CT征象联合外周血嗜酸性粒细胞对鉴别儿童胸肺型并殖吸虫病与结核性胸膜炎的价值研究  

The value of CT signs combined with peripheral blood eosinophils in differentiating pleuropulmonary paragonimiasis from pleural tuberculosis in children

作　　者：李翔 付旭文 许艳玲 干玮 杞敏 黄瑛 Li Xiang;Fu Xuwen;Xu Yanling;Gan Wei;Qi Min;Huang Ying(Department of Radiology,The Third People’s Hospital in Kunming/Yunnan Clinical Medical Center for Infectious Diseases,Kunming 650041,China;Department of Infectious Diseases and Children’s Infectious Diseases,The Third People’s Hospital in Kunming/Yunnan Clinical Medical Center for Infectious Diseases,Kunming 650041,China)

机构地区：[1]昆明市第三人民医院/云南省传染性疾病临床医学中心医学影像科,昆明650041 [2]昆明市第三人民医院/云南省传染性疾病临床医学中心感染性疾病科及儿童传染病科,昆明650041

出　　处：《中国防痨杂志》2023年第1期38-44,共7页Chinese Journal of Antituberculosis

基　　金：昆明市科技局科研立项课题(2020-1-C-004)。

摘　　要：目的:探讨胸部CT征象联合外周血嗜酸性粒细胞百分比对鉴别儿童胸肺型并殖吸虫病与结核性胸膜炎的价值。方法:回顾性收集昆明市第三人民医院2019年1月至2021年12月首次确诊的儿童胸肺型并殖吸虫病患者及结核性胸膜炎患者,其中儿童胸肺型并殖吸虫病患者58例(吸虫组),结核性胸膜炎患者45例(结核组)。分析其临床症状、胸部CT影像学表现及实验室检查结果;利用二元logistic回归建立CT征象的影像模型和结合CT征象与嗜酸性粒细胞的联合模型,计算及对比两个诊断模型的鉴别诊断效能。结果:利用CT征象建立的影像模型显示,出现包裹性胸腔积液(OR=5.11,95%CI:1.64~15.97)和肺部结节(OR=12.33,95%CI:2.51~60.65)时,诊断为结核性胸膜炎的可能性更高,而出现胸膜钙化(OR=0.17,95%CI:0.04~0.68)和隧道征(OR=0.01,95%CI:0.00~0.15)时,诊断为结核性胸膜炎的可能性更低;通过绘制受试者工作特征曲线(ROC),曲线下面积(AUC)为0.850(95%CI:0.777~0.922),敏感度为79.3%(95%CI:66.6%~88.8%),特异度为75.6%(95%CI:60.5%~87.1%)。利用CT征象和嗜酸性粒细胞百分比建立联合模型显示,出现肺部结节(OR=11.56,95%CI:1.76~75.71)时,诊断为结核性胸膜炎的可能性更高,而出现隧道征(OR=0.02,95%CI:0.00~0.48)和嗜酸性粒细胞百分比升高(OR=0.02,95%CI:0.01~0.08)时,诊断为结核性胸膜炎的可能性更低;通过绘制ROC曲线,AUC为0.934(95%CI:0.885~0.982),敏感度为89.7%(95%CI:78.8%~96.1%),特异度为88.9%(95%CI:75.9%~96.3%)。联合模型鉴别诊断效能高于影像模型,其AUC差异有统计学意义(Z=-2.401,P=0.016)。结论:对于儿童胸肺型并殖吸虫病与结核性胸膜炎的鉴别,联合模型鉴别诊断效能高于影像模型;出现肺部结节、嗜酸性粒细胞百分比未升高时更倾向于诊断儿童结核性胸膜炎。Objective:To investigate the value of chest CT signs combined with peripheral blood eosinophil percentage in identifying pleuropulmonary paragonimiasis and pleural tuberculosis in children.Methods:Pediatric patients with pleuropulmonary paragonimiasis and pleural tuberculosis in children first diagnosed from January 2019 to December 2021 in The Third People’s Hospital in Kunming were retrospectively collected,including 58 pediatric patients with pleuropulmonary paragonimiasis(PG group)and 45 pediatric patients with pleural tuberculosis(TB group).The clinical symptoms,chest CT manifestations and laboratory test results were analyzed;an imaging model of CT signs and a combined model combining CT signs and eosinophils were established using binary logistic regression,the differential diagnostic efficacy of the two diagnostic models was calculated and compared.Results:The imaging model of CT signs showed that,encapsulated effusion(OR=5.11,95%CI:1.64-15.97)and pulmonary nodules(OR=12.33,95%CI:2.51-60.65)were more likely to be diagnosed as pleural tuberculosis,while pleural calcification(OR=0.17,95%CI:0.04-0.68)and tunnel sign(OR=0.01,95%CI:0.00-0.15)was less likely to be diagnosed as pleural tuberculosis.According to the ROC curve,when AUC=0.850(95%CI:0.777-0.922),the sensitivity was 79.3%(95%CI:66.6%-88.8%),and the specificity was 75.6%(95%CI:60.5%-87.1%).The combined model of CT signs and eosinophil percentage showed that,when pulmonary nodules(OR=11.56,95%CI:1.76-75.71)was found,pleural tuberculosis was more likely to be diagnosed,while tunnel signs(OR=0.02,95%CI:0.00-0.48)and elevated eosinophil percentage(OR=0.02,95%CI:0.01-0.08)were found,pleural tuberculosis was less likely to be diagnosed,and the ROC curve was plotted with AUC=0.934(95%CI:0.885-0.982),sensitivity of 89.7%(95%CI:78.8%-96.1%),and specificity of 88.9%(95%CI:75.9%-96.3%).The combined model had higher differential diagnostic efficacy than the imaging model,with a statistically significant difference in AUC(Z=-2.401,P=0.016).Conclusion:For the dif

关 键 词：结核 胸膜 并殖吸虫病 诊断 鉴别 体层摄影术 X线计算机 

分 类 号：R529.9[医药卫生—内科学] R532.22[医药卫生—临床医学]