To Explore The Application Value Of LDCT Combined With Tumor Markers And TCM Constitution Identification In Lung Cancer Screening Based On Real-world Research Method

Objective: Based on the statistical analysis of large clinical samples,objectively evaluate the popularization value of low-dose spiral CT(LDCT)combined with serum tumor markers in lung cancer screening,and explore the risk factors,detection rate and TCM Constitution of pulmonary nodules and lung cancer,so as to provide some data support for improving the lung cancer screening rate.Methods:This study adopts the real-world research method.990 hospitalized patients who voluntarily accepted the screening and met the diagnosis of high-risk groups of lung cancer were divided into chest X-ray(CXR)group and ldct+ serum tumor markers group according to the wishes of the patients.Baseline screening,LDCT examination and lung tumor markers examination were carried out.The patients with pulmonary nodules were followed up for 2 years and completed constitution identification according to the traditional Chinese medicine constitution identification instrument in our hospital.All relevant data collected shall be sorted and entered by Excel software,and statistically analyzed and processed by spss22.0 software.The measurement data shall be expressed as mean ± standard deviation according to χ 2.Test the counting data,and use t-test to measure the data.The data analysis results take p<0.05 as the standard,and it is considered that the difference is statistically significant.The relationship between the detection rate of positive nodules and lung cancer and risk factors such as age,sex and smoking index,the difference between the detection rate of positive nodules and lung cancer by CXR and LDCT combined with serum tumor markers,the distribution characteristics of TCM Constitution in patients with positive pulmonary nodules,the relationship between the size of positive nodules and the patient’s constitution,and the relationship between the patient’s constitution and its serum tumor markers were analyzed.Results:1.Comparison of positive nodule detection rate and lung cancer detection rate between ldct+ tumor marker group and CXR group: among 490 screening participants in LDCT + tumor marker group,the positive nodule detection rate was 13 47%,the diagnostic rate of lung cancer was 1.02%.Compared with the CXR group,10 of the 500 participants in the CXR group found different numbers of non calcified nodules,and 2 patients were diagnosed with lung cancer.The positive rate of LDCT screening was high.Chi square test was used.The chi square value of the two detection methods was 12.102,P value was 0.018,indicating that there was a significant difference in the detection rate of lung cancer between the two methods.2.In ldct+ tumor marker group,the detection rate of <6mm nodules was53.03%,6-8mm nodules was 25.8%,and >8mm nodules was 21.1%.In CXR group,the detection rate of <6mm nodules was 20%,6-8mm nodules was 30%,and >8mm nodules was 50%.LDCT was significantly more sensitive than CXR in the detection rate of overall positive nodules,especially in the screening population with small diameter.The comparison between the two groups was statistically significant(P < 0.01).3.Analysis of related risk factors of patients in LDCT + tumor marker group: there was no significant difference in age and sex between the groups.There was significant difference in smoking index between lung cancer group and negative group(all P < 0.05),indicating that smoking is a high risk factor for lung cancer.4.The ldct+ tumor marker group was divided into lung cancer group,positive nodule group and negative group for CEA,CA12-5 and NSE tumor markers comparison: the levels of NSE and CA12-5 in the three groups were compared.The tumor marker water in the positive nodule group and negative group was lower than that in the diagnosed lung cancer group on average,and the difference was statistically significant(all P < 0.05).There was no significant difference in CEA levels among the three groups(P >0.05).5.Among the 66 positive patients,there were 12 cases of Yang deficiency,11 cases of damp heat,10 cases of qi deficiency,10 cases of qi depression,6 cases of yin deficiency,5 cases of blood stasis,4 cases of phlegm dampness,2 cases of special nature and 6 cases of peace.There were 60 cases of biased constitution.Among the patients with positive nodules,Yang deficiency,damp heat,Qi deficiency and qi depression accounted for the most.Compared with the negative group,the positive nodules group had the most peaceful and qi depression.There was a significant difference in the number of peaceful,qi depression,phlegm dampness,blood stasis and yin deficiency between the positive nodules group and the negative group(P < 0.05).6.Analysis of the correlation between the physique of patients with positive nodules and the size of nodules and tumor markers: there was a significant correlation between physique and the size of nodules(p=0.036),and the correlation coefficient was-0.249,indicating that the higher the physique count was,the larger the nodules were,and the lower the physique count was,the smaller the nodules were;There is a significant correlation between the size of nodules and the patient’s constitution.Further analysis and construction of a regression model,P value is 0.036,b value is-3.396,t=-4.963,indicating that constitution has a great impact on the size of nodules.Conclusion:First,LDCT can significantly improve the positive rate of primary screening,and the detection rate of nodules < 6mm is significantly higher than CXR.Combined with the detection of tumor markers such as NSE and CA12-5,LDCT can further improve the diagnostic rate of lung cancer.Second,Smoking is a high-risk factor for lung cancer among Chinese residents.Third,the TCM Constitution of patients with pulmonary nodules is mainly biased constitution,especially Yang deficiency.The frequency of constitution types is Yang deficiency > damp heat > Qi deficiency > qi depression > Yin deficiency = peace > blood stasis > phlegm dampness >special quality.Fourth,there is a significant correlation between physique and nodule size,and physique has a great influence on nodule size.Fifth,the correlation between constitution and tumor markers such as CEA,NSE,and CA12-5 was not obvious.