本文選題：支氣管超聲 + 彈性成像��； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2016年碩士論文

【摘要】：目的：肺門及縱膈腫大淋巴結(jié)的良惡性判定對(duì)于疾病的診治至關(guān)重要,隨著超聲技術(shù)的迅猛發(fā)展,經(jīng)支氣管超聲彈性成像技術(shù)開始應(yīng)用于臨床,并在鑒別淋巴結(jié)良惡性方面表現(xiàn)出良好的前景.本研究旨在通過測(cè)定肺門及縱膈腫大淋巴結(jié)的超聲彈性成像各參數(shù),探討支氣管超聲彈性技術(shù)對(duì)肺門及縱膈腫大淋巴結(jié)良惡性的診斷價(jià)值；并通過構(gòu)建Logistic回歸模型綜合評(píng)價(jià)常規(guī)超聲特征及超聲彈性成像在肺門及縱膈腫大淋巴結(jié)良惡性鑒別方面的應(yīng)用價(jià)值。方法：研究對(duì)象為2015年10月-2016年3月在解放軍總醫(yī)院呼吸科氣管鏡室行EBUS-TBNA檢查的83位患者共131例淋巴結(jié)。使用儀器為日本Olympus公司的EU-ME2 (Premier Plus)超聲檢查儀。在進(jìn)行穿刺操作前,分別對(duì)目標(biāo)淋巴結(jié)行常規(guī)超聲和彈性成像檢查,影像資料錄像留存。分析并記錄淋巴結(jié)常規(guī)超聲特征及彈性成像各個(gè)參數(shù),以EBUS-TBNA穿刺的病理結(jié)果及6個(gè)月的隨訪確認(rèn)作為診斷的金標(biāo)準(zhǔn),構(gòu)建各個(gè)特征參數(shù)的受試者工作特征曲線,得到曲線下面積及最佳診斷界值,計(jì)算出各個(gè)特征參數(shù)的診斷的準(zhǔn)確率、敏感度、特異度、比數(shù)積等指標(biāo),比較分析彈性成像的診斷價(jià)值;運(yùn)用Logistic回歸分析,構(gòu)建回歸方程,綜合研究肺門及縱膈腫大淋巴結(jié)的常規(guī)超聲特征及彈性成像參數(shù)對(duì)良惡性病變的診斷價(jià)值；然后以淋巴結(jié)位置的不同進(jìn)行分組,分別構(gòu)建各組藍(lán)色面積比例和應(yīng)變率比值均值的受試者工作特征曲線,確定診斷界值,對(duì)不同組的淋巴結(jié)采用相應(yīng)的界值進(jìn)行診斷,進(jìn)一步分析藍(lán)色面積比例及應(yīng)變率比值均值的診斷價(jià)值.結(jié)果：1.超聲彈性成像藍(lán)色面積比例診斷淋巴結(jié)良惡性的的最佳診斷界值為0.6,曲線下面積為0.875,診斷的準(zhǔn)確率、敏感度、特異度分別為84.43%、83.33%、86.00%,曲線下面積和診斷準(zhǔn)確率均顯著高于常規(guī)超聲；2.超聲彈性應(yīng)變率比值均值診斷病變良惡性的的最佳診斷界值為14.33,曲線下面積為0.882,診斷的準(zhǔn)確率、敏感度、特異度分別為81.97%、81.94%、82.00%,曲線下面積和診斷準(zhǔn)確率顯著高于部分常規(guī)超聲特征；3.超聲彈性圖像評(píng)分診斷病變良惡性的曲線下面積為0.837,診斷的準(zhǔn)確率、敏感度、特異度分別為83.61%、88.89%、76.00%,曲線下面積和診斷準(zhǔn)確率顯著高于部分常規(guī)超聲特征；4.超聲彈性成像藍(lán)色面積比例、應(yīng)變率比值均值、彈性評(píng)分之間診斷的準(zhǔn)確率比較,差異沒有統(tǒng)計(jì)學(xué)意義；但三者的比數(shù)積分別為30.71、20.68、25.33,表明藍(lán)色面積比例綜合診斷價(jià)值更高；5.Logistic回歸分析顯示邊界、回聲強(qiáng)弱、血供、短徑和藍(lán)色面積比例對(duì)診斷病變良惡性有顯著意義。利用構(gòu)建的回歸模型對(duì)病變性質(zhì)進(jìn)行預(yù)報(bào),以回歸值P0.5為惡性,P≤0.5為良性,則診斷的準(zhǔn)確率為91.80%,敏感度為94.44%,特異度為88.00%,顯著高于常規(guī)超聲特征以及彈性成像各個(gè)參數(shù)的相應(yīng)診斷值；6.按淋巴結(jié)位置分組后,藍(lán)色面積比例診斷良惡性的準(zhǔn)確率為90.08%,敏感度為89.87%，，特異度為90.38%；應(yīng)變率比值均值診斷的準(zhǔn)確率為85.25%,敏感度為84.72%,特異度為86.00%,較分組前均有所提高,但差異沒有統(tǒng)計(jì)學(xué)意義。結(jié)論：1.藍(lán)色面積比例、應(yīng)變率比值均值和彈性評(píng)分等超聲彈性成像參數(shù)對(duì)肺門及縱膈腫大淋巴結(jié)良惡性的鑒別診斷具有較高的臨床使用價(jià)值,其中以藍(lán)色面積比例綜合診斷能力最高；2.Logistic回歸模型能篩選出對(duì)肺門及縱膈腫大淋巴結(jié)良惡性診斷有意義的超聲特征,并能夠綜合常規(guī)超聲和彈性成像診斷的價(jià)值,有利于良惡性病變鑒別診斷；3.按淋巴結(jié)位置分組后,以不同組的藍(lán)色面積比例及應(yīng)變率比值均值的界值進(jìn)行診斷,能夠提高病變良惡性的診斷價(jià)值。
[Abstract]:Objective: hilar and mediastinal lymph nodes benign and malignant is essential for the diagnosis and treatment of the disease, with the rapid development of ultrasound technology, endobronchial ultrasound elasticity imaging technology has been applied to the clinic, and in the differential diagnosis of benign and malignant lymph nodes showed good prospects. This study aims to determine the parameters of ultrasound elastography in hilum of lung mediastinal lymph node enlargement, bronchial ultrasound elasticity value of benign and malignant node technology in diagnosis of hilar and mediastinal lymph nodes; and the application value of constructing Logistic regression model of comprehensive evaluation of characteristics of conventional ultrasound and ultrasound elastography in hilar and mediastinal lymph nodes in differential diagnosis of benign and malignant areas. Methods: the research object for the October 2015 -2016 year in March 83 in the Department of respiration, bronchoscope room of PLA General Hospital of EBUS-TBNA examination in patients with a total of 131 cases of lymph node. The use of instruments for the Japanese Olympu S EU-ME2 (Premier Plus) ultrasound instrument. In puncture operation, respectively to the target lymph node underwent conventional ultrasound and elastography images, video analysis and record retention. Lymph node characteristics of conventional ultrasound and elastography parameters, EBUS-TBNA biopsy and puncture 6 months follow-up confirmed as the gold standard for diagnosis, the construction parameters of the receiver operating characteristic curves, obtained the area under the curve and the optimal cutoff value, calculate the accurate rate of diagnosis of various characteristic parameters of sensitivity, specificity, ratio of product index, comparative analysis of diagnostic value of elastography; using Logistic regression analysis. To construct the regression equation, the value of hilar and mediastinal lymph nodes of the characteristics of conventional ultrasound and elastography in diagnosis of benign and malignant lesions of the parameters; then to lymph nodes in different groups, Each blue were constructed area ratio and strain ratio mean of the receiver operating characteristic curve to determine the diagnostic value of different groups of lymph nodes, adopt the corresponding boundary value for diagnosis, further analysis of the diagnostic value of blue area ratio and strain ratio mean. Results: 1. ultrasonic elastography in diagnosis of lymph node area proportion of blue the diagnosis of benign and malignant optimal cutoff value was 0.6, the area under the curve was 0.875, the accuracy rate of diagnosis, the sensitivity and specificity of 84.43%, respectively, 83.33%, 86%, the accuracy rate of diagnosis and the area under the curve were significantly higher than that of conventional ultrasound; 2. ultrasonic elastography strain ratio of benign and malignant lesions diagnosis mean the best diagnosis value of 14.33, area under the curve was 0.882, the accuracy rate of diagnosis, the sensitivity and specificity of 81.97%, respectively, 81.94%, 82%, the area under the curve and the diagnostic accuracy is higher than that of conventional ultrasound characteristics significantly Area 3.; elastography score for diagnosis of benign and malignant lesions under the curve is 0.837, the accuracy rate of diagnosis, the sensitivity and specificity of 83.61%, respectively, 88.89%, 76%, the accuracy rate of diagnosis was significantly higher than that of the area under the curve and some characteristics of conventional ultrasound elastography; 4. blue area ratio, mean strain ratio, more accurate the diagnosis rate of the elastic score, the difference was not statistically significant; but the three ratio of the number of integral 30.71,20.68,25.33 is, that blue area proportion of the value of higher comprehensive diagnosis; 5.Logistic regression analysis showed that the boundary, echo intensity, blood supply, short diameter and blue area ratio was significant in the diagnosis of benign and malignant lesions. To predict the nature of the lesions by regression model, the regression value of P0.5 for malignant and benign P is less than or equal to 0.5, the accurate rate of diagnosis was 91.80%, the sensitivity was 94.44%, specificity was 88%, significantly higher The corresponding diagnosis in conventional ultrasound elasticity imaging characteristics and the value of each parameter; 6. according to lymph node position after grouping the blue area proportion of benign and malignant diagnostic accuracy rate was 90.08%, the sensitivity was 89.87%, specificity was 90.38%; the accuracy rate of diagnosis of the mean strain ratio was 85.25%, the sensitivity was 84.72%, specificity was 86%. That is before grouping all increased, but the difference was not statistically significant. Conclusion: 1. blue area ratio, strain ratio and mean score of elastic parameters of ultrasound elastography has high of hilar and mediastinal lymph nodes in differential diagnosis of benign and malignant clinical value, the blue area proportion of comprehensive diagnosis ability is highest; the 2.Logistic regression model can screen out the ultrasound features of hilar and mediastinal lymph node diagnosis of malignant and benign sense, and can integrate conventional ultrasound and elastography in the diagnosis of the value of a It is helpful for differential diagnosis of benign and malignant lesions. 3., according to the location of lymph nodes, we can diagnose the value of the blue area ratio and the mean value of strain rate ratio of different groups, which can improve the diagnostic value of benign and malignant lesions.

【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R56;R734

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