摘要
目的探讨与尘肺患者肺功能损伤程度相关的CT影像特征,为尘肺患者肺功能损伤分级评估提供新的指标。方法回顾性分析456例尘肺患者的肺部CT影像和肺功能检查结果,对尘肺结节大小、累及范围、密集程度进行定量评分,使用推想医疗软件定量分析肺部CT影像中肺气肿体积占比、间质性改变占比,并定性分析是否合并肺气肿、合并大块肺纤维化/尘肺结节的融合、合并肺门淋巴结钙化。计数资料组间比较采用χ^(2)检验或Fisher精确概率法,计量资料采用Wilcoxon秩和检验或F检验,采用Ordinal logistic回归分析不同肺部CT特征与肺功能损伤程度的相关性,并进行受试者工作特征曲线(ROC)分析。结果尘肺结节大小、结节累及肺野范围、结节密集程度、出现大块肺纤维化/尘肺结节融合,以及肺门淋巴结钙化能够提示尘肺患者肺功能受损及其程度(P<0.05);其中,尘肺结节大小[(OR(95%CI)3.811(2.713~5.350),P<0.001]和尘肺结节累及肺野范围[OR(95%CI)1.405(1.177~1.680),P<0.001]均与肺功能损伤分级独立相关,两者预测肺功能重度损伤ROC曲线下面积分别为0.694(敏感度89.0%,特异度41.0%)和0.615(敏感度71.0%,特异度45.2%),两者联合预测重度肺功能损伤的ROC曲线下面积为0.716(敏感度75.0%,特异度59.0%)。结论尘肺结节大小和结节累及肺野范围与肺功能的损伤分级独立相关,两者联合可以较好地预测肺功能重度损伤,可能成为评估尘肺患者肺部损伤程度的有效影像学标志物。
Objective To explore the CT imaging features related to the degree of pulmonary function change in patients with pneumoconiosis,thereby provide new indicator for the grading evaluation of pulmonary function damage in patients with pneumoconiosis.Methods A retrospective analysis was conducted on lung CT images and pulmonary function test results of 456 patients with pneumoconiosis.The size,extend,and density of pneumoconiosis nodules were quantitatively scored,the proportions of emphysema volume and interstitial changes in the lung CT images were quantitatively analyzed using the predictive medical software;while the presence of emphysema,fusion of large pulmonary fibrosis/pneumoconiosis nodules,and the calcification of hilar lymph nodes were qualitatively analyzed.The comparison of count data between groups was conducted using the Chi-square test or Fisher's exact probability method,the measurement data was analyzed using the Wilcoxon rank sum test or F-test,the Ordinal logistic regression was used to analyze the correlation between different lung CT features and the degree of lung function impairment,and the ROC curve analysis was performed as well.Results The results showed that the size of pneumoconiosis nodules,the extent of pneumoconiosis nodule involvement in the lung field,the density of nodules,the occurrence of large pulmonary fibrosis/pneumoconiosis nodule fusion,and the calcification of hilar lymph nodes can all reflect whether the lung function of the patients was impaired and its degree(P<0.05).Among them,the size of pneumoconiosis nodules[OR(95%CI)3.811(2.713—5.350),P<0.001]and the involvement extent of pneumoconiosis nodules in lung field[OR(95%CI)1.405(1.177—1.680),P<0.001]both were independently correlated with the grading of lung function impairment.The areas under the ROC curves for predicting severe lung function injury using both methods were 0.694(sensitivity 89.0%,specificity 41.0%)and 0.615(sensitivity 71.0%,specificity 45.2%),respectively,the combined prediction of the ROC area under the curve for severe lung function injury was 0.716(sensitivity 75.0%,specificity 59.0%).Conclusion The results suggested that the size of pneumoconiosis nodules and the extent of nodules are independently correlated with the grading of pulmonary function damage,the combination of the two can effectively predict the occurrence of severe pulmonary function damage,which may become an helpful imaging marker for evaluating the degree of pulmonary injury in pneumoconiosis patients.
作者
周琅
袁梅
王博深
张巧耘
谢丽庄
韩磊
鲁珊珊
ZHOU Lang;YUAN Mei;WANG Boshen;ZHANG Qiaoyun;XIE Lizhuang;HAN Lei;LU Shanshan(Department of Radiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China;Occupational Disease Prevention and Control Institute of Jiangsu Provincial Center for Disease Control and Prevention,Nanjing,Jiangsu 210029,China;不详)
出处
《中国工业医学杂志》
2025年第3期278-283,共6页
Chinese Journal of Industrial Medicine
基金
江苏省青年科技人才托举工程(JSTJ-2024-361)
江苏省职业健康科研项目(JSJZ20231207)。
关键词
尘肺病
影像标志物
肺功能
pneumoconiosis
image markers
lung function
