嗜铬细胞瘤的MRI影像学特征及其误诊为冠心病的相关因素分析  

MRI Imaging Features of Pheochromocytoma and Analysis of Related Factors Misdiagnosed as Coronary Heart Disease

作　　者：单华静 黄能为 李火平[1] SHAN Huajing;HUANG Nengwei;LI Huoping(Department of Cardiology,Huanggang Central Hospital,Huanggang Hubei 438000,China;Department of Thyroid and Mammary,Huanggang Central Hospital,Huanggang Hubei 438000,China)

机构地区：[1]黄冈市中心医院心血管内科,湖北黄冈438000 [2]黄冈市中心医院甲乳外科,湖北黄冈438000

出　　处：《中国医疗设备》2022年第12期95-99,共5页China Medical Devices

摘　　要：目的探讨嗜铬细胞瘤的MRI影像学特征,分析误诊为冠心病的相关因素,将临床误诊率降到最低。方法选取2015年1月到2020年12月我院收治的205例嗜铬细胞瘤(Pheochromocytoma,PHEO)患者为研究对象,其中误诊为冠心病者80例。分析误诊与未误诊患者的临床资料,多因素Logistic回归分析误诊为冠心病的危险因素,建立风险评分模型,并对模型进行评价。结果两组血钙、中性粒细胞、淋巴细胞、嗜碱粒细胞、红细胞压积、T波改变、左室高电压比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血钙降低、中性粒细胞增加、淋巴细胞增加、嗜碱粒细胞增加、红细胞压积降低、T波改变、左室高电压均是PHEO误诊为冠心病的独立危险因素(P<0.05)。受试者工作特征曲线(Receiver Operating Characteristic Curve,ROC)结果显示,血钙、中性粒细胞、淋巴细胞、嗜碱粒细胞、红细胞压积、T波改变以及左室高电压预测PHEO误诊为冠心病均具有较高的灵敏度(分别为0.959、0.950、0.961、0.967、0.960、0.901、0.961)以及特异度(分别为0.699、0.645、0.394、0.695、0.647、0.389、0.522)。PHEO误诊为冠心病分为低(≤60分)、中(>60分且≤90分)以及高风险(>90分)3组。ROC以及校准曲线结果显示,模型区分度、准确度良好。结论PHEO合并冠心病患者的MRI影像学特征和单纯有冠心病的影像表现有一定的相似之处,误诊率相对较高。对于PHEO患者,在临床诊断中需要合理分析患者的各项因素,如血钙、中性粒细胞、淋巴细胞、嗜碱粒细胞、红细胞压积、T波改变、左室高电压等指标有无异常,以提升PHEO的诊断准确率。Objective To explore the MRI imaging features of Pheochromocytoma,analyze the related factors of misdiagnosed as coronary heart disease,and try to minimize the clinical misdiagnosis rate.Methods A total of 205 patients with pheochromocytoma(PHEO)who were admitted to our hospital from January 2015 to December 2020 were selected as the research subjects,of which 80 were misdiagnosed as coronary heart disease.The clinical data of misdiagnosed and non-misdiagnosed patients were analyzed,and the risk factors of misdiagnosed coronary heart disease were analyzed by multivariate Logistic regression.The risk scoring model was established and the model was evaluated.Results There was a statistically significant difference between the two groups in terms of serum calcium,neutrophils,lymphocytes,basophils,hematocrit,T wave changes,and left ventricular high voltage(P<0.05).The results of multivariate Logistic regression analysis showed that decreased serum calcium,increased neutrophils,increased lymphocytes,increased basophils,decreased hematocrit,T wave changes,and left ventricular high voltage were all independent risk factors for PHEO misdiagnosed as coronary heart disease(P<0.05).The ROC curve results showed that serum calcium,neutrophils,lymphocytes,basophils,hematocrit,T wave changes and left ventricular high voltage had high sensitivity(0.959,0.950,0.961,0.967,0.960,0.901,0.961,respectively)and specificity(0.699,0.645,0.394,0.695,0.647,0.389,0.522,respectively)in predicting the misdiagnosis of PHEO as coronary heart disease.PHEO misdiagnosed as coronary heart disease was divided into three groups:low(≤60 scores),intermediate(>60 scores and≤90 scores),and high risk(>90 scores).The results of ROC and calibration curve showed that the model had good discrimination and accuracy.Conclusion The MRI imaging features of patients with pheochromocytoma and coronary heart disease are similar to those of patients with coronary heart disease alone,and the probability of misdiagnosis is relatively high.For patients with PHEO,it

关 键 词：嗜铬细胞瘤 磁共振成像 误诊 冠心病 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]