摘要
目的观察肺纯磨玻璃结节微血管CT成像征,探讨其预测恶性纯磨玻璃结节的价值。方法肺纯磨玻璃结节患者218例,均行手术治疗,根据术后组织病理检查结果分为恶性组158例,非恶性组60例。2组术前均行胸部CT扫描,记录结节位置、数量、最大直径及有无支气管通气征,分析微血管CT成像征。比较2组性别、年龄、吸烟史、家族肿瘤史等临床资料;多因素logistic回归分析肺纯磨玻璃结节恶性的影响因素;绘制ROC曲线,评估其预测恶性纯磨玻璃结节的效能。结果恶性组微血管CT成像征Ⅰ型(11.39%)、Ⅱ型(15.19%)比率均低于非恶性组(33.33%、40.00%)(χ^(2)=14.545,P<0.001;χ^(2)=10.345,P<0.001),Ⅳ型比率(47.47%)高于非恶性组(10.00%)(χ^(2)=26.145,P<0.001),年龄[(54.89±9.88)岁]、结节最大直径[13.60(11.01,18.85)mm]均大于非恶性组[(50.53±9.17)岁、10.80(7.73,16.45)mm](P<0.05),单发结节比率(64.6%)高于非恶性组(45.0%)(χ^(2)=6.885,P=0.009),结节位置及男性、吸烟史、个人肿瘤史、家族肿瘤史及微血管CT成像征Ⅲ型比率与非恶性组比较差异均无统计学意义(P>0.05)。结节最大直径(OR=1.114,95%CI:1.042~1.192,P=0.002)、单发结节(OR=2.066,95%CI:1.061~4.024,P=0.033)、微血管CT成像征Ⅳ型(OR=6.976,95%CI:2.711~4.024,P<0.001)是肺纯磨玻璃结节为恶性的独立危险因素。结节直径以9.11 mm为最佳截断值,诊断恶性肺纯磨玻璃结节的AUC为0.681(95%CI:0.595~0.766,P<0.001),灵敏度为91.1%、特异度为45.0%;结节单发、微血管CT成像征Ⅳ型诊断恶性肺纯磨玻璃结节的AUC分别为0.598(95%CI:0.513~0.683,P=0.026)、0.687(95%CI:0.615~0.760,P<0.001),灵敏度分别为64.6%、47.5%,特异度分别为55.0%、90.0%;3项指标联合诊断恶性肺纯磨玻璃结节的AUC为0.790(95%CI:0.722~0.857,P<0.001),大于单独检测(Z=5.073,P<0.001;Z=3.666,P=0,002;Z=4.831,P<0.001)。结论结节最大直径、结节单发、微血管CT成像征Ⅳ型是纯磨玻璃结节为恶性的独
Objective To observe the CT angiogram of tumor angiogenesis and to investigate its value to the prediction of malignant pulmonary pure ground-glass nodules(pGGN).Methods Totally 218 patients with pGGN were performed operation,and were randomly divided into malignant group(n=158)and non-malignant group(n=60)according to the postoperative histopathological results.Before operation,all patients received chest CT scan to record the location,number and maximum diameter of pGGN,and the bronchial ventilation signs.The CT angiogram of tumor angiogenesis was analyzed.The gender,age,smoking history,and family tumor history were compared between two groups.Multivariate logistic regression analysis was used to assess the influencing factors of malignant pGGN.ROC curve was drawn to evaluate the efficiency of combined application of the influencing factors on predicting malignant pGGN.Results The percentages of CT angiogram of tumor angiogenesis type Ⅰ and Ⅱ were lower in malignant group(11.39%,15.19%)than those in non-malignant group(33.33%,40.00%)(χ^(2)=14.545,P<0.001;χ^(2)=10.345,P<0.001),and the percentage of CT angiogram of tumor angiogenesis type Ⅳ was higher in malignant group(47.47%)than that in non-malignant group(10.00%)(χ^(2)=26.145,P<0.001).The patients were older in malignant group[(54.89±9.88)years]than in non-malignant group[(50.53±9.17)years](P<0.05),the maximum diameter of pGGN was greater in malignant group[13.60(11.01,18.85)mm]than that in non-malignant group[10.80(7.73,16.45)mm](P<0.05),and the percentage of solitary pGGN was higher in malignant group(64.6%)than that in non-malignant group(45.0%)(χ^(2)=6.885,P=0.009).There were no significant differences in the location of pGGN,and percentages of male patients and patients with smoking history,personal tumor history,family tumor history,and tumor angiogenesis typeⅢbetween two groups(P>0.05).The maximum diameter of pGGN(OR=1.114,95%CI:1.042-1.192,P=0.002),solitary pGGN(OR=2.066,95%CI:1.061-4.024,P=0.033),and CT angiogram of tumor angiogenesis t
作者
辛瑞夏
于春艳
林晨晨
周超
张晓菊
XIN Rui-xia;YU Chun-yan;LIN Chen-chen;ZHOU Chao;ZHANG Xiao-ju(Department of Respiratory and Critical Care Medicine,Zhengzhou University People’s Hospital,Henan Provincial People’s Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2022年第7期710-713,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划省部共建项目(SB201901091)。
关键词
纯磨玻璃结节
恶性风险
微血管CT成像征
pure ground-glass nodule
malignant risk
CT angiogram of tumor angiogenesis
