亚实性肺结节CT动态随访与影响后续生长的危险因素分析  

CT dynamic follow-up of non-solid pulmonary nodules and risk factors for subsequent growth

作　　者：何慧[1] 杨亚茹 姜立美 张勇 周长武 HE Hui;YANG Yaru;JIANG Limei;ZHANG Yong;ZHOU Changwu(Department of Radiology,The Affiliated Hospital of Yangzhou University,Yangzhou 225000,Jiangsu Province,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China)

机构地区：[1]扬州大学附属医院医学影像中心,江苏扬州225000 [2]上海影像医学研究所,上海200032

出　　处：《肿瘤影像学》2022年第1期74-80,共7页Oncoradiology

摘　　要：目的:探讨计算机体层成像(computed tomography,CT)对肺结节的动态随访及确定与后续生长相关的临床及放射学危险因素。方法:回顾并收集2010年4月—2017年11月于扬州大学附属医院行胸部CT检查发现肺结节的患者188例,共计207个肺结节,并进行超过24个月CT随访观察。分析患者年龄、性别、既往恶性肿瘤病史、吸烟史等临床资料及肺结节的大小、成分、形态等放射学特征。结果:生长组中患者的平均年龄大于非生长组(P<0.001),且女性患者更易有肺结节生长(P<0.001);既往有恶性肿瘤病史(P=0.002)及吸烟史(P<0.001)患者的肺结节也更易发生后续生长;在单因素分析中,肺结节初始直径越大,具有实性成分、有毛刺、胸膜凹陷征、不明确的边缘、分叶、空气支气管征及增强后有强化是肺结节后续生长的危险因素(P<0.001);在多因素分析中,60岁及以上(P=0.006)、既往恶性肿瘤病史(P=0.001)、初始直径≥8 mm(P<0.001)、分叶(P=0.01)、空气支气管征(P=0.012)是肺结节生长的独立危险因素。结论:具有年龄为60岁及以上、既往恶性肿瘤病史、初始直径≥8 mm、结节呈分叶状和空气支气管征等危险因素的肺结节患者需要较长的随访时间动态观察肺结节变化。Objective:To investigate the dynamic follow-up of pulmonary nodules by computed tomography(CT)and to determine the clinical and radiological risk factors related to subsequent growth.Methods:A total of 188 patients with pulmonary nodules found by chest CT in the Affiliated Hospital of Yangzhou University from April 2010 to November 2017 were retrospectively collected.A total of 207 pulmonary nodules were followed up for more than 24 months.Age,gender,history of malignant tumor,smoking history and other clinical data were analyzed,and the size,composition,morphology and other radiological characteristics of pulmonary nodules were analyzed.Results:The average age of patients in the growth group was higher than that in the non-growth group(P<0.001),and female patients were more likely to have pulmonary nodule growth(P<0.001);patients with a history of malignancy(P=0.002)and smoking(P<0.001)were also more likely to have subsequent growth.In univariate analysis,the larger the initial diameter of pulmonary nodules,solid components,burr,pleural retraction,undefined margin,lobulation,air bronchogram sign and enhancement after enhancement were the risk factors for subsequent growth of pulmonary nodules(P<0.001).In multivariate analysis,age 60 and above(P=0.006),previous history of malignant tumor(P=0.001),initial diameter≥8 mm(P<0.001),lobulation(P=0.01)and air bronchogram(P=0.012)were independent risk factors for pulmonary nodule growth.Conclusion:Pulmonary nodule patients with risk factors,such as≥60 years old,previous history of malignant tumor,initial diameter≥8 mm,lobulation and air bronchogram sign,need a long follow-up time to dynamically observe the changes of pulmonary nodules.

关 键 词：肺结节 计算机体层成像 随访 危险因素 

分 类 号：R734.2[医药卫生—肿瘤] R445.3[医药卫生—临床医学]