疑难肺部阴影临床与病理分析  

Clinical and pathological analysis of difficult pulmonary shadow

作　　者：赵延军 张红军 贾丽娟 顾兴 李文洁 柴雅琴 冯斐 张海涛 Zhao Yanjun;Zhang Hongjun;Jia Lijuan;Gu Xing;Li Wenjie;Chai Yaqin;Feng Fei;Zhang Haitao(Department of Respiratory and Critical Care Medicine,Xi′an Chest Hospital,Xi′an 710100,China;Department of Respiratory and Critical Care Medicine,Tangdu Hospital,Air Force Military Medical University,Xi′an 710038,China)

机构地区：[1]西安市胸科医院,西安710100 [2]空军军医大学第二附属医院,西安710038

出　　处：《中华肺部疾病杂志（电子版）》2023年第1期26-30,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金资助项目(82103537)。

摘　　要：目的 分析CT引导下经皮肺穿刺活检诊断的疑难肺部阴影患者临床资料,提高临床与病理诊断相关性。方法 选择2021年5月至2022年8月我院呼吸与危重症医学科行CT引导下经皮肺穿刺活检诊断的疑难肺部阴影患者25例,对临床资料、肺恶性肿瘤和肺结核进行分析。结果 疑难肺部阴影活检结果中,肺恶性肿瘤和肺结核23例(92.0%)。肺恶性肿瘤13例(56.5%),其中腺癌9例(69.2%)、鳞癌2例(15.4%)、小细胞癌和腺样囊性癌各1例(7.6%);肺结核10例(43.4%),其中肉芽肿性病变9例(36%)、慢性炎+坏死+多核巨细胞1例(4%)。2例(8.0%)为慢性炎伴碳末沉积。肺恶性肿瘤和肺结核在性别、年龄、基础病、病程、病变部位、病灶大小和影像学高危征象及结核菌素试验(PPD)、结核菌感染T细胞斑点实验(T-SPOT)、全自动医用PCR分析系统(Gene-Xpert)、结核菌聚合酶链式反应(TB-PCR)、结核菌核糖核酸(TB-RNA)和结核抗体等结核相关参考指标进行分析,无统计学差异(P>0.05)。两者在肺部肿瘤标志物,癌胚抗原(CEA)、鳞状细胞癌相关抗原(SCC)、胃泌素释放肽前肽(Pro-GRP)和细胞角蛋白19片段(CYFRA21-1)的阳性率差异明显,肺恶性肿瘤组阳性率高于肺结核组(P<0.001)。结论 疑难肺部阴影多伴为肺恶性肿瘤和肺结核,需借助肺部肿瘤标志物和组织病理进行鉴别,肺结核的诊断和鉴别诊断有时难于肺恶性肿瘤,临床应更多关注。Objective The clinical data of patients with difficult pulmonary shadows by CT guided percutaneous lung biopsy diagnosed were retrospectively analyzed, to improve the correlation between clinical and pathological diagnosis. Methods All of 25 patients with difficult pulmonary shadows by CT guided percutaneous lung biopsy diagnosed were recruited in the Department of Respiratory and Critical Care Medicine of our hospital. The general clinical data, pulmonary malignant tumor group and pulmonary tuberculosis group were analyzed from May 2021 to August 2022. Results In difficult lung shadow biopsy results, 23 cases(92.0%) were pulmonary malignant tumors and tuberculosis. 13 cases(56.5%) were malignant tumors of the lung, including 9 cases(69.2%) of adenocarcinoma, 2 cases(5.4%) of squamous cell carcinoma, 1 case(7.6%) of small cell carcinoma and 1 case(7.6%) of adenoid cystic carcinoma;10 cases(43.4%) were pulmonary tuberculosis, including 9 cases(90.0%) of granulomatous lesions, 1 case(10.0%) of chronic inflammation+necrosis+multinuclear giant cells. 2 cases(8.0%) of chronic inflammation with carbon deposition. Sex, age, underlying disease, course of disease, lesion location, lesion size and imaging high-risk signs, tuberculosis related reference indicators, such as tuberculin test(PPD), T-SPOT test of tuberculosis infection, automated medical PCR analysis system(Gene Xpert), tuberculosis polymerase chain reaction(TB-PCR), tuberculosis ribonucleic acid(TB-RNA) and tuberculosis antibody, were analyzed. There was no significant difference(P>0.05) in the analysis. The positive rates of lung tumor markers, such as carcinoembryonic antigen(CEA), squamous cell carcinoma associated antigen(SCC), gastrin releasing peptide prepreptide(Pro GRP) and cytokeratin 19 fragment(CYFRA21-1), were significantly different between the two groups. The positive rates of pulmonary malignant tumor group were significantly higher than those of and pulmonary tuberculosis group(P<0.001). Conclusion Most of the difficult lung shadows are pulmona

关 键 词：疑难肺部阴影 肺恶性肿瘤 肺结核 

分 类 号：R563[医药卫生—呼吸系统]