临床常用指标在肺结核高发地区对结核性及恶性孤立性肺结节的鉴别诊断效能评价  

Evaluation of the differential diagnostic efficacy of tuberculous and malignant isolated pulmonary nodules in areas with high incidence of pulmonary tuberculosis

作　　者：蒋云龙 吴志超 张迅夫 加娜提·托勒恒 侯昌建 马金山[2] JIANG Yunlong;WU Zhichao;ZHANG Xunfu;TOLLEHENG Gannati;HOU Changjian;MA Jinshan(Shihezi University School of Medicine,Shihezi 832002,China;Department of Thoracic Surgery,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]石河子大学医学院,新疆石河子832002 [2]新疆维吾尔自治区人民医院胸外科,新疆乌鲁木齐830001

出　　处：《黑龙江医药科学》2024年第4期33-37,共5页Heilongjiang Medicine and Pharmacy

基　　金：新疆维吾尔自治区自然科学基金,编号:2020D01A112。

摘　　要：目的:探讨临床常用指标在肺结核高发地区对孤立性肺结核结节鉴别诊断的价值。方法:收集2019年12月至2023年4月新疆维吾尔自治区人民医院胸外科收治并手术切除病理为肺结核和肺癌的536例SPN患者作为研究对象,对比记录并统计分析临床常用指标的危险因素,获得一个预测模型。结果:结核组男性发病率、非老年患者(<60岁)、少数民族比例、毛刺征、入院时血清CRP、ESR、T-SPOT、AFP、CEA高于肺癌组,均无血管集束征,差异有统计学意义(P<0.05);建立二元Logistic回归模型,结果显示男性、<60岁、少数民族、有临床症状、SPN毛刺征、血清CRP、ESR、T-SPOT呈高表达是SPN恶性病变的危险因素(OR>1,P<0.05);绘制ROC曲线结果显示,T-SPOT AUC值为0.7,预测价值较理想,其余单个危险因素AUC均>0.5,预测价值一般;但联合诊断AUC为0.905,特异度为0.823,灵敏度为0.922,预测价值高。结论:新疆作为肺结核病高发地区,结核和肺癌SPN目前难以通过单一检测手段明确鉴别,对于男性、中青年、少数民族、有明显临床症状、胸部CT检查考虑良性可能、血清CRP、ESR、T-SPOT呈高表达的SPN患者,若无明显倍增或其他恶性征象,可考虑定期随访,暂缓手术。Objective:To explore the value of common clinical indicators in the differential diagnosis of tuberculosis and lung cancer in isolated pulmonary nodules(SPN)in areas with high incidence of tuberculosis.Methods:536 SPN patients admitted to the pathology of tuberculosis and lung cancer from December 2019 to April 2023 were collected as study subjects,and the risk factors of common clinical indicators were compared,recorded and statistically analyzed,and a prediction model was obtained.Results:In the TB group,Male incidence,non-elderly patients(<60 years),proportion of non-Han nationality,burr sign,CRP,ESR,T-SPOT,AFP and CEA were higher than the lung cancer group.None of them had signs of blood vessel.The difference was statistically significant(P<0.05);By establishing a binary Logistic regression model,the results showed that male,<60 years old,non-Han,with clinical symptoms,burr sign of SPN,and high expression of serum CRP,ESR,and T-SPOT were risk factors for malignant lesions of SPN.(OR>1,P<0.05).By drawing the ROC curve,the T-SPOT AUC value is 0.7,the predictive value was ideal.The other individual risk factors AUC was>0.5,and the predictive value was general.The combined diagnosis AUC was 0.905,the specificity was 0.823,the sensitivity is 0.922,and the predictive value was high.Conclusion:For young and middle-aged Han male SPN patients with obvious clinical symptoms,benign possibility in chest CT examination,and high expression of CRP,ESR,and T-SPOT,if there is no significant doubling or other malignant signs,regular follow-up can be considered and surgery can be postponed.

关 键 词：孤立性肺结节 肺结核 结核感染T细胞斑点试验 肿瘤标记物 肺癌 预测模型 

分 类 号：R734.2[医药卫生—肿瘤]