脊柱转移性肿瘤与脊柱结核门诊快速鉴别诊断量表的制定

A scoring system for rapid outpatient differential diagnosis of spinal metastases（SM） and spinal tuberculosis（STB）

摘要:

目的：制定1项可用于脊柱转移性肿瘤与脊柱结核门诊快速鉴别诊断的评分量表，以提高二者的门诊诊断准确率。方法：回顾性分析我科2014年至2016年收治的141例经术后病理检查确诊为脊柱转移性肿瘤或脊柱结核的患者门诊就诊时的病历资料，包括年龄、性别、既往史、病变椎体的个数、病变椎体的分布特点、病变椎体的受累部位、椎间盘是否受累、是否有死骨形成、病变椎体周围是否有软组织肿块影。采用多因素逻辑回归分析筛选出具有诊断意义的临床及影像学特点，制定出门诊快速鉴别诊断量表。结果：纳入141例患者中，脊柱转移性肿瘤82例，脊柱结核59例。多因素logistic回归分析显示年龄、性别、既往史、椎旁软组织肿块影无鉴别诊断价值。快速鉴别诊断量表包括病变椎体的分布特点、病椎的受累部位、椎间盘是否受累以及是否有死骨形成4个影像学特点。脊柱转移性肿瘤的门诊快速鉴别诊断量表评分显著高于脊柱结核，且差异有统计学意义（6.09 vs. 1.56；t=-18.157，P=0.000）。门诊快速鉴别诊断量表的敏感度和特异度分别为86.44%和96.34%。结论：门诊快速鉴别诊断量表在鉴别脊柱转移性肿瘤和脊柱结核时具有较满意的灵敏度和特异度，评分为0~3分则诊断为脊柱结核；评分为4~7分则诊断为脊柱转移性肿瘤。本量表尚需进一步修订与完善。

Abstract:

Objective：To develop a scoring system for rapid outpatient differential diagnosis of SM and STB and to improve outpatient diagnostic accuracy. Methods：The records of 141 patients who had a pathological diagnosis of SM or STB from 2014 to 2016 in our department were retrospectively reviewed. The following clinical and imaging data that they provided in outpatient were recorded：age，gender，relative history，number of the vertebral lesions，the distribution of vertebral lesions，the involved vertebral element，the intervertebral disc was involved or not，if there was a sequestra formation and if there was a soft tissue component. Then a multivariate logistic regression analysis was conducted，and the rapid outpatient differential diagnosis scoring system was established. Results：Among the total 141 patients，82 cases were diagnosed with SM and 59 cases were STB. Multivariate logistic regression analysis showed that age，gender，relative history and a soft tissue component can hardly provide accurate diagnostic information. The rapid outpatient differential diagnosis scoring system was based on four characteristic imaging features namely the distribution of vertebral lesions，the involved vertebral element，the intervertebral disc was involved or not，and if there was a sequestra formation. SM showed a statistic significant higher score than did STB（6.09 vs. 1.56，t=-18.157，P=0.000）. The sensitivity and specificity of rapid outpatient differential diagnosis scoring system were 86.44% and 96.34%，respectively. Conclusion：The differential diagnosis scoring system shows satisfactory sensitivity and specificity in rapid outpatient diagnosis of SM and STB. Spinal lesions with the score of 0 to 3 are STB，and the score of 4 to 7 are SM. This scoring system still needs further revision and improvement.