目的 探讨支气管肺类癌的CT表现,为临床诊断提供更多信息。方法 回顾性地分析我院8例经病理证实的支气管肺类癌患者的CT资料及临床表现,并复习相关文献。结果 8例CT表现均为肺内单发病灶,其中周围型2例,中央型6例,病理证实非典型类癌2例,典型类癌6例;6例边界清楚,且密度多均匀;2例呈分叶状,1例边缘毛糙、伴短毛刺;5例病灶内部见钙化灶,1例病灶内见脂肪成分,1例见少量胸积液;5例肿块表现为“冰山征”,2例表现为支气管腔内结节,1例病灶边缘毗邻支气管分支;6例出现阻塞性肺不张或肺实变;增强扫描5例强化较明显,CT值升高≥30HU,其中2例不典型类癌强化不均匀,2例见可见强化血管影;3例呈轻-中度强化表现。结论 支气管肺类癌的CT表现具有一定特征性,对于临床诊断有一定价值,但其确诊多需要依靠病理检查。

Objective To investigate the CT findings of bronchial carcinoid and to provide more information for clinical diagnosis. Methods The CT findings and clinicaldata were retrospectively analyzed in 8 patientsconfirmed by biopsy. Results All the 8 cases manifested as single round mass on CT images, including 2 peripheral lesions and 6 central lesions. It was proved that 2 atypical tumors and 6 typical tumors. CT findings of these cases consisted of well-defined border and uniform density(6 cases),lobulated contour(2 cases) and rough margin with short burr(1 case). 5 cases contained calcification,1 case contained fat component and 1 case contained a small amount of pleural lesionscould present as an “iceberg sign”(5 cases), intra-bronchial nodule(2 cases) or near the edge of the bronchus(1 case).The obstructive atelectasis or pulmonary consolidation was found in 6 cases. On CT contrast scanning, these lesions presented relatively significant enhancement(5 cases),usually the CT value increased ≥30HU, in which 2 cases of atypical carcinoid were inhomogeneous enhancement, and 2 cases showed enhanced vascular and mild to moderte enhancement(3 cases). Conclusion The CT findings of bronchial carcinoid have certain characteristics, which are certain value for clinical diagnosis, but the final diagnosis mostly depends on pathology.

目的 通过研究统计痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血清T-SPOT.TB试验对肺结核的诊断敏感度、特异度、诊断预测值、诊断准确率,进一步探讨不同临床检测方法对肺结核的诊断价值,指导肺结核患者的临床诊治。方法 通过回顾性分析我院2017年1月—2019年12月呼吸内科、感染性疾病科诊断为活动性肺结核的患者,以痰结核菌培养结果为对照标准,分别统计出痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血T-SPOT.TB试验对肺结核的诊断敏感度、特异度、阳性预测值、阴性预测值、诊断准确率,探讨我院临床上四种实验室方法对诊断肺结核的临床价值。结果 通过上述方法统计出痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血T-SPOT.TB试验对肺结核的诊断敏感度分别是84.7%、88.1%、74.7%、96.0%,特异度分别是65.3%、69.2%、86.5%、17.8%,阳性预测值分别是83.0%、85.%、92.0%、70.7%,阴性预测值分别是68.1%、73.5%、62.1%、68.4%,诊断准确率分别是78.2%、82.0%、78.5%、70.5%。结论 跟传统方法痰结核菌培养、痰涂片找抗酸杆菌比较,TB-DNA、分枝杆菌核酸、TB-SPOT.TB试验在时效、灵敏度方面更具优势,能敏感检测出人体是否感染肺结核,对患者的早期诊断及指导治疗具有重要意义。

Objective To investigate the diagnostic sensitivity, specificity, predictive value and diagnostic accuracy of TB-DNA, mycobacterium sputum nucleic acid, acid-fast bacilli on sputum smear and serum T-SPOT.TB test for tuberculosis, so as to further explore the significance of different clinical detection methods for tuberculosis and guide the clinical diagnosis and treatment of tuberculosis patients. Methods By retrospective analysis of January 2017-December 2019, patients from respiratory medicine, infectious diseases departments diagnosed with active tuberculosis, sputum culture results of tuberculosis bacterium as control standard, we figured out sputum TB-DNA, sputum mycobacterium nucleic acid blood, sputum smear for acid fast bacilli, T-SPOT. TB test to the diagnosis sensitivity, specific degree, positive predictive value, negative predictive value, diagnostic accuracy, to explore the clinical value of four clinical laboratory methods in our hospital. Results According to the above methods, the diagnostic sensitivity of sputum TB-DNA, sputum mycobacterial nucleic acid, sputum acid-fast bacilli on smear and blood T-SPOT.TB test for tuberculosis was 84.7%、88.1%、74.7%、96.0%, and the specificity was 65.3%、69.2%、86.5%、17.8%, respectively. The positive predictive value was 83.0%、86.6%、92.0%、70.7%, and the negative predictive value was 68.1%、73.5%、62.1%、68.4%, respectively. The diagnostic accuracy was 78.2%、82.0%、78.5%、70.5%, respectively. Conclusion Compared with the traditional methods of culture and sputum smear for acid-fast bacilli, TB-DNA, mycobacterial nucleic acid and T-SPOT.TB test had more advantages in terms of timeliness and sensitivity. It is great significance for the early diagnosis and treatment of patients to detect whether they are infected with tuberculosis sensitively.

目的 探讨Napsin A、TTF-1和CK7在恶性胸水细胞蜡块中的表达及对肺腺癌的诊断价值。方法 收集已确诊为恶性胸水且行Napsin A、TTF-1及CK7免疫组化标记,并收集患者的血清和胸水CEA,将患者按组织来源分为肺腺癌组和非肺腺癌组,比较Napsin A、TTF-1、CK7、血清CEA和胸水CEA在两组中的表达和浓度并计算它们的诊断价值。结果 相对于非肺腺癌组,肺腺癌组患者的Napsin A(83.9% vs 16.1%,P<0.001)、TTF-1(93.5% vs 6.5%,P<0.001)和CK7(98.1% vs 1.9%,P<0.001)阳性表达升高。Napsin A诊断肺腺癌的敏感度为83.9%,特异度为93.9%,TTF-1诊断肺腺癌的敏感度为93.5%,特异度为90.9%;CK7诊断肺腺癌的敏感度为98.1%,特异度为42.4%;明显高于传统肿瘤标志物血清CEA(诊断肺腺癌的敏感度为69.7%,特异度为58.5%)和胸水CEA(诊断肺腺癌的敏感度为69.0%,特异度为66.7%)。结论 Napsin A、TTF-1及CK7对于鉴别肺腺癌恶性胸水及其他肿瘤所致的恶性胸水具有较高的诊断价值。

Objective To investigate the expression of Napsin A, TTF-1 and CK7 in paraffin cells block of malignant pleural effusion and their diagnostic value for lung adenocarcinoma. Methods Immunohistochemistry of Napsin A, TTF-1, CK7, serum and pleural fluid CEA were collected from patients with malignant pleural effusion. The patients were divided into lung adenocarcinoma group and non-lung adenocarcinoma groups according to tissue source. The expression of Napsin A, TTF-1, CK7, CEA and the levels of serum and CEA in pleural fluid were compared and their diagnostic value was calculated. Results The positive expression of Napsin A (83.9% vs 16.1%, P<0.001), TTF-1 (93.5% vs 6.5%, P<0.001) and CK7 (98.1% vs 1.9%, P<0.001) in malignant pleural effusion caused by lung adenocarcinoma were higher compared to other tumors. The sensitivity and specificity of Napsin A were 83.9% and 93.9%,the sensitivity and specificity of TTF-1 were 93.5% and 90.9%, and those of CK7 were 98.1% and 42.4%; which were higher than those of serum CEA (69.7% and 58.5%) and pleural fluid CEA (69.0% and 66.7%) respectively. Conclusion Napsin A, TTF-1 and CK7 are of high value in the diagnosis of malignant pleural effusion caused by lung adenocarcinoma from other tumors.

目的 本研究旨在探讨肺癌合并肺栓塞的相关危险因素及肺栓塞对肺癌患者预后的影响。方法 检索2000年1月—2020年3月万方、中国知网、维普期刊、Medline Pubmed及EMBASE数据库中所有相关文献,并使用RevMan 5.3软件进行统计分析。结果 9项临床病例对照研究共1 179例患者纳入本研究。分析结果显示肺癌合并肺栓塞患者的中位生存时间明显低于单纯肺癌患者(HR=2.82,95%CI[2.06,3.87],P＜0.000 1)。危险因素分析显示腺癌发生肺栓塞的风险高于非腺癌(比值比(OR)=3.07, P＜0.000 1),III-IV期患者发生肺栓塞的风险明显高于I-II期患者(OR=2.97,P＜0.000 1),D-二聚体水平高的患者发生肺栓塞的风险是正常患者的4.32倍(P<0.000 1),白细胞(WBC) >11×109/L的患者发生肺栓塞的风险是WBC≤11×109/L患者的6.62倍(P＜0.000 1)。化疗史和中心静脉置管显著增加肺栓塞风险,OR值分别为3.02 (P＜0.000 1)和2.30 (P＜0.000 1)。然而,吸烟史、饮酒史、性别、糖尿病、COPD、高血压病等临床因素与肺栓塞发生无统计学相关性。结论 肺栓塞的发生明显影响肺癌患者的预后,其相关的危险因素为病理类型、分期、化疗史、中心静脉导管置入史、D-二聚体升高、白细胞＞11×10⁹/L。

Objective To investigate the risk factors of developing pulmonary embolism and its influence on the prognosis of lung cancer patients. Methods The following databases such as Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Weipu Database, Medline Pubmed and EMBASE were searched to identify relevant articles which were published during January 2000 to March 2020. Statistical analysis was performed using RevMan 5.3 software. Results 9 controlled trials incorporating 1 179 patients were included in this study. The results showed that the overall survival of lung cancer patients complicated with pulmonary embolism was significantly lower than that of lung cancer patients without pulmonary embolism (HR=2.82, 95%CI[2.06,3.87], P<0.000 1). The analysis on risk factors of developing pulmonary embolism showed that adenocarcinoma had a higher risk of pulmonary embolism than non-adenocarcinoma with Odds Ratio (OR)=3.07 (P<0.000 1). Patients in stage III-IV encountered significantly higher risk of pulmonary embolism than those in stage I-II (OR=3.07,P<0.000 1). Furthermore, the risk of pulmonary embolism in patients with high level of D-dimer was 4.32 times higher than in normal patients (P<0.000 1), and 6.62 times higher than those with WBC ≤11×10⁹/L (P<0.000 1). Additionally, the history of chemotherapy and central venous catheterization significantly increased the risk of pulmonary embolism, with OR of 3.02 (P<0.000 1) and 2.30 (P<0.000 1), respectively. However, smoking, alcohol consumption, gender, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease, hypertension were not statistical correlated with the occurrence of pulmonary embolism in lung cancer patients. Conclusion The occurrence of pulmonary embolism significantly affects the prognosis of patients with lung cancer, and the related risk factors were pathological type, stage, chemotherapy, central venous catheterization, increased D-dimer level, and WBC>11×10⁹/L.

目的 观察翘芩清肺剂中药免煎颗粒剂及饮片煎煮剂的体外抑制金黄色葡萄球菌和鲍曼不动杆菌抑菌的效果,以评估其体外抑菌效果的差异,为翘芩清肺剂临床应用提供新的思路及科学依据。方法 使用KB试纸扩散法和改良液体稀释法观察翘芩清肺剂中药免煎颗粒剂和饮片煎煮剂对金黄色葡萄球菌ATCC25923、鲍曼不动杆菌ATCC19606的最小抑菌浓度(MIC)。结果 用KB法检测颗粒冲服剂和饮片煎煮剂金黄色葡萄球菌最低抑菌浓度为1.38 g/mL(P<0.01);鲍曼不动杆菌最低抑菌浓度为2.75 g/mL(P<0.01)。用改良液体稀释法冲服剂金黄色葡萄球菌最低抑菌浓度为10.0 g/mL(P<0.01);鲍曼不动杆菌最低抑菌浓度为5.5 g/mL(P<0.01)。煎煮剂两菌MIC均为5.5 g/mL(P<0.01)。饮片煎煮剂效果较冲服剂好(P<0.01)。结论 翘芩清肺剂中药免煎颗粒冲服剂及饮片煎煮剂均可有效抑制金黄色葡萄球菌和鲍曼不动杆菌的生长,饮片煎煮剂的抑菌效果比免煎颗粒剂较优;对鲍曼不动杆菌的抑菌效果均较金黄色葡萄球菌弱,但无显著性差异性。

Objective To observe the antibacterial effects of Qiaoqinqingfei traditional Chinese medicine decoction and herbal concentrate-granules on Staphylococcus aureus (SA) and Acinetobacter baumannii (AB) in vitro. To assess the different antibacterial effects in vitro between them. It would provide a new idea and scientific basis for the clinical application of Qiaoqinqingfei Formula. Methods The KB test paper diffusion method and modified liquid dilution method were used to observe the minimum inhibitory concentration (MIC) of Qiaoqinqingfei traditional Chinese medicine decoction and herbal concentrate-granules on the Staphylococcus aureus ATCC25923 and Acinetobacter baumannii ATCC19606. Results The MIC of SA and AB in the two form of Qiaoqinqingfei were 1.38 g/mL (P<0.01) and 2.75 g/mL(P<0.01) by the KB test paper diffusion method. The MIC of SA and AB in herbal concentrate-granules of Qiaoqinqingfei were10.0 g/mL (P<0.01) and 5.5 g/mL (P<0.01) by the modified liquid dilution method. And the MIC of SA and AB in decoction both were 5.5 g/mL (P<0.01) in traditional Chinese medicine decoction of Qiaoqinqingfei. Decoction was better than granules (P<0.01). Conclusion Traditional Chinese medicine decoction and herbal concentrate-granules of Qiaoqinqingfei may both effectively inhibited the growth of SA and AB. The bacteriostatic effect of decoction was better than decoction-free granules. The bacteriostatic effect of AB was weaker than Staphylococcus aureus, but there was no significant difference between them.

目的 探讨继发性肺结核合并肺部真菌感染的临床特点及相关高危因素。方法 收集广州市胸科医院2017年7月—2019年10月收治的继发性肺结核患者资料,病程均大于3个月,分为真菌感染组106例和非真菌感染组100例进行回顾性分析。结果 单因素分析结果显示,合并肺部其他疾病、非初治、咯血、空洞、应用广谱抗生素>l周、侵袭性操作存在统计学差异(P<0.05)。Logistic多因素分析结果显示,广谱抗生素使用>l周、侵袭性操作为真菌感染的独立危险因素(P<0.05)。结论 对于应用广谱抗生素、进行侵袭性操作的肺结核患者应警惕真菌感染风险,及早预防及诊治。

Objective To investigate the clinical characteristics and related high risk factors of secondary pulmonary tuberculosis complicated with pulmonary fungal infection. Methods Data of patients with secondary tuberculosis admitted to Guangzhou Chest Hospital from July 2017 to October 2019 were collected. All patients with a course of disease longer than 3 months were divided into the fungal infection group (n =106) and the non-fungal infection group (n =100) for retrospective analysis. Results Univariate analysis results showed that there were statistical differences in combined other pulmonary diseases, non-initial treatment, hemoptysis, cavity, application of broad-spectrum antibiotic > for 1 week, and invasive operation (P<0.05). Logistic multivariate analysis showed that >1 week of broad-spectrum antibiotics and invasive procedures were independent risk factors for fungal infection (P<0.05). Conclusion Patients with tuberculosis who are treated with broad-spectrum antibiotics and invasive procedures should be alert to the risk of fungal infection, early prevention and treatment should be undertaken.

目的 探讨血常规、血沉、C-反应蛋白水平对小儿急性肺炎的诊断价值。方法 选取2014年1月—2019年12月我院收治的小儿急性肺炎100例作为研究组,同时根据有无发生感染将其分为感染组(26例)与非感染组(74例),另外选择同期在我院检查的健康儿童100例作为对照组。比较感染组与非感染组血常规、血沉、C-反应蛋白水平、感染组与对照组血常规、血沉、C-反应蛋白水平、非感染组与对照组血常规、血沉、C-反应蛋白水平。结果 感染组中性粒细胞百分比、白细胞计数、C-反应蛋白高于非感染组(P＜0.05),两组血沉对比,无明显差异(P＞0.05);感染组中性粒细胞百分比、白细胞计数、C-反应蛋白、血沉高于对照组(P＜0.05);两组中性粒细胞百分比、C-反应蛋白水平相比,无明显差异(P＞0.05),非感染组白细胞计数、血沉高于对照组(P＜0.05)。结论 小儿急性肺炎的诊断中,对小儿的血常规、血沉、C-反应蛋白水平进行检测对诊断疾病非常重要,值得临床使用。

Objective To investigate the diagnostic value of blood routine, erythrocyte sedimentation rate and C-reactive protein level in children with acute pneumonia. Methods A total of 100 cases of acute pneumonia in children admitted to our hospital from January 2014 to December 2019 were selected as the study group. At the same time, they were divided into an infected group (26 cases) and a non-infected group (74 cases) according to the presence or absence of infection. In addition, 100 healthy children examined in our hospital during the same period were selected as the control group. Blood routine examination, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level were compared between infected and non-infected group; in infection and control group blood routine examination, ESR, C-reactive protein level were compared; in non-infection and control group blood routine examination, ESR, C-reactive protein level were compared. Results The percentage of neutrophils, white blood cell count and C-reactive protein in the infected group were higher than those in the non-infected group (P<0.05). There was no significant difference in erythrocyte sedimentation rate between the two groups (P> 0.05). The percentage of neutrophils, leukocyte count, C-reactive protein and erythrocyte sedimentation rate in the infected group were higher than those in the control group (P<0.05). There was no significant difference in the percentage of neutrophils and C-reactive protein levels between the two groups (P> 0.05), and the white blood cell count and erythrocyte sedimentation rate in the non-infected group were higher than those in the control group (P<0.05). Conclusion In the diagnosis of acute pneumonia in children, it is very important to detect the blood routine, erythrocyte sedimentation rate and C-reactive protein level in children, and it is worthy of clinical use.

目的 探讨老年急性缺血性脑卒中并发肺部感染患者的临床特征和相关危险因素。方法 采用回顾性研究方法,选择2017年7月— 2019年10月深圳市第二人民医院神经内科收治的1 113例老年急性缺血性脑卒中患者,其中卒中并发肺部感染患者(108 例)纳入感染组,未并发肺部感染患者(1 005例)纳入对照组。以单因素对比分析两组患者的临床资料,采用 Logistic多因素回归分析方法分析合并肺部感染的高危因素。结果 单因素分析提示两组年龄(尤其是高龄患者)、住院天数、房颤、脑梗死史、慢性肺疾病、吞咽困难、言语不清、意识障碍差异有统计学意义(P <0.05)。多因素 Logistics 回归分析显示,高龄(≥80岁)、住院天数、脑梗死史、吞咽困难、言语不清、意识障碍与老年急性缺血性脑卒中并发肺部感染密切相关。结论 老年急性缺血性脑卒中并发肺部感染的独立危险因素主要是高龄(≥80 岁)、住院天数、脑梗死史、吞咽困难、言语不清、意识障碍,临床应高度重视。

Objective Objective To investigate the clinical characteristics and risk factors of elderly patients with acute ischemic stroke complicated with pulmonary infection. Methods A retrospective study was conducted on 1 113 elderly patients with acute ischemic stroke admitted to the department of neurology, Shenzhen Second People's Hospital from July 2017 to October 2019. Among them, 108 patients with stroke complicated with pulmonary infection were included in the infection group and 1 005 patients without concurrent pulmonary infection were included in the control group. The clinical data of the two groups were analyzed by single factor comparison, and the risk factors for pulmonary infection were analyzed by logistic multiple factor regression analysis. Results Single factor analysis showed there were statistically significant differences between the two groups in age (especially elderly patients), length of stay in hospital, atrial fibrillation, history of cerebral infarction, chronic pulmonary disease, dysphagia, slurred speech, and disturbance of consciousness (P <0.05). Multi-factor logistic regression analysis showed that old age (≥80 years old), length of stay in hospital, history of cerebral infarction, dysphagia, slurred speech, and disturbance of consciousness were closely related to pulmonary infection in elderly patients with acute ischemic stroke. Conclusion The independent risk factors of acute ischemic stroke complicated with pulmonary infection in the elderly mainly include old age (≥80 years old), length of stay in hospital, history of cerebral infarction, dysphagia, slurred speech and disturbance of consciousness, which should be paid more attention to clinically.

目的 分析濮阳市人民医院肺炎克雷伯菌(Klebsiella pneumoniae,K. pneumoniae, KPN) 的临床分布、流行病学特点及耐药情况,以促进临床合理用药。方法 回顾性分析濮阳市人民医院2020年1—3月临床送检标本中分离出的209株肺炎克雷伯菌的分布及耐药情况。结果 临床标本中共分离出肺炎克雷伯菌209株,在肠杆菌科细菌中占比为68.30%;标本来源以痰液、血液和尿液为主,分别占75.11%、9.09%、5.74%;分离菌株数量较多的科室为ICU、神经外科一病区、EICU病区和胸外科病区,分别占比47.37%、 17.7%、3.35%和3.35%。产超广谱β-内酰胺酶(ESBLs)菌株检出率为11.48%,耐碳青霉烯肺炎克雷伯菌(CRKP)检出率为58.37%。不同来源KPN的耐药性具有显著差异, 综合ICU KPN的耐药率高于其他病区。结论 濮阳市人民医院临床分离KPN对常用抗菌药物有一定的耐药性,尤其以综合ICU分离菌株耐药严重,应加强监测KPN耐药情况,有针对性的选择抗菌药物,并增强院感防控,以减轻KPN的耐药情况。

Objective To analyze the characteristic of clinical distribution, epidemiological and drug resistance of Klebsiella pneumoniae (KPN) in the People's Hospital of Puyang City,and to provide evidence for rational use of antimicrobial drugs in clinical treatment. Methods A retrospectively analysis was conducted on 209 strains of KPN isolated from the clinical specimens in the People's Hospital of Puyang City from January 2020 to March 2020. Results A total of 209 strains of KPN were isolated from clinical specimens, accounting for 68.30% of enterobacteriaceae bacteria; the sources of specimen were mainly from sputum, blood and urine, accounting for 75.11%, 9.09% and 5.74% respectively; the departments with more isolated strains were ICU department, neurosurgery first department, EICU department, and thoracic surgery department, accounting for 47.37%, 17.7%, 3.35% and 3.35% respectively. Besides, the detection rate of extended spectrum β-lactamase(ESBLs) strains was 11.48%,and the detection rate of carbapenems-resistant klebsiella pneumoniae (CRKP) strains was 58.37%. The results showed that the drug resistance of KPN from different sources was with a significantly difference, and the drug resistance rate of KPN in comprehensive ICU was significantly higher than that of other departments. Conclusion The resistance of KPN isolated from the People's Hospital of Puyang City to common antibiotics is not optimistic. In particularly, the drug resistance of KPN isolated strains from the comprehensive ICU is more serious. Hence, the monitoring of KPN resistance should be strengthened and the effective prevention and control measures of hospital infection should be adopted. Furthermore, antibacterial drugs should be used rationally to reduce the generation of drug-resistant bacteria.

目的 通过建立特征参数曲线模型分析在不同CT扫描条件下对肺结节鉴别诊断的量化意义。方法 回顾性分析2018年9月—2019年10月我院收治的肺结节患者的CT胸部平扫图像为研究对象,纳入标准为结节直径≥3 mm,无其他病史。在筛选出的96例样本中,符合条件的样本68例(男性39例,女性29例),按扫描剂量的不同将研究对象分为低剂量观察组(管电压120 kV,管电流20 mA)和常规剂量组(管电压120 kV,管电流150 mA),每组各34例;通过测量并计算扫描长度、有效剂量、样本体型、信噪比相关参数,观察不同管电流与有效辐射剂量之间的相关性以及图像质量;运用PACS人工智能软件以及人工综合提取肺结节特征信息(直径、体积、密度纹理、边缘细节、内部结构)并记录数据,进而通过公式计算出肺结节质量;应用U检验分析比较不同管电流下各参数的组间差异,经过单元逻辑对确定的重要参数体积与质量纳入多元逻辑分析,建立特征参数曲线模型并测量曲线下面积及勾画ROC;使用卡方分析评价不同管电流下建立特征参数曲线模型对肺结节定量诊断分析的差异并同时比较不同管电流下的图像质量。结果 研究中发现,样本接受的有效辐射剂量在管电压一定的条件下,随管电流的增加而线性增加;样本肥胖患者(BMI≥23.9)的CT图像在使用低剂量扫描中呈现出明显噪声,影响组织间观察,而BMI标准(18.5≤BMI≤23.9)的样本的CT图像中,肺结节的信噪比与管电流变化未出现明显趋势阈值,差异无统计学意义(P＜0.05);通过特征参数曲线模型显示,肺结节的体积与质量均质性曲线显示出其变化趋势与管电流变化成相关性,且稳定性和一致性较好,故此二要素为模型主要分析成分,观察组ROC曲线显示其曲线下面积为0.826高于常规组ROC曲线显示其曲线下面积为0.747。结论 与常规剂量相比,低剂量CT扫描模式下建立特征参数曲线模型对肺结节鉴别诊断更有可量化意义。

Objective The quantitative significance of differential diagnosis of pulmonary nodules under different CT scanning conditions was analyzed by establishing characteristic parameter curve model. Methods CT plain chest scan images of patients with pulmonary nodules treated in our hospital from September 2018 to October 2019 were analyzed retrospectively. The inclusion criteria were nodule diameter ≥3 mm and no other medical history. Of the 96 selected samples, 68 met the criteria (39 males and 29 females).According to the different scanning dose, the subjects were divided into low dose observation group (tube voltage 120 kV, tube current 20 mA) and conventional dose group (tube voltage 120 kV, tube current 150 mA).There were 34 cases in each group, and the correlation between different tube current and effective radiation dose and image quality were observed by measuring and calculating the relevant parameters of scanning length, effective dose, sample shape and signal-to-noise ratio. PACS artificial intelligence software and artificial synthesis were used to extract the characteristic information (diameter, volume, density texture, edge details, internal structure) of pulmonary nodules and record the data. Furthermore, the mass of pulmonary nodules was calculated by formula, the differences of parameters under different tube currents were compared by U test, the volume and mass of important parameters determined by unit logic were incorporated into multivariate logic analysis. The curve model of characteristic parameters was established, the area under the curve was measured and ROC was sketched. Chi-square analysis was used to evaluate the difference of characteristic parameter curve model for quantitative diagnosis of pulmonary nodules under different tube currents, and to compare the image quality under different tube currents at the same time. Results In the study, it is found that the effective radiation dose received by the sample increases linearly with the increase of tube current under the condition of constant tube voltage. The CT images of obese patients (BMI≥23.9) showed obvious noise when using low dose scan, which affected the inter-tissue observation. However, in the CT images of the samples with BMI standard (18.5 ≤ BMI ≤ 23.9), there was no obvious trend threshold between the signal-to-noise ratio and tube current of pulmonary nodules, and the difference was not statistically significant (P<0.05).The characteristic parameter curve model showed that the volume and mass homogeneity curve of pulmonary nodules showed the change trend was correlated with the change of tube current, and the stability and consistency were good, so the two elements were the main analytical components of the model. The ROC curve of the observation group showed that the area under the curve was 0.826, which was higher than that of the conventional group, the area under the curve of the ROC curve was 0.747. Conclusion Compared with conventional dose, the establishment of characteristic parameter curve model under low dose CT scan mode is more quantifiable for differential diagnosis of pulmonary nodules.