高分辨率CT影像学特征预测老年髋部骨折患者早期急性肺损伤的价值

Value of high-resolution CT imaging features in predicting early acute lung injury in elderly patients with hip fracture

摘要:

目的： 探讨基于高分辨率CT（high resolution computed tomography，HRCT）影像学特征建立的预测模型在早期诊断老年髋部骨折患者急性肺损伤（acute lung injury，ALI）中的应用价值。方法： 纳入重庆市中医院收治的老年髋部骨折早期ALI组患者121例与非ALI组患者180例。通过单因素和多因素分析比较2组患者的年龄、性别及胸部HRCT扫描影像学资料，观察HRCT表现并建立HRCT诊断老年髋部骨折早期ALI的预测模型。结果： 老年髋部骨折早期ALI组患者常见HRCT征象包括斑片影、肺实变（intense parenchymal opacification，IPO）、弥漫性磨玻璃影（diffuse ground glass opacity，DGGO）和小叶间隔增厚，与非ALI组比较差异均有统计学意义（P<0.05）。多因素logistic回归分析得到包括IPO、DGGO及小叶间隔增厚在内的独立危险因素建立HRCT预测模型（OR>1，P<0.05）。该模型用于诊断老年髋部骨折患者早期ALI的灵敏度为93.4%，特异度为85.6%，准确率为88.7%，阳性预测值为81.3%，阴性预测值为95.1%。结论： 基于HRCT影像特征的预测模型有助于诊断老年髋部骨折早期ALI，为临床诊疗提供直接可靠影像学依据。

Abstract:

Objective: To explore the diagnostic value of prediction model established on high resolution computed tomography (HRCT) imaging features in elderly hip fracture patients with early acute lung injury (ALI). Methods: We retrospectively collected the data from 301 elderly patients with hip fracture. All patients were divided into two groups according to the presence of ALI, including ALI group (n=121) and non-ALI group (n=180). Univariate and multivariate analyses were used to compare the sex, age, and chest HRCT data between the two groups. The HRCT performance of the ALI group was observed, and the prediction model of HRCT was established for diagnosis of elderly hip fracture patients with early ALI. Results: The HRCT signs of patch shadow, intense parenchymal opacification (IPO), diffuse ground glass opacity (DGGO) and interlobular septal thickening were significantly more common in the ALI group than in the non-ALI group (P<0.05). The prediction model of HRCT was established using multivariate logistic regression, on the basis of following independent risk factors: IPO, DGGO, and interlobular septal thickening (OR>1, P<0.05). For diagnosis of elderly hip fracture patients with early ALI, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of this model were 93.4%, 85.6%, 88.7%, 81.3%, 95.1%, respectively. Conclusion: The prediction model based on HRCT imaging characteristics is helpful to diagnose elderly hip fracture patients with early ALI, providing direct and reliable imaging information for clinical diagnosis and treatment.