菌阴活动性肺结核的多层螺旋CT影像学特征及诊断模型构建  

Construction of a diagnostic model for smear- negative active pulmonary tuberculosis based on multi-slice CT imaging features

作　　者：李欣[1] 朱小刚 骆敏霞[1] LI Xin;ZHU Xiaogang;LUO Minxia(Department of Infection Management,Changzhou Third People's Hospital,Changzhou 213000,China;Department of Dermatology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Changzhou 213000,China)

机构地区：[1]常州市第三人民医院感染管理科,江苏常州213000 [2]南京医科大学附属常州第二人民医院皮肤科,江苏常州213000

出　　处：《分子影像学杂志》2024年第1期83-87,共5页Journal of Molecular Imaging

摘　　要：目的 分析菌阴活动性肺结核的多层螺旋CT(MSCT)影像学特征,并构建诊断模型。方法 选择2020年1月~2023年1月本院收治的肺部疾病患者1016例,按照临床诊断分为菌阴肺结核组(n=478)、非结核肺病组(n=538,其中肺癌200例、肺炎338例),均行MSCT检查,分析两组MSCT影像学特征,以Logistic回归分析明确菌阴活动性肺结核的诊断相关征象,构建菌阴活动性肺结核诊断模型,以ROC曲线下面积评估模型诊断效能。结果 两组间的树芽征、小叶中心结节、空洞、钙化、分叶征等MSCT征象差异有统计学意义(P<0.05)。Logistic回归分析结果显示树芽征、小叶中心结节、空洞是菌阴活动性肺结核的独立危险因素(P<0.05)。根据Logistic回归获得联合诊断模型方程式:Log(P)=-1.256+1.455×树芽征+0.982×小叶中心结节+1.023×空洞,该模型曲线下面积为0.825,诊断敏感度、特异性分别为93.94%、70.97%。结论 以MSCT影像学特征构建的菌阴活动性肺结核诊断模型具有较高诊断价值,可为临床诊疗菌阴活动性肺结核提供可靠依据。Objective To analyze the multi-slice CT(MSCT)features of patients with smear-negative active pulmonary tuberculosis and construct a diagnostic model.Methods A total of 1016 patients with pulmonary diseases who were admitted to our hospital were enrolled from January 2020 to January 2023,and they were divided into smear-negative pulmonary tuberculosis group(n=478)and non-tuberculous pulmonary disease group(n=538,including 200 cases of lung cancer and 338 cases of pneumonia)according to clinical diagnosis.All patients received MSCT examination,and their MSCT imaging features were analyzed.Logistic regression analysis was conducted to identify the signs related to the diagnosis of smear negative active pulmonary tuberculosis,and a diagnostic model for smear-negative active pulmonary tuberculosis was constructed.The diagnostic efficiency of the model was evaluated with AUC.Results There were statistically significant differences in MSCT signs such as tree in bud,centrilobular nodule,cavity,calcification and lobulation between the two groups(P<0.05).Logistic regression analysis found that tree in bud sign,centrilobular nodule and cavity were independent risk factors for smear-negative active pulmonary tuberculosis(P<0.05).The equation of the combined diagnosis model constructed based on logistic regression analysis was as follow:Log(P)=-1.256+1.455×tree in bud sign+0.982×centrilobular nodule+1.023×cavity.The AUC,sensitivity and specificity of this model were 0.825,93.94%and 70.97%,respectively.Conclusion The diagnostic model constructed based on MSCT imaging features is of high value in diagnosis of smear-negative active pulmonary tuberculosis and can provide a reliable basis for clinical diagnosis and treatment of the disease.

关 键 词：计算机断层扫描 多层螺旋 影像学特征 菌阴活动性肺结核 诊断模型 诊断价值 

分 类 号：R521[医药卫生—内科学] R816.41[医药卫生—临床医学]