肺磨玻璃结节生长规律及风险因素的CT长期随访研究

Long-term CT follow-up study on growth pattern and risk factors of pulmonary ground-glass nodules

目的 通过长期动态CT随访了解肺磨玻璃结节(GGN)的生长及演变规律,明确影响其生长的危险因素。方法 回顾性收集行通过胸部CT检查显示肺部出现持续GGN且后续随访至少5年的病人120例(共计174个GGN),其中男30例,女90例,平均年龄(59.85±12.45)岁。随访中位时间为1 947 d。根据随访期间结节是否有增长将病人分为增长组(42例,58个GGN)及稳定组(78例,116个GGN)。收集记录病人的一般临床资料及GGN的CT影像特征,2组病人的一般临床资料及2种GGN的CT影像特征的比较采用卡方检验或Fisher确切概率检验。以单因素分析中P<0.05的变量作为输入变量进行多因素Cox生存回归分析。采用组内相关系数(ICC)分析2名医师测量数据(GGN平均直径及CT值)的一致性。结果 2组间一般资料各项指标的差异均无统计学意义(均P>0.05)。174个GGN中有58个(33.33%)出现增长,随访中位时间为1 303 d,有13个GGN(7.5%)在稳定5年后仍出现增长。2组GGN间初始直径、初始CT值、实性成分、胸膜凹陷征、主血管穿行征、空气支气管征、空泡征、分叶征、结节形态及结节-肺界面的差异均有统计学意义(均P<0.05),其中GGN初始直径≥7 mm、有主血管穿行或空泡征是影响其增长的独立风险因素[风险比(HR)分别为3.251、5.085、2.053,均P<0.05]。2名医师测量GGN平均直径及平均CT值的一致性均较好(均ICC>0.9)。结论 大多数肺GGN呈缓慢惰性生长,当GGN具备增长风险因素时需合理安排定期CT随访的周期,建议视增长情况采取必要的临床干预措施。

Objective To explore the growth and evolution of pulmonary ground glass nodules(GGNs) during longterm dynamic CT follow-up, and to identify the risk factors affecting the growth. Methods We retrospectively collected 120 patients(30 males and 90 females, 59.85±12.45 years) who presented persistent GGN(174 GGNs in total) on chest CT scans and followed up for at least 5 years(median follow-up time 1 947 days). According to whether the nodules grew during the follow-up period, the patients were divided into growth group(42 patients with 58 GGNs) and stable group(78 patients with 116 GGNs). The patient’s general clinical data were collected and GGN CT imaging characteristics were recorded. The clinical data and CT features of the two group of GGN were compared with chi-square test or Fisher exact probability test. The variables with a P<0.05 in the univariate analysis were fed into a multivariate Cox survival regression analysis. Intra-group correlation coefficient(ICC) was used to analyze the consistency of two physician measurements(mean GGN diameter and CT value). Results There were no significant differences in general clinical data between the two groups(all P>0.05). There were 58/174(33.33%) of GGNs grew, the median follow-up time was 1 303 days, 13/174(7.5%) of GGNs grew after 5 years of stabilization. The differences in GGN initial diameter, initial CT value, solid component, pleural depression sign, main vessel passage sign, air bronchus sign, vacuole sign, lobular sign, nodule morphology, and nodule-lung interface were statistically significant(P<0.05) between the two groups. The initial diameter ≥7 mm, presence of intact vessels passing through GGNs or vacuole sign were highly indicative of nodular growth(hazard ratio was 3.251, 5.085, and 2.053, P<0.05, respectively). The consistencies of the average diameter of GGN and the average CT values measured by the two physicians were good(ICC>0.9). Conclusion Most lung GGNs grow inertly, when the GGN has the growth risk factors, it is recommended to arrange regular CT follow-up visits and clinical intervention measures if presence of considerable nodular growth.