高（P＜0.05），生化检测和血常规指标在用药前后差异无统计学意义（P＞0.05）。结论 ALK抑制剂与安罗替尼联用，疗效最好为阿来替尼，其次为塞瑞替尼，最后为克唑替尼。三种ALK抑制剂与安罗替尼联用后，均未导致心、肝、肾功能和血细胞损害。
Objective To evaluate the efficacy of different anaplastic lymphoma kinase（ALK）inhibitors combined with anlotinib in the treatment of non-small cell lung cancer（NSCLC）．Methods Clinical data of drug resistant NSCLC patients with ALK positive mutation was collected who were treated with ALK inhibitors and anlotinib synchronously．According to different regimens，three groups were set，alectinib+anlotinib，ceritinib+anlotinib，and crizotinib+anlotinib．The latest imageological examination results of the patient before the synchronous therapy was set as the baseline to evaluate the therapeutic effect according to Recist1.1．The event free survival（EFS）of each group was calculated with disease progression，patient death，treatment discontinuation and changing regimen as endpoints．Data of tumor markers，hematology test，liver function，cardiac function，renal function biochemical examination was collected and analyzed statistically before and after the combination therapy，with P＜0.05 as the statistically significant difference．Results After screening，clinical data of 49 patients were collected．Twenty-three patients in the alectinib+anlotinib group，with a disease control rate（DCR） of 86.96%；mean EFS was（10.8±3.6）months，median EFS of 8.3 months；14 patients in the ceritinib+anlotinib group，with a DCR of 71.43%，mean EFS was（6.5±2.9）months，median EFS was 5.6 months；12 patients in the crizotinib+anlotinib group，with a DCR of 66.67%，mean EFS was（7.7±3.2）months，median EFS was 7.2 months．EFS of alectinib+anlotinib group was longer significantly than the other two groups（P＜0.05）．Only CyFra21-1，increased significantly after the combination of crizotinib and anlotinib（P＜0.05）．No statistically significant difference in biochemical test and hematology test before and after the treatment（P＞0.05）．Conclusions The therapeutic effect of ALK inhibitors with anlotinib was ordered，alectinib being the most effective，followed by ceritinib and finally crizotinib．The combination of ALK inhibitors with anlotinib did not cause any abnormal results in the examination of heart，liver，kidney and blood cells．
