肺结节鉴别诊断的临床分析  

Analysis about differential diagnosis of pulmonary nodules

作　　者：卢兴时 仲毅 王小雷[1] 王莉[1] 马金山 LU Xingshi;ZHONG Yi;WANG Xiaolei;WANG Li;MA Jinshan(People's Hospital of Xinjiang Uygur Autonomous Region,Xinjiang,Urumqi,830001,China;Xinjiang Clinical College,Anhui Medical University,Urumqi,830000,China)

机构地区：[1]新疆维吾尔自治区人民医院,乌鲁木齐830001 [2]安徽医科大学新疆临床学院,乌鲁木齐830001

出　　处：《新疆医学》2019年第5期460-464,469,共6页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区自然科学基金（项目编号：2015211C193）

摘　　要：目的对肺结节鉴别进行研究,并分析肺癌和结核瘤的危险因素。方法选择367例肺结节患者,收集患者的临床资料,包括性别、民族、年龄、病程、症状(咳嗽、咯血、胸痛、发热、体质量减轻)、吸烟指数、肿瘤既往史、家族肿瘤史。收集影像学资料包括结节的直径、位置、分叶征、毛刺征、血管集束征、胸膜凹陷征、空泡征、空洞、钙化、卫星灶、边界及标准摄取值(SUV)。采集患者外周静脉血,收集T-Spot结果、纤维蛋白原、血沉、中性粒细胞淋巴细胞比值(NLR)、CRP、ALB及ADA血清肿瘤标记物癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19(CYFRA21-1)、鳞状上皮细胞癌抗原(SCC)、CA724和CA125水平。采用Logistic回归分析筛选肺癌和结核瘤的危险因素。结果多因素Logistic回归分析以结核瘤为参考,相对于肺癌筛选出男性、有钙化、CYFRA21-1阴性、T-Spot阳性为独立预测因子。结论肺癌相对于结核瘤,女性、CYFRA21-1阳性、无钙化、T-Spot阴性的肺结节为肺癌的可能性较大,有助于指导临床鉴别肺结节中肺癌和肺结核瘤。Objective To study the identification of pulmonary nodules and analyze the risk factors of lung cancer and tuberculosis.Methods A total of 367 patients with pulmonary nodules were enrolled.The clinical data of the patients were collected,including gender,ethnicity,age,course of disease,symptoms(cough,hemoptysis,chest pain,fever and body mass loss),smoking index,past tumor history,and family tumor history.Imaging data were collected including diameter,location,lobulated sign,burr sign,vascular bundle sign,pleural intaglio sign,vacuole sign,cavity,calcification,satellite foci,border and standard uptake value(SUV).Peripheral venous blood was collected from patients,including T-Spot results,fibrinogen,erythrocyte sedimentation rate,neutrophil lymphocyte ratio(NLR),CRP,ALB and ADA serum tumor markers carcinoembryonic antigen(CEA),neuron specific Retinolase(NSE),cytokeratin 19(CYFRA21-1),squamous cell carcinoma antigen(SCC),CA724 and CA125 levels.Logistic regression analysis was used to screen the risk factors of lung cancer and tuberculosis.Results Multivariate logistic regression analysis showed the independent predictors of tuberculosis included male,calcified,CYFRA21-1 negative and T-Spot positive results compared with lung cancer.Conclusion Compared with tuberculosis,lung cancer has a higher possibility of lung nodules including female,CYFRA21-1 positive,no calcification,and T-Spot negative results.It is helpful to guide the clinical identification of lung cancer and tuberculosis in lung nodules.

关 键 词：肺结节 肺结核瘤 危险因素 计算机断层扫描 

分 类 号：R604[医药卫生—外科学]