摘要
目的探讨多层螺旋CT(MSCT)对肺结核合并肺癌漏诊、误诊分析及治疗转归。方法选取河南省胸科医院2018年1月至2023年7月收治的60例肺结核合并肺癌患者作为观察组,40例单纯肺结核患者作为对照组。分析两组患者临床症状、影像学表现、漏诊和误诊情况,比较两组患者MSCT参数和肺功能检查仪检查结果,分析MSCT参数与肺功能参数的相关性;对观察组患者进行预后追踪随访,随访时间均在3年以上,比较预后不良组与预后良好组MSCT参数,受试者特征曲线(ROC)曲线分析MSCT各项参数预测肺结核合并肺癌临床疗效的价值。结果临床症状方面,观察组咳嗽患者多于对照组,差异有统计学意义(P<0.05);影像学方面,观察组钙化、空洞低于对照组,分叶征、毛刺征、肺不张多于对照组,差异有统计学意义(P<0.05);肺癌漏诊6例,误诊10例;观察组深吸气末全肺容积(Vin)、深呼气末全肺容积(Vex)、肺容积比(Vex/Vin)、深吸气末平均肺密度(MLDin)、深呼气末平均肺密度(MLDex)、单位体积密度高于对照组,肺容积差(Vin-Vex)低于对照组,差异均有统计学意义(P<0.05);Vin与肺总量(TLC)相关性最佳,呈正相关(r=0.75,P<0.05),Vex与残气容积(RV)相关性最佳,呈正相关(r=0.84,P<0.05),Vex/Vin与用力肺活量(FVC)相关性最佳,呈负相关(r=-0.82,P<0.05),Vin-Vex与FVC相关性最佳,呈正相关(r=0.79,P<0.05);预后不良组Vin、Vex、Vex/Vin高于预后良好组,Vin-Vex低于预后良好组,差异均有统计学意义(P<0.05);Vin、Vex、Vex/Vin、Vin-Vex的曲线下面积(AUC)值分别为0.633、0.758、0.782、0.870;敏感度分别为70.00%、47.50%、62.50%、92.50%;特异度分别为56.67%、95.00%、83.33%、71.67%。结论MSCT对肺结核合并肺癌的漏诊率、误诊率较低,MSCT参数与肺功能存在良好相关性,其对预测患者治疗效果有一定价值。
Objective To investigate the missed diagnosis,misdiagnosis and treatment outcome of pulmonary tuberculosis complicated with lung cancer by multi-slice spiral CT(MSCT).Methods A tortal of 60 patients with pulmonary tuberculosis complicated with lung cancer admitted to Henan Chest Hospital from January 2018 to July 2023 were selected as the observation group,and 40 patients with simple pulmonary tuberculosis were selected as the control group.Clinical symptoms,imaging findings,missed diagnosis and misdiagnosis of patients in the two groups were analyzed.MSCT parameters and pulmonary function test results were compared between the two groups,and the correlation between MSCT parameters and pulmonary function parameters was analyzed.The patients in the observation group were followed up for prognosis,and the follow-up time was more than 3 years.The MSCT parameters of the poor prognosis group and the good prognosis group were compared,and the value of MSCT parameters in predicting the clinical efficacy of pulmonary tuberculosis complicated with lung cancer was analyzed by receiver characteristic curve(ROC)curve.Results In terms of clinical symptoms,the observation group had more patients with cough than the control group,and the difference was statistically significant(P<0.05).In terms of imaging,calcification and cavitation in the observation group were lower than those in the control group,while foliation,burr sign and atelectasis were higher than those in the control group,the differences were statistically significant(P<0.05).Lung cancer was missed in 6 cases and misdiagnosed in 10 cases.The total lung volume(Vin),total lung volume(Vex),lung volume ratio(Vex/Vin),mean lung density(MLDin),mean lung density(MLDex)and unit volume density at the end of deep inspiration in observation group were higher than those in control group,and the lung volume difference(VIN-VEX)was lower than those in control group.The differences were statistically significant(P<0.05).Vin had the best correlation with total lung volume(TLC)and was positively correlated(r=0.75,P<0.05);Vex had the best correlation with residual air volume(RV)and was positively correlated(r=0.84,P<0.05);Vex/Vin had the best correlation with forced lung capacity(FVC)and was negatively correlated(r=-0.82,P<0.05),Vin-Vex had the best correlation with FVC and was positively correlated(r=0.79,P<0.05).Vin,Vex and Vex/Vin in the poor prognosis group were higher than those in the good prognosis group,and Vin-VEX was lower than those in the good prognosis group,the differences were statistically significant(P<0.05).The area under the curve(AUC)values of Vin,Vex,Vex/Vin and Vin-VEx were 0.633,0.758,0.782 and 0.870,respectively.Sensitivity was 70.00%,47.50%,62.50%,92.50%,respectively.The specificity was 56.67%,95.00%,83.33%and 71.67%,respectively.Conclusion The missed diagnosis rate and misdiagnosis rate of MSCT for pulmonary tuberculosis complicated with lung cancer are low,and there is a good correlation between MSCT parameters and lung function,which has a certain value in predicting the therapeutic effect of patients.
作者
弓莉
高红
杨瑞
刘继伟
GONG Li;GAO Hong;YANG Rui;LIU Jiwei(Department of Medical Imaging,Henan Chest Hospital,Zhengzhou Henan 450000,China)
出处
《临床研究》
2024年第2期124-127,共4页
Clinical Research
基金
河南省医学科技攻关计划联合共建项目(LHGJ20210242)。
关键词
肺结核合并肺癌
多层螺旋CT
漏诊误诊
肺功能
相关性
pulmonary tuberculosis complicated with lung cancer
Multislice spiral CT
Missed diagnosis and misdiagnosis
Lung function
correlation
