摘要
目的分析影响孤立性肺结节(SPN)良恶性鉴别的因素并建立预测恶性可能性的数学模型。方法选择105例接受PET/CT检查的SPN患者为研究对象,采用单因素回归分析,分析患者年龄、性别、吸烟史、恶性肿瘤病史、恶性肿瘤家族史、临床症状、结节直径、结节位置、CT征象、18 F-2-氟-2脱氧-D-葡萄糖(18 F-FDG)摄取程度等因素与SPN良恶性的关系。采用logistic回归分析,将确定诊断作为因变量,单因素分析所得的与SPN良恶性相关性具有统计学意义的因素为独立变量,建立预测SPN恶性可能性的回归方程,并对方程进行检验,根据受试者工作特性曲线(ROC)的曲线下面积(AUC)判断预测模型的检验效能。结果回归分析表明,性别、年龄、吸烟史、毛刺征、FDG摄取程度与SPN恶性可能性有相关性,所得的回归方程为:Logit(P)=-8.722+2.448(性别)+2.023(吸烟)+0.851(年龄)+1.057(直径)+2.432(毛刺)+1.502(FDG摄取程度)。Hosmer-Lemeshow检验表明χ2=8.623,P=0.375,说明模型的拟合度好。将预测所得的概率值与实际观察到的概率值比较,预测的可能性与观察到的可能性差异无统计学意义(χ2=7.899,P=0.443),证明模型的精确度非常好,AUC为0.892(95%CI0.817～0.941),以预测概率0.67作为良恶性诊断的临界值时,敏感性、特异性和准确性分别为90.2%、84.1%、87.6%。结论建立的回归方程可以预测病变的恶性可能性。
Objective To evaluate the role of 18F-FDG PET/CT in characterizating solitary pulmonary nodule（SPN） and bone lesions.Methods 105 patients with a SPN smaller than 30 mm in axial diameter were recruited for this study.PET/CT images were obtained 60 min after intravenous injection of 18F-FDG.Logistic regression analysis was performed to identify clinical predictors of SPN malignancy including age,sex,smoking history,malignant history,family history,symptoms,size,location,CT appearances,18F-FDG uptake,and to develop a clinical prediction model to estimate the probability of malignancy in the patients with SPN.The model fit was evaluated and the area under curve（AUC） of receiver operating characteristic（ROC） was used to evaluate the power of the model.Results The logistic regression analysis indicated that male,a positive smoking history,older age,larger nodule diameter,nodule with specula and nodule with high 18F-FDG uptake were more likely to have malignant SPN.The clinical prediction model is described by the following equation： Logit（P）=-8.722＋2.448（gender）＋2.023（smoking）＋0.851（age）＋1.057（diameter）＋2.432（spiculation）＋ 1.502（FDG uptake）.The AUC of the model was 0.892（95% confidence interval 0.817-0.941）.The prediction model had high accuracy in predicting malignant SPN,with 90.2%,84.1 % and 87.6% sensitivity,specificity and accuracy respectively when the cut off value was set at 0.67.Conclusion The prediction model is valid in predicting the probability of malignant SPN.
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2012年第3期404-408,共5页
Journal of Sichuan University(Medical Sciences)
基金
国家自然科学基金(项目批准号30570519)资助
