本文選題：孤立性肺結(jié)節(jié) + 鑒別診斷　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:孤立性肺結(jié)節(jié)(solitary pulmonary nodule,SPN)是目前臨床常常碰到的問(wèn)題,隨著影像學(xué)檢查技術(shù)的進(jìn)步,尤其是胸部CT檢查的推廣,其檢出率顯著增加,而SPN性質(zhì)的準(zhǔn)確評(píng)估對(duì)采取及時(shí)合理的臨床干預(yù)具有重要指導(dǎo)意義。為了減少經(jīng)驗(yàn)醫(yī)學(xué)的漏診、誤診和過(guò)度干預(yù),發(fā)展無(wú)創(chuàng)且準(zhǔn)確度高的SPN診斷方法或工具是十分需要的。因此國(guó)內(nèi)外醫(yī)學(xué)中心通過(guò)分析SPN良惡性的獨(dú)立危險(xiǎn)因素,先后提出了多種數(shù)學(xué)預(yù)測(cè)模型以更為客觀地指導(dǎo)SPN的診治。同時(shí)值得一提的是,目前多項(xiàng)研究均表明SPN的惡性概率隨著結(jié)節(jié)直徑的增大而增加,結(jié)節(jié)直徑20mm的惡性率較高,且臨床醫(yī)生更易判斷,不易漏診或誤診;因此結(jié)節(jié)直徑≤20mm的良惡性鑒別更為具有挑戰(zhàn)性,對(duì)早期診斷和治療更具有重要的臨床意義。目的:根據(jù)收集到的最大直徑≤20mmSPN患者的臨床及影像學(xué)資料,通過(guò)單因素和多因素分析篩選SPN良惡性的獨(dú)立危險(xiǎn)因素,并構(gòu)建一種預(yù)測(cè)數(shù)學(xué)模型。方法:回顧性收集2015年6月至2016年6月期間浙江大學(xué)附屬邵逸夫醫(yī)院362例經(jīng)手術(shù)明確病理診斷的≤20mmSPN患者的臨床及影像學(xué)特征,通過(guò)單因素分析患者確診年齡、性別、癥狀、吸煙史及吸煙指數(shù)、既往腫瘤史、腫瘤家族史、結(jié)節(jié)位置、最大直徑、毛刺、分葉、胸膜凹陷征、邊界、結(jié)節(jié)類型、空泡征、鈣化、血管集束征等在良惡性結(jié)節(jié)中的差異,并以多因素logistic回歸分析篩選出判斷SPN性質(zhì)的獨(dú)立危險(xiǎn)因素,最后構(gòu)建數(shù)學(xué)預(yù)測(cè)模型。結(jié)果:單因素分析發(fā)現(xiàn)性別、直徑(10mm)、結(jié)節(jié)類型(含磨玻璃成分)、毛刺、鈣化、空泡征、血管集束征在≤20mm的良惡性SPN之間存在統(tǒng)計(jì)學(xué)差異(P0.05)。多因素logistic回歸分析顯示,性別、直徑(10mm)、結(jié)節(jié)類型(含磨玻璃成分)、毛刺、空泡征在≤20mm的良惡性SPN之間存在統(tǒng)計(jì)學(xué)差異(P0.05)),是判斷≤20mm SPN良惡性的獨(dú)立危險(xiǎn)因素。構(gòu)建數(shù)學(xué)預(yù)測(cè)模型為:P(≤20mm SPN的惡性預(yù)測(cè)值)=ex/(1+ex),X=-1.472+(0.959×性別)+(1.002×直徑)+(1.890×毛刺)+(2.879×磨玻璃成分)+(1.605×空泡征)。其中e為自然對(duì)數(shù)。受試者工作特征(Receiver operating characteristic,ROC)曲線下面積(Area under the curve,AUC)為 0.841(95%CI:0.781-0.900)。選取P=0.801 為預(yù)測(cè)≤20mmSPN 良惡性的截點(diǎn),敏感度為89.4%,特異度為69.5%,陽(yáng)性預(yù)測(cè)值為93.4%,陰性預(yù)測(cè)值為55.6%。結(jié)論:單因素及多因素分析顯示,性別、直徑(10mm)、結(jié)節(jié)類型(含磨玻璃成分)、毛刺、空泡征是判斷≤20mmSPN良惡性的獨(dú)立危險(xiǎn)因素。建立的數(shù)學(xué)預(yù)測(cè)模型有一定的準(zhǔn)確性,可用于輔助臨床診斷。
[Abstract]:Background: solitary pulmonary noduleus (SPNs) is a common clinical problem at present. With the development of imaging techniques, especially the popularization of chest CT, the detection rate of SPNs has increased significantly.The accurate evaluation of the nature of SPN has important guiding significance for timely and reasonable clinical intervention.In order to reduce missed diagnosis, misdiagnosis and excessive intervention in empirical medicine, it is necessary to develop noninvasive and accurate SPN diagnostic methods or tools.Therefore, by analyzing the independent risk factors of benign and malignant SPN, medical centers at home and abroad have put forward a variety of mathematical prediction models to guide the diagnosis and treatment of SPN more objectively.At the same time, it is worth mentioning that at present, many studies show that the malignant probability of SPN increases with the increase of nodular diameter, the malignant rate of nodular diameter 20mm is higher, and clinicians are more easy to judge, difficult to miss diagnosis or misdiagnosis;Therefore, the differential diagnosis of benign and malignant nodules with diameter 鈮，

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