CT引导下肺穿刺活检患者发生咯血风险预测模型构建及验证  

Construction and validation of hemoptysis risk prediction model for CT-guided lung biopsy patients

作　　者：尤艳楠 顾小丽[1] 吉磊燕[1] YOU Yan-nan;GU Xiao-li;JI Lei-yan(Department of Imaging,Nantong Tumor Hospital,Nantong226361,Jiangsu,China)

机构地区：[1]南通市肿瘤医院影像科,江苏南通226361

出　　处：《生物医学工程与临床》2024年第5期624-633,共10页Biomedical Engineering and Clinical Medicine

基　　金：2020年度南通市市级科技计划项目(CZ20032)。

摘　　要：目的调查常规进行CT引导下经胸穿刺活检(CT-TNB)程序的肺部结节患者咯血的发生率和主要危险因素,并建立风险预测模型以指导临床实践。方法选择2020年4月至2023年4月在南通市肿瘤医院行常规CT筛查肺部结节患者306例,其中男性163例,女性143例;年龄51~72岁,平均年龄63.8岁;结节直径1~4 cm,平均直径2.7 cm;病灶位于左肺112例,右肺197例;位于肺门28例,肺上段125例,肺中段42例,肺下段61例;收缩压117~136 mmHg,平均收缩压128.9 mmHg;舒张压68~89 mmHg,平均舒张压79.0 mmHg;心率67~96次/分,平均心率82.1次/分;血氧饱和度95%~100%,平均血氧饱和度97.9%;慢性阻塞性肺疾病(COPD)65例;凝血酶原时间(PT)10.6~14.8 s,平均PT 12.4 s;D-二聚体0.2~0.7 mg/L,平均值0.5 mg/L;血小板计数187.3~297.4×10^(9)/L,平均血小板计数239.9×10^(9)/L;C反应蛋白(CRP)3.9~9.3 mg/L,平均值6.5 mg/L;空腹血糖3.2~10.1 mmol/L,平均值5.7 mmol/L;总胆固醇3.5~7.7 mmol/L,平均值5.5 mmol/L;鳞状上皮细胞癌(SCC)抗原0.51~0.92μg/L,平均值0.68μg/L;癌胚抗原(CEA)2.4~3.8 ng/L,平均值2.9 ng/L。采用CT-TNB进行良恶性鉴别诊断。根据术后有无发生咯血现象分为咯血组与无咯血组。306例患者以2:1随机分为训练集204例和验证集102例,比较训练集咯血组与无咯血组患者的人口学资料、血生化指标、结节特征和手术信息,并经最小绝对收缩与选择算子方法(LASSO)回归和多因素Logistic回归模型筛选危险因素,并建立列线图模型。结果训练集诊断咯血患者65例(31.9%,65/204),验证集29例(28.4%,29/102);两组咯血发生率比较,差异无统计学意义(P>0.05)。训练集咯血组与无咯血组临床资料比较,差异无统计学意义(P>0.05)。但两组肺结节最大直径例数分布差异有显著统计学意义(χ^(2)=11.101,P=0.004)。单因素分析发现,训练集咯血组穿刺距离显著大于无咯血组,磨玻璃样结节、良性结节和结节直径<3 cm例数增多,穿刺时间�Objective To investigate incidence and main risk factors of hemoptysis in patients with pulmonary nodules undergoing routine CT-guided transthoracic needle biopsy(CT-TNB)procedures,and establish risk prediction model for guiding clinical practice.Methods From April 2020 to April 2023,a total of 306 patients with pulmonary nodules screened by conventional CT were enrolled,which included 163 males and 143 females,aged 51-72 years old with mean age of 63.8 years old;diameter of nodules was 1-4 cm with mean diameter of 2.7 cm;lesions located on pulmo sinister in 112 cases and pulmo dexter in 197;28 cases located on pulmonary hilar,125 on pulmonary uperior segment,42 pulmonary middle segment and 61 on pulmonary inferior segment;systolic blood pressure was 117-136 mmHg with mean systolic blood pressure of 128.9 mmHg;diastolic blood pressure was 68-89 mmHg with mean diastolic blood pressure of 79.0 mmHg;heart rate was 67-96 beats/minute with mean heart rate was 82.1 beats/minute;blood oxygen saturation was 95%-100%with mean oxygen saturation of 97.9%;chronic obstructive pulmonary disease(COPD)in 65 cases;prothrombin time(PT)was 10.6-14.8 seconds with mean PT was 12.4 seconds;D-dimer was 0.2-0.7 mg/L with mean value of 0.5 mg/L;platelet count was(187.3-297.4)×10^(9)/L with mean platelet count of 239.9×10^(9)/L;C-reactive protein(CRP)was 3.9-9.3 mg/L with mean CRP of 6.5 mg/L;fasting blood glucose was 3.2-10.1 mmol/L with mean of 5.7 mmol/L;total cholesterol was 3.5-7.7 mmol/L with mean of 5.5 mmol/L;squamous cell carcinoma(SCC)antigen was 0.51-0.92μg/L with mean of 0.68μg/L;carcinoembryonic antigen(CEA)was 2.4-3.8 ng/L with mean of 2.9 ng/L.CT-TNB was used for differential diagnosis of benign and malignant.According to incidence of hemoptysis after operation,all of the patients were divided into hemoptysis group and non-hemoptysis group according to their postoperative situation.The 306 patients were randomly divided into training set(n=204)and validation set(n=102)at ratio of 2:1.The demographic data,blood biochemic

关 键 词：计算机体层摄影术 经胸穿刺活检 咯血 肺结节 列线图 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]