煤工尘肺患者肺结节检出状况和高危结节危险因素分析  

Prevalence of pulmonary nodules in patients of coal worker’s pneumoconiosis and analysis of risk factors of high-risk nodules

作　　者：杭文璐 李婉君 许乘铭 薄芸 周贤梅[4] 马雷 HANG Wenlu;LI Wanjun;XU Chengming;BO Yun;ZHOU Xianmei;MA Lei(Department of Respiratory and Critical Care Medicine,Second Affiliated Hospital of Xuzhou Medical University and Xuzhou Mine Group General Hospital,Jiangsu 221000,China;不详)

机构地区：[1]徐州医科大学第二附属医院/徐州矿务集团总医院呼吸与危重症医学科,江苏221000 [2]徐州医科大学 [3]安徽理工大学 [4]南京中医药大学,南京210023

出　　处：《工业卫生与职业病》2024年第1期31-35,共5页Industrial Health and Occupational Diseases

基　　金：江苏省自然科学基金青年项目(BK20220236);徐州市科技局医药卫生面上项目(KC22212)。

摘　　要：目的探讨煤工尘肺患者发生肺结节的检出状况及危险因素,并基于CT定量分析明确高危结节的CT参数及诊断效能。方法回顾性分析2019年1月1日至2023年6月30日在徐州矿务集团总医院住院的煤工尘肺患者的人口学资料,进行CT定量参数分析,了解肺结节发生的危险因素,用二元logistics回归分析和ROC曲线明确高危结节筛查的CT参数及诊断效能。结果156例患者中,煤工尘肺壹期124例(79.5%),煤工尘肺贰期28例(18.0%),煤工尘肺叁期4例(2.6%)。低危肺结节患者86例(55.1%),高危结节患者9例(5.8%)。高危结节的平均直径、最大横截面积明显高于非高危结节(Z=-2.690、-2.836,P<0.05),最小CT值显著低于非高危结节(Z=2.994,P<0.05)。影响患者发生高危结节的二元logistic回归结果显示,最小CT值在模型中有统计学意义(Waldχ^(2)=5.897,P<0.05)。预测高危结节的ROC曲线表明,平均直径(AUC 0.775,灵敏度77.8%、特异度79.2%)、最小CT值(AUC 0.807,灵敏度77.8%、特异度76.6%)、最大横截面积(AUC 0.790,灵敏度77.8%、特异度83.1%)具有预测高危结节的价值。结论半数以上煤工尘肺患者检出肺结节,采用CT定量分析以平均直径、最小CT值、最大横截面积为参数指标可评估煤工尘肺患者的高危结节,临床中应予以关注。Objective To investigate the prevalence and risk factors of pulmonary nodules in coal worker’s pneumoconiosis patients and to clarify the CT parameters and diagnostic efficacy of high-risk nodules.Methods The demographic data of coal worker’s pneumoconiosis patients hospitalized at Xuzhou Mining Group General Hospital from January 1,2019,to June 30,2023,were retrospectively included,and the data of quantitative CT parameters were analyzed to understand the risk factors for the occurrence of pulmonary nodules.The binary logistics regression analysis and ROC curve were used to clarify the CT parameters and diagnostic efficacy of high-risk nodule screening.Results Among 156 patients,124(79.5%)had stage I pneumoconiosis,28(18.0%)had stage II pneumoconiosis,and 4(2.6%)had stage III pneumoconiosis.Low-risk silica dust nodules were detected in 86 patients(55.1%)and high-risk nodules in 9 patients(5.8%)had.The mean diameter and maximum cross-sectional area of high-risk nodules were significantly higher than those of non-high-risk nodules(Z=-2.690,-2.836,P<0.05),and the minimum CT value was significantly lower than that of non-high-risk nodules(Z=2.994,P<0.05).The binary logistic regression results showed that the occurrence of high-risk nodules was closely related to the minimum CT value(Waldχ^(2)=5.897,P<0.05).The ROC curve for predicting high-risk nodules showed that the mean diameter(AUC 0.775,sensitivity 77.8%,specificity 79.2%),minimum CT value(AUC 0.807,sensitivity 77.8%,specificity 76.6%),and maximum cross-sectional area(AUC 0.790,sensitivity 77.8%,specificity 83.1%)had predictive value for high-risk nodules.Conclusion More than half of coal worker’s pneumoconiosis patients have been detected with pulmonary nodules.Quantitative analysis CT with mean diameter,minimum CT value,and maximum cross-sectional area as indicators can assess high-risk nodules of coal worker’s pneumoconiosis patients,it should be given attention in clinical practice.

关 键 词：煤工尘肺 肺结节 CT定量分析 危险因素 

分 类 号：R135.2[医药卫生—劳动卫生]