Symptomatic Radiation Pneumonitis in NSCLC Patients Receiving EGFR-TKIs and Concurrent Oncedaily Thoracic Radiotherapy:Predicting the Value of Clinical and Dose-volume Histogram Parameters

Background and objectives:The incidence of symptomatic radiation pneumonitis(RP)and its relationship with dose-volume histogram(DVH)parameters in non-small cell lung cancer(NSCLC)patients receiving epidermal growth factor receptortyrosine kinase inhibitors(EGFR-TKIs)and concurrent once-daily thoracic radiotherapy(TRT)remain unclear.We aim to analyze the values of clinical factors and dose-volume histogram(DVH)parameters to predict the risk for symptomatic RP in these patients.Methods:Between 2011 and 2019,we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and oncedaily TRT simultaneously(EGFR-TKIs group)and 129 patients who had received concurrent chemoradiotherapy(CCRT group).The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event(CTCAE)criteria(grade 2 or above).Statistical analyses were performed using SPSS 26.0.Results:In total,the incidences of symptomatic(grade≥2)and severe RP(grade≥3)were 43.5%(37/85)and 16.5%(14/85)in EGFR-TKIs group vs 27.1%(35/129)and 10.1%(13/129)in CCRT group respectively.After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching,chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group(χ^(2)=4.469,P=0.035).In EGFRTKIs group,univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving≥30 Gy(ilV_(30))[odds ratio(OR):1.163,95%CI:1.036-1.306,P=0.011]and the percentage of total lung volume receiving≥20 Gy(tlV_(20))(OR:1.171,95%CI:1.031-1.330,P=0.015),with chronic obstructive pulmonary disease(COPD)or not(OR:0.158,95%CI:0.041-0.600,P=0.007),were independent predictors of symptomatic RP.Compared to patients with lower iIV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)<cut-off point values)and without COPD,patients with higher ilV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)>cut-off point values)and COPD had a significantly higher risk for developing symptomatic RP,with a hazard ratio(HR)of 1.350(95%CI:1.190-1.531,P<0.001).Conclusion:Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy.The ilV_(30),tlV_(20),and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.

Plasma brain natriuretic peptide, platelet parameters, and cardiopulmonary function in chronic obstructive pulmonary disease

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a chronic respiratory disease with worldwide occurrence and high disability and mortality rate.It occurs mostly in the elderly population with pulmonary heart disease,type II respiratory failure,and other serious complications.AIM To investigate the correlation of plasma brain natriuretic peptide(BNP)and platelet parameters with cardiac function and pulmonary hypertension in patients with COPD and pulmonary heart disease.METHODS From June 2016 to June 2019,52 patients with COPD-pulmonary heart disease(pulmonary heart disease group),30 patients with COPD(COPD group),and 30 healthy individuals(control group)in our hospital were enrolled in the study.The pulmonary heart disease group was further divided into subgroups according to cardiac function classification and pulmonary artery pressure.Plasma BNP and platelet parameters were estimated and compared among each group and subgroup.The correlation of plasma BNP and platelet parameters with cardiac function classification and pulmonary artery pressure was then analyzed.RESULTS In the pulmonary heart disease group,the COPD group,and the control group,the levels of plasma BNP,platelet distribution width(PDW),and mean platelet volume(MPV)showed a decreasing trend(P<0.05),while an increasing trend was found in platelet count(PLT)and plateletcrit(PCT)levels among the three groups(P<0.05).In the pulmonary hypertension mild,moderate,and severe subgroups,the levels of plasma BNP,PDW,and MPV showed an increasing trend(P<0.05),while a decreasing trend was observed in PLT levels(P<0.05);however,PCT levels showed no significant difference among the three subgroups(P>0.05).In the cardiac function grade I,II,III,and IV subgroups,the levels of plasma BNP,PDW,and MPV showed an increasing trend(P<0.05),while a decreasing trend was noted in PLT and PCT levels among the four subgroups(P<0.05).Correlation analysis showed that the levels of plasma BNP,PDW,and MPV in patients with pulmonary heart disease were positively correlated with their pulmonary artery pressure(P<0.05),while PLT was negatively correlated with their pulmonary artery pressure(P<0.05).Moreover,plasma BNP,PDW,and MPV levels were positively correlated with cardiac function grade(P<0.05)of these patients,while PLT and PCT levels were negatively correlated with their cardiac function grade(P<0.05).CONCLUSION Plasma BNP and PLT parameters are significantly correlated with the cardiac function and pulmonary hypertension in patients with COPD and pulmonary heart disease,indicating that these parameters have high clinical relevance in reflecting the health condition of these patients and for guiding their treatment.

Correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size

Objective： To evaluate the correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size. Methods： Sixty-eight patients with malignant solitary pulmonary nodules （SPNs） （diameter 〈4 cm） underwent multi-location dynamic contrast material-enhanced （nonionic contrast material was administrated via the antecubitai vein at a rate of 4mL/s by using an autoinjector, 4×5 mm or 4×2.5 mm scanning mode with stable table were performed）. Precontrast and postcontrast attenuation on every scan was recorded. Blood flow （BF）, peak, height （PHSPN）, ratio of peak height of the SPN to that of the aorta （SPN-to-A ratio） and mean transit time （MTT） were calculated. The correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size were assessed by means of linear regression analysis. Results： No significant correlations were found between the tumor size and each of the peak height （PHSPN） （35.79±10.76 Hu）, ratio of peak height of the SPN to that of the aorta （SPN-to-A ratio）, （14.27%±4.37） and blood flow （BF） （30.18 mL/min/100 g±9.58） （r=0.180, P=0.142〉0.05; r=0.205, P=0.093〉0.05; r=0.008, P=0.947〉0.05）. Conclusion： No significant correlations were found between the tumor size and each of the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules.

Significance of the left ventricular ejection/filling parameters in patients with pulmonary arterial hypertension:a magnetic resonance imaging based study

Background The goal of this study was to explore the significance of left ventricular(LV)ejection/filling parameters in assessing severity and prognosis of pulmonary arterial hypertension(PAH).Methods Newly diagnosed PAH patients were recruited between July 2011 and December 2013 prospectively.Cardiopulmonary hemodynamics derived from right heart catheterization,and LV ejection/filling parameters derived from CMR were collected.Follow-up data were collected periodically using a specifically-designed network database until April 30,2016.

Effects of alprostadil on respiratory parameters and hemodynamics of newborns with persistent pulmonary hypertension

Objective: To investigate the effects of alprostadil on respiratory parameters and hemodynamics of newborns with persistent pulmonary hypertension. Methods: According to random data table method, 80 newborns of pulmonary hypertension were randomly divided into the control group (n=40) and observation group (n=40), patients in the control group were given normal frequency ventilation, on the basis of the treatment of the control group, the observation group received alprostadil. The changes of respiratory parameters and hemodynamics were compared between the two groups before and after treatment. Results:The levels of respiratory parameters (SaO2, PaO2, PaCO2) and hemodynamics (PA, PVR, SVR) in the two groups before treatment were not statistically significant. After treatment, The levels of SaO2, PaO2in the two groups were significantly higher than those in the same group before treatment, and the observation group levels were (90.71±8.92)%, (85.27±8.23) mmHg, which were significantly higher than those in the control group after treatment;The levels of PaCO2, PA, PVR and SVR in the two groups after treatment were significantly lower than those in the same group before treatment, and the observation group were (35.22±3.46) mmHg, (26.95±3.78) mmHg, (725.71±108.82) dyns/cm5, (1 125.27±152.23) dyns/cm5, which were significantly lower than that of the control group. Conclusion: Adding alprostadil based on conventional frequent ventilation thraphy can effectively improve blood pressure and oxygen saturation, and improve hemodynamics of newborns with persistent pulmonary hypertension, which has important clinical value.

High Dose-Volume SBRT Following TACE Improves Clinical Outcomes of Patients with Unresectable Hepatocellular Carcinoma

This study aimed to investigate the dose-volume effects of γ-ray stereotactic body radiotherapy (SBRT) on clinical outcomes of patients with huge-size (≥10 cm) unresectable hepatocellular carcinoma (HCC). A total of 59 patients with huge-size unresectable HCC were treated with SBRT following TACE between May 2006 and Dec. 2009. The analyzed parameters included fractional dose, marginal dose, maximal dose, and mean dose that the target received, as well as percentages of tumor volume encompassed by 60% (P60), 70% (P70), and 80% (P80) of isodose curves in entire tumor. The clinical outcomes included objective response rate (ORR), disease-free survival (DFS), overall survival (OS), and adverse event (AE). During median follow-up of 18.4 months, 81.4% of ORR (8.5% CR and 72.9% PR) was achieved, higher than 28.9% of ORR recently reported for TACE alone. 1- and 3-year DFS rates were 31.1% and 2.6% with median DFS of 8.7 months;1-, 3-, and 5-year OS rates were 46.5%, 13.7%, and 2.9%, with median OS of 11.8 months. P70 was the only factor significantly correlating to DFS (P = 0.009) and OS (P = 0.01). Neither severe radiation-related liver disease nor > grade 3 AE was observed. In conclusion, SBRT was a safe and effective option for treatment of huge-size unresectable HCC. P70 represented a parameter for predicting DFS and OS, and high dose-volume (e.g., P70) might be required to achieve improved clinical outcomes of patients with this type of HCC.

Effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure

Objective:T o analyze the effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with chronic obstructive pulmonary disease (COPD) and type II respiratory failure. Methods:90 patients with COPD and type II respiratory failure were randomly divided into observation group and control group (n=45). Control group received conventional therapy, observation group received conventional therapy+adjuvant noninvasive positive pressure ventilation, and differences in blood gas parameters, cardiac function, inflammatory state, etc., were compared between two groups of patients 2 weeks after treatment. Results:Arterial blood gas parameters pH and alveolar-arterial partial pressure of oxygen [P(A-a)O2] levels of observation group were higher than those of control group while, potassium ion (K+), chloride ion (Cl-) and carbon dioxide combining power (CO2CP) levels were lower than those of control group 2 weeks after treatment;echocardiography parameters Doppler-derived tricuspid lateral annular systolic velocity (DTIS) and pulmonary arterial velocity (PAV) levels were lower than those of control group (P<0.05) while pulmonary artery accelerating time (PAACT), left ventricular end-diastolic dimension (LVDd) and right atrioventricular tricuspid annular plane systolic excursion (TAPSE) levels were higher than those of control group (P<0.05);serum cardiac function indexes adiponectin (APN), Copeptin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), cystatin C (CysC), growth differentiation factor-15 (GDF-15) and heart type fatty acid binding protein (H-FABP) content were lower than those of control group (P<0.05);serum inflammatory factors hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), IL-8, IL-10, and transforming growth factor-β1 (TGF-β1) content were lower than those of control group (P<0.05). Conclusions:Adjuvant noninvasive positive pressure ventilation can optimize the blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure, and it is of positive significance in improving the overall treatment outcome.

Study of the Impact of the Patient Rhythm during Cryoballoon Ablation on the Acute Biophysical Parameters

Background: Pulmonary vein isolation by means of cryoballoon is a well-established way of treatment of atrial fibrillation. The aim of the study was to compare the acute cryoballoon biophysical parameters attained during energy applications to the individual pulmonary vein during sinus rhythm versus atrial fibrillation. Methods: 100 Patients who underwent their first-time PVI using second-generation cryoballoon for symptomatic and drug-refractory AF, between the beginning of March to end of August 2016, were initially screened. 61 patients with paroxysmal AF were included in the present study. 39 patients with persistent AF were excluded. No pre-procedural anatomical imaging was reported. Results: A total of 61 patients (male 80%, age 59.3 ± 13.4 years) were included in the present analysis. A total of 243 pulmonary veins were isolated with an average of 1.87 ± 1.14 cryo energy applications per individual vein. During cryo application, there were no significant differences between applications delivered during sinus rhythm or ongoing AF in the rate of temperature drop at 5 and 30 s, rate of warming at 5 s after freezing stop or achieved balloon nadir temperature. The same also was observed for both the balloon cooling rate and warming times. Conclusions: The present analysis shows no impact of the patient baseline rhythm at the time of energy application upon the acute balloon biophysical parameters in patients with normal sinus rhythm and those with ongoing atrial fibrillation using the second-generation cryoballoon.

CT心功能参数结合生化指标及Wells评分在急性肺动脉栓塞30 d不良预后中的评估价值

目的 探讨256层螺旋CT心功能相关参数、实验室指标及Wells评分对急性肺栓塞(acute pulmonary embolism, APE)严重程度的诊断效能,观察联合应用对提高急性肺栓塞患者30 d不良预后的预测价值。方法 纳入2018年5月至2021年11月行肺CT血管造影(CTPA)检查确诊为急性肺动脉栓塞住院患者进行回顾性分析,随访30 d且资料齐全者共225例,对照组为同期接受CTPA检查并确诊无肺栓塞患者70例。收集患者临床资料和实验室指标[肌酸激酶(CK)、肌酸激酶-特异性同工酶(CK-MB)和D-二聚体],计算Wells评分。采用心功能软件定量测量右心室(RV)、左心室(LV)体积;分别在横轴位图像、重建四腔心层面上测量右、左心室短径及截面积,计算其比值。对2组患者的上述定量指标进行分析。结果 2组患者肺部感染、冠心病史、既往肺栓塞或深静脉血栓病史、癌症活动期、手术/制动史及心率≥100次/min比较差异有统计学意义(P<0.05)。RVD/LVD-ax、RVA/LVA-ax、RVD/LVD-4ch、RVA/LVA-4ch、RVV/LVV、D-二聚体及Wells评分在对照组、急性肺栓塞预后良好与预后不良间差异有统计学意义(P<0.05)。RVD/LVD-ax在预测30 d不良预后及早期死亡方面AUC值最大,分别为0.692、0.724。RVA/LVA-ax与D-二聚体、Wells评分三者联合检测时在预测早期死亡方面AUC值最大。ROC曲线分析显示冠状窦直径>8.65 mm时急性肺栓塞后右心后负荷增加的风险增大。结论 RVA/LVA-ax与D-二聚体、Wells评分三者联合预测效能最佳;与重建四腔心径线、面积及体积相比,横轴位测量心脏形态改变对评价APE预后更优;当冠状窦直径>8.65 mm时急性肺栓塞后右心后负荷增加的风险增大,可帮助临床进行风险分层。

阿托伐他汀钙片联合布地奈德福莫特罗吸入粉雾剂治疗慢性阻塞性肺疾病的临床疗效及对患者血气分析指标的影响

目的:探讨阿托伐他汀钙片联合布地奈德福莫特罗吸入粉雾剂治疗慢性阻塞性肺疾病(COPD)患者的临床疗效,及对患者血气分析指标的影响。方法:选取2021年12月~2023年12月期间某院收治的120例COPD患者作为研究对象,按照随机数字表法分为对照组和观察组,每组60例。对照组患者给予布地奈德福莫特罗吸入粉雾剂(Ⅱ)治疗,观察组在对照组治疗基础上加用阿托伐他汀钙片,两组均连续治疗4周。比较两组患者临床疗效、肺功能[用力肺活量(FVC)、呼气流量峰值(PEF)和第1秒用力呼气容积/用力肺活量(FEV1/FVC)]、血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和血氧饱和度(SO_(2))]、辅助性T细胞1/辅助性T细胞2(Th1/Th2)、辅助性T细胞17/调节性T细胞(Th17/Treg)及不良反应发生情况。结果:治疗后,观察组患者治疗总有效率(93.33%)高于对照组(75.00%,P<0.05)。两组患者FVC、PEF及FEV1/FVC均升高(P<0.05),且观察组高于对照组(P<0.05);两组患者PaO_(2)、SO_(2)均升高(P<0.05),且观察组高于对照组(P<0.05);两组患者PaCO_(2)均降低(P<0.05),且观察组低于对照组(P<0.05);两组患者Th1/Th2和Th17/Treg均降低(P<0.05),且观察组低于对照组(P<0.05)。两组患者不良反应总发生率比较无统计学差异(P>0.05)。结论:与单用布地奈德福莫特罗吸入粉雾剂相比,阿托伐他汀钙片联合布地奈德福莫特罗吸入粉雾剂治疗COPD的临床疗效更佳,可有效改善患者肺功能、血气分析指标,且未增加不良反应的发生风险。

血小板参数联合Wells评分对肺血栓栓塞症诊断及预后的评估价值

目的:探讨血小板参数联合肺栓塞临床预测评分(Wells评分)对肺血栓栓塞症(PTE)诊断及预后的评估价值。方法:选取120例疑似PTE患者为研究对象,根据多层CT肺动脉造影(CTPA)结果分为PTE组(n=88)和非PTE组(n=32);PTE组患者再根据30 d内预后分为死亡组(n=18)和存活组(n=70)。比较PTE组与非PTE组、PTE组不同预后患者血小板参数[血小板计数(PLT)、平均血小板体积(MPV)、血小板体积分布宽度(PDW)]及Wells评分,分析Wells评分联合血小板参数诊断PTE的价值及其与死亡事件的相关性。结果:PTE组患者PLT低于非PTE组(P<0.05);MPV、PDW及Wells评分高于非PTE组(P<0.05)。ROC曲线分析显示,PLT、MPV、PDW联合诊断PTE敏感度、特异度分别为80.68%、78.13%;以CTPA为金标准,Wells评分联合血小板参数诊断PTE的准确度为90.83%。死亡组患者PLT低于存活组(P<0.05),MPV、PDW及Wells评分高于存活组(P<0.05)。相关性分析显示,PTE患者死亡事件与PLT负相关(P<0.05);与MPV、PDW及Wells评分正相关(P<0.05)。结论:PLT、MPV、PDW联合Wells评分诊断PTE与CTPA一致性较高,对预后判断有一定参考价值。

肺功能和剂量学参数与放射性肺炎发生相关性的初步研究

目的:探索放疗前肺功能、肺剂量学参数与放射性肺炎(radiation pneumonitis,RP)发生的相关性。方法:回顾性分析了2020年至2023年在我院接受容积调强弧形放疗且在放疗前6个月内进行过肺功能测试的85例肺癌患者的资料,临床观测的终点为RP。使用单因素和多因素分析方法分析了患者的临床资料、肺功能、肺剂量学参数与RP发生的关系。结果:在85例患者中,39例发生了≥2级RP,发生率为45.8%。单因素分析显示,吸烟状况和放疗前肺病与≥2级RP的发生具有显著相关性(P<0.05);放疗前患者的肺功能与发生≥2级RP没有显著相关性(P>0.05);双肺V 20(WLV 20)、V 30(WLV 30)、V 40(WLV 40)和双肺平均剂量(mean lung dose,MLD)、同侧肺的V 5(ILV 5)和V 20(ILV 20)、对侧肺的V 20(CLV 20)、肿瘤PTV大小,都与≥2级RP的发生有显著相关性(P<0.05)。多因素分析显示,放疗前肺部疾病、MLD、ILV 5是发生≥2级RP的独立危险因素(P<0.05)。结论:放疗前肺功能不是预测患者RP发生的重要因素,肺部疾病、双肺的MLD以及ILV 5是预防接受容积调强弧形放疗肺癌患者2级以上RP发生的独立危险因素。

呼出气一氧化氮结合CT三维重建定量小气道参数评估慢性阻塞性肺疾病患者肺功能的价值

目的 探究呼出气一氧化氮(FeNO)结合CT三维重建定量小气道参数评估慢性阻塞性肺疾病(COPD)患者肺功能的价值。方法 回顾性选取2022年6月至2023年6月马鞍山市人民医院收治的80例COPD患者,对患者进行COPD全球倡议(GOLD)分级标准评估,33例评定为1~2级的患者纳入轻度组,47例评定为3~4级的患者纳入重度组。比较两组患者的FeNO、白细胞总数、中性粒细胞百分比及相关肺功能[第1秒用力呼气容积占预计值的百分比(FEV1%pred)、1秒用力呼气量(FEV1)/用力肺活量(FVC)、用力呼出25%、50%、75%肺活量时的平均呼气流速(MEF25%pred、MEF50%pred、MEF75%pred)]水平。所有患者均接受CT三维重建,记录相关小气道参数[气道壁面积百分比(WA%)、壁厚外径比(TDR)、主肺动脉∶升主动脉(PA∶A)、低衰减区域百分比(LAA%-950HU)],采用Pearson相关性分析探究患者的FeNO、CT三维重建参数与患者肺功能的相关性,采用受试者工作特征(ROC)曲线探究其对COPD病情严重程度的诊断价值。结果 重度组患者的FeNO水平为(29.55±1.56) ppb,高于轻度组[(23.66±1.23) ppb],差异有统计学意义(P<0.05);轻度组和重度组患者的白细胞总数及中性粒细胞百分比组间比较,差异均无统计学意义(P>0.05)。重度组的FEV1/FVC、FEV1%pred、MEF25%pred、MEF50%pred、MEF75%MEFpred分别为(40.11±3.56)%、(39.49±5.49)%、(20.88±2.38)%、(29.74±2.46)%、(39.23±3.11)%,均低于轻度组[(69.89±5.12)%、(54.22±6.12)%、(26.81±2.13)%、(36.22±2.34)%、(53.55±4.12)%],差异均有统计学意义(P<0.05)。重度组患者的WA%_(7~8)、TDR_(7~8)、PA∶A、全肺LAA%-950HU分别为(86.98±3.45)%、32.78±4.15、0.85±0.05、(10.88±2.16)%,均高于轻度组[(85.44±3.11)%、31.16±5.15、0.79±0.08、(2.98±0.61)%],差异均有统计学意义(P<0.05)。经Pearson相关性分析,患者的FEV1%pred、FEV1/FVC、MEF25%pred、MEF50%pred、MEF75%pred与一氧化氮、PA∶A、全肺LAA%-950HU、TDR_(7~8)、WA%_(7~8)呈负相关(P<0.05)。经ROC曲线分析,一氧化氮、TDR_(7~8)、WA%_(7~8)、PA∶A、全肺LAA%-950HU对重度COPD具有一定诊断价值,其曲线下面积值分别为0.840、0.763、0.752、0.781、0.818(P<0.05)。结论 FeNO及CT三维重建定量小气道参数与患者的肺功能存在一定相关性,对COPD患者肺功能和疾病严重程度的诊断具有一定价值,有助于更全面地了解COPD患者的病情,并指导临床诊断和治疗决策。

18F-FDG PET/CT代谢采集参数在老年孤立性肺腺癌和肺结核的诊断价值

目的探讨18 F-FDG PETCT代谢采集参数在老年孤立性肺腺癌和肺结核的诊断价值。方法回顾性分析2023年6月-2024年1月在首都医科大学附属北京胸科医院行18F-FDG PET/CT检查随后经组织学病理等检查确诊的640例患者的临床资料,其中老年孤立性肺腺癌326例(设为孤立性肺腺癌组),老年孤立性肺结核314例(设为孤立性肺结核组)。比较2组18F-FDG PET/CT代谢采集参数、CT形态学特征观察值、凝血指标(凝血活酶时间、凝血酶原时间、纤维蛋白原水平、凝血酶时间、D-二聚体、)值、肿瘤标志物(糖类抗原153、神经元特异性烯醇化酶)值;采用Kappa一致性分析18F-FDG PET/CT对老年孤立性肺腺癌和肺结核的诊断价值,并绘制受试者工作特征(ROC)曲线,评估各参数对老年孤立性肺腺癌和肺结核鉴别价值。结果640例患者均顺利完成检查,图像清晰,显像效果良好。2组CT形态学特征在形态、边界、毛刺征、卫星灶、空洞、空泡、空气支气管征、淋巴结肿大观察值差异均无统计学意义(P>0.05);2组患者CT形态学特征在分叶征、血管集束征、树芽征观察值差异均有统计学意义(P<0.05)。2组患者肿瘤代谢体积(MTV)、凝血活酶时间、凝血酶时间差异均无统计学意义(P>0.05);孤立性肺腺癌组患者标准化摄取值(SUV)max、SUVmin、SUVmean、SUVpeak均高于孤立性肺结核组;孤立性肺腺癌组患者凝血酶原时间、纤维蛋白原水平、D-二聚体水平均少/低于孤立性肺结核组(P<0.05);孤立性肺腺癌组患者糖类抗原153、神经元特异性烯醇化酶水平均高于孤立性肺结核组(P<0.05)。以患者SUVmax≥2.5作为判断标准,所有肺腺癌患者SUVmax值均≥2.5,89例肺结核患者的SUVmax值<2.5。18F-FDG PET/CT鉴别诊断老年孤立性肺腺癌、肺结核的敏感度、特异度、准确率分别为100.00%、28.34%、64.84%。ROC曲线分析显示,SUVmax、SUVmin、SUVmean、SUVpeak鉴别诊断老年孤立性肺腺癌和肺结核的曲线下面积(AUC)值分别为0.723、0.734、0.966、0.851,血清指标凝血酶原时间、纤维蛋白原水平、D-二聚体、糖类抗原153、神经元特异性烯醇化酶鉴别诊断老年孤立性肺腺癌和肺结核的AUC值分别为0.721、0.668、0.793、0.998、0.992。结论18F-FDG PET/CT代谢采集参数在老年孤立性肺腺癌和肺结核的鉴别诊断中具有一定诊断价值,单独以SUVmax≥2.5作为判断标准具有较大局限性,临床上应同时参考多个参数进行辅助鉴别诊断。

MSCT灌注成像参数鉴别诊断孤立性肺结节良恶性的价值

目的:探讨多层螺旋CT(multi-slice spiral CT,MSCT)灌注成像参数鉴别诊断孤立性肺结节(solitary pulmonary nodules,SPN)良恶性的价值。方法:选取2021年10月至2022年10月我院收治的80例SPN患者,所有患者入院后均行MSCT灌注成像检查、病理检查。根据组织病理学检查结果将患者分为良性结节组和恶性结节组。比较2组患者的MSCT灌注成像参数(血容量、平均通过时间、血流量、表面渗透系数),采用受试者工作特征曲线分析MSCT灌注成像参数鉴别诊断SPN良恶性的价值。结果:80例SPN患者中,经组织病理学检查确诊47例为恶性结节,33例为良性结节。2组患者MSCT灌注成像参数中的平均通过时间比较,差异无统计学意义(P>0.05);恶性结节组MSCT灌注成像参数中的血容量、血流量、表面渗透系数高于良性结节组(P<0.05)。受试者工作特征曲线结果显示,MSCT灌注成像参数中的血容量、血流量、表面渗透系数单独及联合诊断SPN良恶性的曲线下面积(AUC)分别为0.823(95%CI:0.721~0.926)、0.855(95%CI:0.761~0.949)、0.850(95%CI:0.752~0.948)、0.963(95%CI:0.924~1.000),均有一定诊断价值,且当血容量、血流量、表面渗透系数分别为4.405 ml/100 g、51.325 ml/(min·100 g)、21.115 ml/(min·100 g)时,可获得最佳诊断效能,且联合诊断的价值较高。结论:MSCT灌注成像参数中血容量、血流量、表面渗透系数联合诊断SPN良恶性的价值较高,可为SPN良恶性的早期诊断与治疗提供有效依据。

良恶性肺结节影像学特征及定量参数的鉴别诊断价值

目的分析良恶性肺结节影像学特征及定量参数的鉴别诊断价值,以提高诊断的准确性。方法回顾性分析本院经手术及穿刺活检病理证实的95例恶性肺结节和44例良性肺结节为研究对象。分析良恶性肺结节CT征象及定量参数的差异,并构Logistic回归模型,绘制受试者工作特征(ROC)曲线并计算出曲线下面积(AUC)鉴别肺结节的良恶性。结果良恶性肺结节CT征象中支气管征、空泡征、棘突征、胸膜凹陷征差异无统计学意义(P>0.05),分叶征、毛刺征、血管集束征差异有统计学意义(P<0.05)。良恶性肺结节定量参数中病灶的长径、体积占比(体积占比<-300 HU、体积占比-300~50 HU、体积占比>50 HU)、总体积、质量占比(质量占比<-300 HU、质量占比-300~50 HU、质量占比>50 HU)、总质量、最大CT值、最小CT值、平均CT值、标准差、中位数差异无统计学意义(P>0.05),熵、偏度、峰度差异有统计学意义(P<0.05)。Logistic回归分析显示熵、偏度、峰度是鉴别良恶性肺结节的独立预测因子。ROC曲线显示CT定量参数中鉴别诊断价值由高到低为熵的AUC为0.918,阈值为8.28,敏感度和特异度分别为89.47%、88.64%;偏度的AUC为0.812,阈值为-0.95,敏感度和特异度分别为83.16%、75.00%;峰度的AUC为0.881,阈值为7.15,敏感度和特异度分别为88.42%、81.82%。结论分叶征、毛刺征、血管集束征是恶性肺结节重要的影像学特征;CT定量参数中的熵、偏度、峰度鉴别良恶性肺结节的价值较大。

慢性阻塞性肺疾病急性加重患者高分辨率CT肺血管参数与肺功能、病情严重程度及预后相关性分析

目的:探讨慢性阻塞性肺疾病急性加重(AECOPD)患者高分辨率CT(HRCT)肺血管参数与肺功能、病情严重程度及预后的相关性。方法:选取AECOPD患者138例为AECOPD组,按疾病严重程度分组轻度组(48例)、中度组(44例)和重度组(46例)。另选同期体检健康者42例为对照组。比较AECOPD组与对照组HRCT肺血管参数和肺功能指标,分析HRCT肺血管参数与肺功能的相关性。比较不同病情程度AECOPD患者HRCT肺血管参数。随访1年后,根据预后情况分为预后不良组和预后良好组,分析AECOPD患者预后影响因素。结果:与对照组比较,AECOPD组横截面<5 mm~2肺小血管面积百分比(%CSA<5)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及FEV1/FVC下降,主肺动脉直径与主动脉直径比值(PA/A)增加(均P<0.05)。%CSA<5与肺功能指标呈正相关,PA/A与肺功能指标呈负相关(均P<0.05)。轻度组与中度组%CSA<5高于重度组(均P<0.05),但两组比较无统计学差异(P>0.05)。与预后良好组比较,预后不良组重度病情占比和PA/A升高,%CSA<5降低(均P<0.05)。AECOPD患者预后不良的危险因素包括重度AECOPD、低%CSA<5和高PA/A(均P<0.05)。结论:AECOPD患者肺血管参数与肺功能和病情严重程度密切相关,且肺血管参数能够有效评估患者预后情况。

周围型肺栓塞患者CT肺动脉造影特征与心血管参数的相关性

目的探究周围型肺栓塞(pulmonary embolism,PE)患者肺动脉栓塞指数(pulmonaryartery obstruction index,PAOI)和心血管参数的相关性。方法选择2020年1月—2023年1月我院收治的周围型PE患者97例作为研究对象。根据病情严重程度分为非危重组(n=49)和危重组(n=48)。比较两组患者的一般资料以及计算机断层扫描(computed tomography,CT)肺动脉造影参数。分层交互检验分析PAOI对心血管参数的影响。比例风险回归模型(proportional hazards model,简称Cox模型)调整混杂变量,分析PAOI和心血管参数与危重PE之间的关系。建模队列评估探讨PAOI和心血管参数结合对危重PE事件的预测能力。Cox比例风险模型评价PAOI和心血管参数各因子之间的交互作用。结果PAOI和主肺动脉最大直径、升主动脉直径比值、右心室短轴最大径、右心室短轴最大径/左心室短轴最大径呈正相关,PAOI和左心室短轴最大径呈负相关。PAOI、MPAd、rPA、RVd、LVd、RVd/LVd数值与周围型PE患者危重风险增加显著相关(P<0.001),PAOI(OR=1.82,95%CI:1.77~2.26)、MPAd(OR=1.63,95%CI:1.54~2.03)、rPA(OR=1.62,95%CI:1.51~1.94,)、RVd(OR=1.97,95%CI:1.68~2.15)、LVd(OR=0.67,95%CI:0.55~0.89)、RVd/LVd(OR=1.70,95%CI:1.68~1.98)。PAOI和心血管参数结合,会提高对周围型PE患者危重风险预测能力ROC曲线下面积为:0.815(0.678~0.879)。PAOI联合右心室短轴最大径对周围型PE患者危重风险事件的预测效应最高(OR=3.24,95%CI:2.51~4.68)。结论PAOI和心血管参数关系密切,PAOI和心血管参数结合,会提高对周围型PE患者出现危重风险的预测能力,有助于改善周围型PE患者预后。

基于衰弱分级的肺康复护理对老年慢性阻塞性肺疾病患者肺功能的影响

目的 探讨将基于衰弱分级的肺康复护理应用于老年慢性阻塞性肺疾病(COPD)患者中的效果。方法 以2020年8月至2021年8月华中科技大学同济医学院附属同济医院收治的90例老年COPD患者,按照随机数字表法分为2组,对照组45例采用常规分级护理,观察组45例采用基于衰弱分级的肺康复护理。比较2组患者的肺功能恢复情况、血气分析指标和急性加重次数。结果 护理2周后,2组的肺功能恢复情况和血气分析指标均优于同组干预前,且观察组均优于同期对照组,均存在统计学差异(P均<0.05)。出院2个月后,2组的急性加重次数均少于同组干预前,且观察组少于同期对照组,均存在统计学差异(P均<0.05)。结论 基于衰弱分级的肺康复护理可促进患者的肺功能恢复,改善其血气分析指标,减少急性加重次数。

慢性肺源性心脏病应用心脏彩超行病情评估的价值研究

目的:探讨心脏彩超中特异性指标在评估肺源性心脏病临床研究价值。方法:将医院收治的62例稳定期慢性肺源性心脏病患者依据住院治疗期间是否出现心脏失代偿临床表现分为代偿组(SP组,51例)及失代偿组(DP组,11例)。于接诊首日采用心脏彩超技术对两组的血管和心脏参数进行评估。Spearman分析法分析上述指标与肺源性心脏病临床的相关性;ROC曲线分析各指标的对失代偿转归的参考价值。结果:SP组患者Nakata指数、左室等容舒张时间、肺动脉压力指标均低于DP组(P<0.05);Mcgoon指数、主动脉瓣口面积、左室射血分数、E波减速时A峰E峰流速比值则升高(P<0.05)。Nakata指数、肺动脉压力与失代偿进展呈负相关;主动脉瓣口面积、左室射血分数、左室等容舒张时间、E波减速时A峰E峰流速比值与慢性肺源性心脏病失代偿进展存在线性正相关;全参数评估病情转归的ROC曲线下面积较优(AUC=0.806)。结论:心脏彩超指标在慢性肺源性心脏病早期病情评估、失代偿恶化进程中,有极高临床参考、应用意义及价值。