基于临床影像学指标的CT引导下经皮肺穿刺活检术后肺部并发症风险预测模型构建  

Risk Prediction Model Construction of Pulmonary Complications After CT-Guided Percutaneous Lung Biopsy Based on Clinical Imaging Indexes

作　　者：郭军号 金刚 赵智 南方圆 胡允胜 胡蕖 GUO Junhao;JIN Gang;ZHAO Zhi(Department of Thoracic Surgery,First People’s Hospital of Jiangxia District,Wuhan City,Wuhan,Hubei Province 430200,P.R.China)

机构地区：[1]武汉市江夏区第一人民医院胸外科,430200 [2]武汉市江夏区中医医院外科,430200

出　　处：《临床放射学杂志》2025年第5期877-881,共5页Journal of Clinical Radiology

摘　　要：目的探讨CT引导下经皮肺穿刺活检术后肺部并发症发生的危险因素并构建基于临床影像学指标的风险预测模型,旨在为后续临床诊治工作提供更多参考。方法回顾性纳入2021年1月至2024年1月于本院完成CT引导下经皮肺穿刺活检术的患者共305例,根据是否出现肺部并发症分组,采用单因素分析以及多因素分析分析CT引导下经皮肺穿刺活检术后肺部并发症发生的危险因素。构建列线图模型预测CT引导下经皮肺穿刺活检术后肺部并发症发生的风险并分析其预测效能。结果纳入305例患者术后出现肺部并发症的患者有65例,发生率为21.31%。单因素分析结果显示,是否合并慢性阻塞性肺疾病、病灶最大径、病灶距胸壁长度、穿刺针刺入时间、穿刺区域平扫CT值及增强CT值与平扫CT值差值均与CT引导下经皮肺穿刺活检术后肺部并发症发生风险有关(P<0.05)。Logistic多因素分析结果证实,合并慢性阻塞性肺疾病、病灶最大径<2.5 cm、病灶距胸壁>3 cm、穿刺针刺入时间>10 min、更高穿刺区域平扫CT值及增强CT值与平扫CT值差值均是CT引导下经皮肺穿刺活检术后肺部并发症发生独立危险因素(P<0.05)。利用Logistic回归模型的独立影响因素构建列线图预测模型,并且利用各独立影响因素以及列线图预测模型对患者的并发症发生情况进行受试者工作特征(ROC)曲线的预测,ROC曲线下面积分别为0.628,0.710,0.672,0.704,0.681,0.686,0.905。结论合并慢性阻塞性肺疾病、病灶最大径<2.5 cm、病灶距胸壁>3 cm、穿刺针刺入时间>10 min、更高穿刺区域平扫CT值及增强CT值与平扫CT值差值的患者在CT引导下经皮肺穿刺活检术后更易出现肺部并发症;利用以上因素构建的数学模型对于患者的并发症预测显示出良好的效能,值得在工作中深入分析。Objective To investigate the risk factors of pulmonary complications after CT-guided percutaneous lung biopsy and construct a prediction model based on clinical imaging indexes to provide more reference for follow-up clinical diagnosis and treatment.Methods A total of 305 patients who underwent CT-guided percutaneous lung biopsy in our hospital from January 2021 to January 2024 were retrospectively included and grouped according to whether pulmonary complications occurred after the procedure.Univariate and multivariate analyses were performed to identify risk factors for pulmonary complications after CT-guided percutaneous lung biopsy.A risk prediction nomogram model was constructed and its predictive efficacy was analyzed.Results Among the 305 patients included in this study,65 developed pulmonary complications,with an incidence rate of 21.31%.Univariate analysis showed that the risk of pulmonary complications after CT-guided percutaneous lung biopsy was associated with chronic obstructive pulmonary disease(COPD),maximum diameter of the lesion,distance of the lesion from the chest wall,puncture needle insertion time,plain CT value of the puncture area,and the difference between enhanced and plain CT values(P<0.05).Logistic multivariate analysis confirmed that COPD,lesion diameter less than 2.5 cm,lesion distance from the chest wall greater than 3 cm,puncture needle insertion time longer than 10 minutes,higher plain CT value of the puncture area,and the difference between enhanced and plain CT values were independent risk factors for pulmonary complications after CT-guided percutaneous lung biopsy(P<0.05).A predictive nomogram model was constructed using the independent influencing factors from the logistic regression model.The areas under the curve(AUC)for predicting complications using these factors individually and in combination were 0.628,0.710,0.672,0.704,0.681,0.686,and 0.905 respectively.Conclusion Patients with COPD,lesion diameter less than 2.5 cm,lesion distance from the chest wall greater than 3 cm,pu

关 键 词：计算机断层扫描 经皮肺穿刺活检术 并发症 模型 

分 类 号：R563[医药卫生—呼吸系统]