低剂量CT肺癌筛查中肺癌危险因素及高危模型的单中心研究  

Lung cancer screening with low-dose CT： a study on risk factors and establishing the high-risk model for lung cancer

作　　者：张迪 范丽[1] 望云[1] 李琼[1] 萧毅[1] 刘士远[1] Zhang Di, Fan Li, Wang Yun, Li Qiong, Xiao Yi, Liu Shiyuan.(Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, Chin)

机构地区：[1]第二军医大学长征医院影像科,上海200003

出　　处：《中华放射学杂志》2018年第5期369-373,共5页Chinese Journal of Radiology

基　　金：国家重点研发计划（2016YFE0103000）;上海生物医药重大专项（13411950100）;国家自然科学基金（81370035,81230030）;上海市浦江人才计划（15PJD002）

摘　　要：目的 通过对肺癌危险因素进行分析,拟制定低剂量CT（LDCT）肺癌筛查项目的高危人群标准.方法 回顾性搜集2013年9月至2016年9月上海长征医院体检人群进行LDCT肺癌筛查,共纳入6990例,其中男4567例,女2423例.阳性结果定义为：任意大小的钙化结节、实性结节、纯磨玻璃结节、混杂磨玻璃密度结节,所有确诊肺癌病例均经病理检查证实.分析肺癌发病率及危险因素,危险因素包括性别、年龄、体质量指数（BMI）、吸烟情况、肺癌和恶性肿瘤家族史、慢性支气管炎或肺气肿病史、肺纤维化病史、肺结核病史、氡接触或职业暴露史、石棉接触或职业暴露史、二手烟暴露史、其他恶性肿瘤病史、心血管疾病病史共13项.采用t检验及χ2检验对肺癌危险因素进行分析,采用logistic回归进行多因素分析,运用ROC曲线分析判断肺癌高危界值.结果 本次筛查共检出肺癌69例,男34例、女35例;年龄24-88岁,平均（60±16）岁,共85个肺癌病灶,均经病理检查证实.单因素分析结果显示,性别、年龄和心血管疾病是肺癌的危险因素.logistic回归分析显示性别（OR值为0.478,95%CI：0.297-0.769,P=0.002）和年龄（OR值为1.024,95%CI：1.024-1.060,P=0.001）是肺癌的独立危险因素.年龄预测肺癌的ROC曲线下面积为0.620,最佳高危节点是56.5岁（敏感度55.1%,特异度75.0%,准确率74.8%）.不同性别和年龄预测肺癌的ROC曲线下面积分别为0.587（男）和0.659 （女）,年龄最佳高危节点分别是男56.5岁（敏感度52.9%,特异度73.4%,准确率73.3%）,女57.5岁（敏感度57.1%,特异度80.5%,准确率80.1%）.结论 性别和年龄是肺癌的危险因素,男性≥56.5岁或女性≥57.5岁发生肺癌风险较高.但由于本研究为单中心研究,不排除其他肺癌危险因素.Objective To establish standards of high-risk populations for low-dose CT（LDCT）lung cancer screening projects by analyzing lung cancer risk factors. Methods LDCT was performed in 6 990 subjects undergoing physical examinations in Changzheng Hospital from September 2013 to September 2016, including 4 567 males and 2 423 females. Mineralization nodes, solid nodules, pure ground glass nodules and partial solid nodules were defined as positive results.All cases of lung cancer were confirmed by pathological examination. The morbidity and risk factors of lung cancer were analyzed using t-test, chi-square test and logistic regression analysis.And there were 13 risk factors involved,including age,sex, body mass index（BMI）,smoking,the family history of lung cancer and other malignant tumors,the history of chronic bronchitis or chronic obstructive pulmonary disease,the history of pulmonary fibrosis,the history of tuberculosis, the history of other malignant tumors, the history of cardiovascular disease, the history of second hand smoke exposure,the history of exposure to radon and the history of exposure to asbestos.The cut point of risk factors was analyzed according to the receiver operating characteristic （ROC） curve. Results Sixty-nine cases of lung cancer and 85 malignant nodules were detected in this screening.There were 34 males and 35 females among the lung cancer patients and their age ranged from 24 to 88 years with an average age of（60±16）years.In all the factors involved in this study,sex（χ2=7.937）,age（t=19.509,χ2=29.991） and cardiovascular disease （χ2=5.333） were proved to be the risk factors of lung cancer by single factor analysis.Logistic regression analysis showed that sex（OR=0.478,95%CI：0.297-0.769,P=0.002）and age（OR=1.024,95%CI：1.024-1.060,P=0.001）were independent risk factors of lung cancer.ROC analysis showed an area under the curve（AUC）of 0.62 for age,0.587 for age of males and 0.659 for age of females. According to ROC curves, people over 56.5 years old

关 键 词：肺肿瘤 体层摄影术 X线计算机 危险因素 筛查 

分 类 号：R730.44[医药卫生—肿瘤] R734.2[医药卫生—临床医学]