【摘要】 目的 分析表皮生长因子受体(EGFR)突变非小细胞肺癌(NSCLC)患者双能量CT定量-定性特征与靶向治疗疗效相关性，并探讨其对靶向治疗疗效的预测价值。方法 选取2021年1月至2024年1月我院145例EGFR突变NSCLC患者作为研究对象，均接受4个周期靶向治疗，根据靶向治疗疗效分为有效组、无效组。比较两组临床资料及治疗前双能量CT定量参数[静脉期标准化碘浓度(NICVP)、动脉期标准化碘浓度(NICAP)、碘浓度差值(ICD)]、定性特征。采用共线性诊断、多因素Logistic回归分析靶向治疗疗效的影响因素。分析双能量CT定量参数对靶向治疗疗效的预测价值。结果 无效组血清癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角蛋白-19片段抗原(Cyfra21-1)水平及低分化程度占比高于有效组(P<0.05)；无效组NICVP、NICAP、ICD高于有效组(P<0.05)，两组双能量CT定性特征比较无明显差异(P>0.05)；共线性分析显示NICVP、NICAP、ICD的VIF值<10，无共线性，而CEA、C YFRA21-1、CA125、低分化程度的VIF>10，存在多重共线性问题，故予以剔除；Logistic回归分析显示，NICVP、NICAP、ICD均为靶向治疗无效的影响因素(P<0.05);NICVP、NICAP、ICD联合预测靶向治疗疗效的AUC高于单一指标预测(P<0.05)；以CEA、CYFRA21-1、CA125、低分化程度作为传统因素，在预测靶向治疗疗效方面，NICVP、NICAP、ICD联合预测的AUC与传统因素相当(P>0.05)，且N ICVP、NICAP、ICD单一预测的AUC与传统因素相当(P>0.05)。结论 EGFR突变NSCLC靶向治疗无效患者NICVP、NICAP、ICD升高，且为靶向治疗无效的影响因素，联合检测其水平对靶向治疗疗效具有良好预测效能，可能作为EGFR突变NSCLC患者靶向治疗反应性的潜在预测指标。更多还原

【Abstract】 Objective To analyze the correlation between quantitative and qualitative characteristics of dualenergy CT and the efficacy of targeted therapy in patients with epidermal growth factor receptor(EGFR) mutated non-small cell lung cancer(NSCLC), and to explore its predictive value for the efficacy of targeted therapy. Methods A total of 145 patients with EGFR-mutated NSCLC in our hospital from January 2021 to January 2024 were selected as the study subjects, all of whom received four cycles of targeted therapy. They were divided into an effective group and an ineffective group based on the efficacy of targeted therapy. The clinical data and pre-treatment dual-energy CT quantitative parameters [normalized iodine concentration during venous phase(NICVP), normalized iodine concentration during arterial phase(NICAP), iodine concentration difference(ICD)] and qualitative characteristics were compared between the two groups. Multicollinearity diagnosis and multifactor Logistic regression analysis were used to analyze the influencing factors of targeted therapy efficacy. The predictive value of dual-energy CT quantitative parameters for targeted therapy efficacy was analyzed. Results The levels of serum carcinoembryonic antigen(CEA), carbohydrate antigen 125(CA125), and cytokeratin-19 fragment antigen(Cyfra21-1), percentage of low degree of differentiation were higher in the ineffective group than in the effective group(P<0.05). The NICVP, NICAP, and ICD values in the ineffective group were higher than those in the effective group(P<0.05). There was no significant difference in dual-energy CT quantitative-qualitative characteristics between the two groups(P>0.05). Collinearity analysis showed that the VIF values for NICVP, NICAP, and ICD were <10, indicating no multicollinearity. However, the VIF values for CEA, CYFRA21-1, CA125, and low degree of differentiation were >10, indicating multicollinearity, which was therefore excluded. Logistic regression analysis revealed that NICVP, NICAP, and ICD were all influencing factors for ineffective targeted therapy(P<0.05). The AUC of combining NICVP, NICAP, and ICD for predicting the efficacy of targeted therapy was higher than that of individual indicators(P<0.05). When CEA, CYFRA21-1, CA125, and low degree of differentiation were considered as traditional factors, the AUC of combining NICVP, NICAP, and ICD for predicting the efficacy of targeted therapy was comparable to that of traditional factors(P>0.05), and the AUC of individual NICVP, NICAP, and ICD predictions was also comparable to that of traditional factors(P>0.05). Conclusion Patients with EGFR-mutated NSCLC who are ineffective to targeted therapy exhibit elevated levels of NICVP, NICAP, and ICD, which are influencing factors for the ineffectiveness of targeted therapy. Combined detection of their levels provides good predictive efficacy for the efficacy of targeted therapy and may serve as potential predictive indicators of response to targeted therapy in EGFR-mutated NSCLC patients.更多还原