局限于单个肺叶的肺炎样肺癌与大叶性肺炎的临床及CT特征分析

Clinical and CT features of lobar pneumonia and pneumonic lung cancer localized to a single lobe

摘要:

目的：探讨局限于单个肺叶的肺炎样肺癌与大叶性肺炎的临床及CT特征差异，以降低肺炎样肺癌的误诊率。方法：回顾性分析41例肺炎样肺癌（肺癌组）及45例大叶性肺炎（肺炎组）患者的临床及CT资料，比较2组患者年龄、性别、临床症状、白细胞计数及CT征象，对差异有统计学意义的参数绘制ROC曲线，利用曲线下面积（area under the curve，AUC）来衡量各参数的鉴别诊断效能。结果：从临床特征来看，肺癌组年龄明显大于肺炎组（P<0.05），但2组间性别构成无统计学差异（P>0.05），肺癌组以咳嗽、胸痛及咯血多见（均P<0.05），而肺炎组以发热及白细胞计数升高多见（均P<0.05），但2组间咳痰发生率无统计学差异（P>0.05）。从CT征象来看，2组实变影的分布情况无统计学差异（P>0.05），肺癌组实变影枯枝型充气支气管征、含气腔隙、不均匀强化及伴随结节影的出现率明显高于肺炎组（均P<0.05），但2组胸腔积液及磨玻璃密度影出现率无统计学差异（均P>0.05）。对上述有统计学意义的参数行ROC曲线分析显示，枯枝型充气支气管征对2种疾病的鉴别价值最大，AUC为0.807，敏感性及特异性分别为0.659、0.956。结论：局限于单个肺叶的肺炎样肺癌与大叶性肺炎的临床及CT特征均存在差异，全面了解这些差异有助于提高肺炎样肺癌的诊断正确率。

Abstract:

Objective：To explore the differences of clinical and CT features between lobar pneumonia and pneumonic lung cancer lo－calized to a single lobe. Methods：The clinical and CT data of 41 pneumonic lung cancer patients（lung cancer group） and 45 patients with lobar pneumonia（pneumonia group） were reviewed respectively. The age，sex，clinical symptoms，leukocyte count and CT find－ings of the two groups were compared. ROC curve was drawn for these parameters with statistical significance，and AUC was used to evaluate the diagnostic performance of each parameter. Results：For clinical features，the age of lung cancer group was older than that of pneumonia group（P<0.05）. No significant difference in gender was observed between both groups（P>0.05）. Cough，chest pain and hemoptysis were more common in lung cancer group（P<0.05），while fever and increased leukocyte count were more common in pneu－monia group（P<0.05）. No significant difference in the occurrence of expectoration was observed between both groups（P>0.05）. For CT features，no significant difference in the distribution of solitary consolidation was observed between both groups（P>0.05）. Air bronchogram sign with wither-stick shape，air-containing space，heterogeneous enhancement，and accompanying nodules were more common in lung cancer group（P<0.05）. No significant differences in the pleural effusion and ground-glass opacity around consolida－tion were observed between both groups. ROC curve analysis showed that air bronchogram sign with wither-stick shape was the most effective feature in the differential diagnosis of the two diseases，with an AUC of 0.807，and a sensitivity and specificity of 0.659 and 0.956，respectively. Conclusion：The clinical and CT features of lobar pneumonia and pneumonic lung cancer localized to a sin－gle lobe are different. Understanding these differences can help to improve the diagnostic accuracy of pneumonic lung cancer.