肺腺癌中miRNA34a和c-myc的表达及意义

目的检测肺腺癌组织中miRNA34a,癌基因c-myc的表达,探讨两者之间的关系及意义。方法采用qRT-PCR法检测mRNA miRNA34a,Western blot、免疫组化法检测c-myc蛋白在正常肺组织、癌旁肺组织、肺腺癌以及转移癌组织中的表达。结果(1)miRNA34a在肺腺癌组织中呈低表达,低于癌旁和正常肺组织(P0.01),高于转移癌组织(P0.01)。c-myc在肺腺癌组织中呈高表达,高于癌旁和正常肺组织(P0.01),低于转移癌组织(P0.01)。miRNA34a及c-myc在癌旁组织和正常肺组织之间的表达差异有统计学意义(P0.05)。(2)病理类型:miRNA34a及c-myc在低分化和高分化肺腺癌之间的表达差异均无统计学意义(P0.05)。两者在转移癌与非转移肺腺癌组织中的表达差异有统计学意义(P0.05)。(3)预后分析:cmyc阳性组的肺腺癌患者生存率低于阴性组(P0.05),miRNA34a低表达组患者的生存时间明显低于高表达组,差异有统计学意义(P0.01)。结论肺腺癌组织中miRNA34a的表达与c-myc蛋白表达呈负相关。c-myc高表达miRNA34a低表达提示患者预后不良。     

miRNA-145在肺腺癌组织中表达及意义

目的 分析微小核糖核酸-145(microRNA-145,miRNA-145)在肺腺癌组织中的表达情况及其临床意义.方法 收集68例于我院接受手术治疗的肺腺癌患者的肺腺癌组织及癌旁组织标本,提取总RNA,采用实时荧光定量反转录-聚合酶链反应法(RT-PCR)测定肺腺癌患者癌组织及癌旁组织miRNA-145表达,分析其生物学功能.结果 ① 肺腺癌患者癌组织miRNA-145相对表达量低于癌旁正常组织,对比差异具有统计学意义(P<0.05);② 不同性别、不同年龄、有无吸烟史、肿瘤大小不同的肺腺癌患者miRNA-145相对表达量对比差异无统计学意义(P>0.05),临床分期为Ⅲ-Ⅳ期、合并淋巴结转移的肺腺癌患者癌组织miRNA-145相对表达量低于Ⅰ-Ⅱ期患者(P<0.05),低分化、中分化肺腺癌患者癌组织miRNA-145相对表达量低于高分化患者(P<0.05),低分化患者癌组织miRNA-145相对表达量又高于中分化患者,对比差异均有统计学意义(P<0.05).结论 肺腺癌患者癌组织miRNA-145相对表达量低于癌旁正常组织,临床分期越高、分化程度越低的伴淋巴结转移的肺腺癌患者癌组织miRNA-145表达水平越低.     

肺鳞状细胞癌组织中Flap-核酸内切酶1和复制因子C2的表达及临床意义

目的 探讨肺鳞状细胞癌组织中Flap-核酸内切酶1(Flap-endonuclease 1, FEN1)和复制因子C2(replication factor C2, RFC2)的表达及其临床意义。方法 采用生物信息学方法分析FEN1、RFC2在肺鳞状细胞癌组织中的表达；采用免疫组化法检测80例肺鳞状细胞癌及癌旁组织中FEN1和RFC2蛋白的表达，利用RT-PCR法检测两者mRNA表达并分析相关性，分析FEN1、RFC2与临床病理特征的关系；收集患者随访资料，绘制患者的生存曲线。结果 FEN1和RFC2在肺鳞状细胞癌组织中的高表达率分别为77.50%(62/80)、70.00%(56/80),在癌旁组织中的高表达率分别为42.50%(34/80)、32.50%(26/80),与公共数据库分析结果一致。RT-PCR结果显示，肺鳞状细胞癌组织中RFC2、FEN1 mRNA表达均高于癌旁组织，差异有统计学意义(P<0.01);相关性分析结果显示，两者的表达存在明显正相关。不同TNM分期患者的FEN1、RFC2蛋白表达差异有统计学意义，是否存在胸膜侵犯与RFC2蛋白的表达差异有关。FEN1...     

C-myc与肺鳞癌中miRNA-21表达的关系

目的:检测肺鳞癌组织中miRNA-21和癌基因C-myc的表达,探讨两者的相关性及其临床意义.方法:采用实时荧光定量PCR(RQ-PCR)和免疫印迹检测25例肺鳞癌组织及其相应癌旁正常组织中miRNA-21及C-myc蛋白的表达水平,分析两者与临床病理指标的关系.结果:肺鳞癌组织中miRNA-21的表达及C-myc的表达均高于癌旁正常组织,在低分化肺鳞癌组织中的表达水平与高分化肺鳞癌组织相比,差异无统计学意义.miRNA-21及C-myc在转移癌组织中表达水平显著高于非转移癌组织.肺鳞癌组织中miRNA-21表达量与C-myc阳性表达存在正相关.结论:miRNA-21和C-myc在肺鳞癌中表达上调,可能与肺癌的发生与演进相关.     

非小细胞肺癌中S100A2、S100A4及S100P表达及意义

目的研究钙结合蛋白S100家族中S100A2、S100A4及S100P基因在非小细胞肺癌(non-small cell lung cancer,NSCLC)中的表达,阐明其与肺癌发生及转移的关系。方法以12例正常肺组织为对照,采用半定量RT-PCR技术检测17例腺癌和12例鳞癌及其癌旁组织中S100A2、S100A4及S100P mRNA的表达水平。结果(1)S100A2、S100A4及S100P mRNA在NSCLC中的表达量均高于癌旁和正常组织。(2)肺腺癌中三者mRNA表达量均高于癌旁和正常组织;肺鳞癌中S100A4和S100P mRNA的表达量高于正常组织。(3)根据不同的临床分期,S100A2、S100A4 mRNA在Ⅱ期与Ⅲ期中的表达量均高于Ⅰ期;S100P mRNA在Ⅲ期中的表达量高于Ⅰ期。(4)根据有无淋巴结转移,三者mRNA在有淋巴结转移癌组织中的表达量均高于无淋巴结转移的癌组织。(5)根据有无静脉癌栓,S100A4 mRNA在有静脉癌栓的癌组织中的表达量高于无静脉癌栓的癌组织。结论S100A4、S100A6、S100P在NSCLC中表达增加,尤其是在有淋巴结转移及TMN分期越高的癌组织中表...     

LMTK3在结直肠癌组织中的表达及其临床意义

目的探讨LMTK3与结直肠癌临床病理特征及预后的关系。方法纳入2009年9月至2011年9月南京鼓楼医院普外科60例结直肠癌患者作为研究对象,所有患者均取手术切除的结直肠癌组织和癌旁正常组织作石蜡切片,采用免疫组织化学染色法检测LMTK3蛋白表达水平,收集60例患者性别、年龄、肿瘤TNM分期等临床病理特征,比较癌组织和癌旁组织中LMTK3表达差异,比较LMTK3不同表达水平病理特征的差异,绘制生存曲线分析LMTK3与结直肠癌患者预后的关系。结果结直肠癌组织中LMTK3表达高于癌旁正常组织,差异具有统计学意义(P0.05);结直肠癌组织中LMTK3表达水平与年龄、性别、肿瘤直径、分化程度和浸润深度无显著相关性(P0.05),而与淋巴结转移和TNM分期显著相关(P0.05);LMTK3高表达组与低表达组生存曲线差异有统计学意义(P0.05)。结论结直肠癌组织LMTK3表达与TNM分期和淋巴结转移显著相关,LMTK3高表达提示结直肠癌预后较差。     

窖蛋白-1在肺癌中的表达及意义

目的 探讨窖蛋白-1（caveolin-1）在不同类型肺癌组织中的表达及其与微血管密度（MVD）和临床病理因素之间的关系。方法 对154例原发性肺癌、相应癌旁正常肺组织及36例淋巴结转移癌行caveolin-1免疫组织化学染色;对154例原发性肺癌行CD34免疫组织化学（SP法）染色并进行微血管密度计数;Western印迹法检测其中50例新鲜肺癌组织及其癌旁正常肺组织中caveolin-1的表达情况。结果 caveolin-1为膜／质表达蛋白,在正常支气管上皮细胞和肺泡上皮细胞中的阳性率为100％。在肺癌组织中的阳性率为59．1％（91／154）,低于癌旁正常肺组织,P＜0．01;Western印迹结果进一步证实caveolin-1在肺鳞癌、肺腺癌组织中的表达均显著低于癌旁正常肺组织,P＜0．01。caveolin-1在小细胞肺癌（SCLC）和非小细胞肺癌（NSCLC）中的阳性率分别为7．1％和64．3％,二者间差异有统计学意义,P＜0．01。NSCLC中,有淋巴结转移组caveolin-1表达高于无淋巴结转移组（P=0．005）;Ⅲ、Ⅳ期组caveolin-1表达显著高于Ⅰ、Ⅱ期组（P=0．042）,caveolin-1表达与NSCLC的其他临床病理因素及MVD值无关（P＞0．05）。结论caveolin-1其作为一种肿瘤抑制因子的同时,可能还具有促进NSCLC进展和转移的活性。     

磷脂酶Cε1基因在不同时期食管癌患者中的表达及对预后的影响

目的研究磷脂酶Cε1基因(PLCε1 mRNA)在不同时期食管癌患者中的表达及对预后的影响。方法选取2012年1月-2012年12月我院收治的157例食管鳞癌患者,根据第8版AJCC食管癌分期标准进行原发肿瘤分期、区域淋巴结转移分期、远处转移分期和临床及病理分期,对比不同分期中不同时期患者的外周血、癌组织和癌旁组织中PLCε1mRNA的表达,对外周血中PLCε1 mRNA表达与患者生存期进行线性回归。结果原发肿瘤分期:外周血和癌组织的PLCε1 mRNA表达差异无统计学意义(P0.05);癌旁组织T_1、T_2和T_3期之间差异无统计学意义(P0.05),而T_4期显著高于T_1、T_2和T_3期(P0.05)。区域淋巴结转移分期:从N0-N3,外周血PLCε1 mRNA表达逐渐增大,且相邻两个分期间差异有统计学意义(P0.05);而癌组织和癌旁组织之间差异无统计学意义(P0.05)。远处转移分期:M1期外周血和癌旁组织的PLCε1 mRNA表达显著高于M0期(P0.05);癌组织表达差异无统计学意义(P0.05)。临床及病理分期:外周血和癌旁组织的PLCε1 mRNA表达逐渐增大,且相邻两个分期间差异有统计学意义(P0.05);癌组织差异无统计学意义(P0.05)。PLCε1 mRNA表达与预后呈一定的负相关关系。结论外周血和癌旁组织中PLCε1 mRNA随着食管癌的浸润、转移而具有不同程度的表达增强,外周血中PLCε1 mRNA的表达预后存在一定的负相关关系。     

14-3-3zeta在T1期非小细胞肺癌中的表达及其临床病理意义

目的探讨14-3-3ζ在T1期非小细胞肺癌(NSCLC)中的表达及其临床病理意义。方法采用免疫组化、免疫印迹及RT-PCR技术检测110例T1期NSCLC及癌旁正常肺组织中14-3-3ζ蛋白的表达。结果 T1期NSCLC中14-3-3ζ蛋白及mRNA表达水平均较正常肺组织明显增强,14-3-3ζ的表达与患者的年龄、性别及病理学分型不相关。但随着肺癌分化程度的降低,14-3-3ζ的表达逐渐增强。在淋巴结转移阳性的癌组织中,14-3-3ζ表达高于淋巴结转移阴性的癌组织。生存曲线分析结果显示14-3-3ζ表达阴性患者的5年生存率及平均生存时间均高于表达阳性者。结论 14-3-3ζ与肺癌的分化程度、淋巴结转移及患者预后密切相关,提示14-3-3ζ有可能作为判断T1期NSCLC发展与预后的生物学指标之一。     

锰超氧化物歧化酶在乳腺浸润性导管癌中的表达及临床意义

目的检测锰超氧化物歧化酶(manganese superoxide dismutase,MnSOD)在乳腺浸润性导管癌组织及癌旁正常组织中的表达,探讨MnSOD在肿瘤的发生及肿瘤侵袭过程中的作用。方法采用RT-PCR和Western blot法分别对20例乳腺浸润性导管癌组织样本和20例癌旁正常组织样本的MnSOD mRNA及蛋白表达进行检测,以β-actin作为定量参考物,比较其在乳腺癌组织和癌旁正常组织中的表达差异,并结合临床特征淋巴结转移和TNM分期,分析MnSOD在肿瘤不同阶段表达的差异。结果乳腺浸润性导管癌组织MnSOD mRNA的表达值为0.61±0.15,癌旁组织为1.24±0.14,两者比较差异具有统计学意义(P<0.01);MnSOD蛋白在癌组织中表达值为0.40±0.04,癌旁组织为0.75±0.06,两者比较差异具有统计学意义(P<0.01)。乳腺浸润性导管癌中淋巴结转移与非淋巴结转移MnSOD mRNA及蛋白表达无统计学意义(P>0.05)。TNM分期:Ⅰ期4例MnSOD mRNA表达值为0.45±0.15,Ⅱ期9例MnSOD mRNA表达值为0.44±0.15,Ⅲ期7例MnSOD mRNA表达值为0.36±0.07,Ⅱ期与Ⅲ期及Ⅰ期与Ⅲ期的比较差异均有统计学意义(P<0.05);Ⅰ期与Ⅱ期比较差异无统计学意义(P>0.05);Ⅰ～Ⅲ期MnSOD蛋白表达三者相互间比较差异均无统计学意义(P>0.05)。结论乳腺浸润性导管癌组织中Mn-SOD mRNA和蛋白表达明显下降,检测MnSOD的表达可作为临床诊治及判定乳腺浸润性导管癌预后的指标。     

Transthoracic ultrasound assessment of B-lines for identifying the increment of extravascular lung water in shock patients requiring fluid resuscitation

Introduction:

Several studies have shown that the number of B-lines was related to the amount of extravascular lung water (EVLW). In our study, we aimed to demonstrate the magnitude of the incremental B-lines in shock patients with positive net fluid balance and the association with gas exchange impairment.

Materials and Methods:

We performed trans-thoracic ultrasound at admission (T₀) and at follow-up period (T_FL) to demonstrate the change of B lines (ΔB-lines) after fluid therapy. We compared the total B-line score (TBS) at T₀ and T_FL and calculated the Pearson''s correlation coefficient between the ΔB-lines and PaO₂/FiO₂ ratio.

Results:

A total of 20 patients were analyzed. All patients had septic shock. Net fluid balance was + 2228.05 ± 1982.15 ml. The TBS at T₀ and T_FL were 36.6 ± 23.73 and 63.80 ± 29.25 (P < 0.01). The ΔB-lines along anterior axillary line (AAL) correlated to the ΔTBS (r = 0.90, P < 0.01). The ΔB-lines along AAL had inverse correlation to PaO₂/FiO₂ ratio (r = −0.704, P < 0.05). The increase of B-lines ≥ 10 was related to the decrease of PaO₂/FiO₂ ratio. The inter-observer reliability between two ultrasound readers was high (r = 0.92, P < 0.01).

Discussion:

The number of B-lines increased in shock patients with positive net fluid balance and correlated to impaired oxygenation. These data supported the benefit of ultrasound for assessing the EVLW.     

CT图像肺结节自动检测

肺癌是对人类生命健康危害最大的恶性肿瘤之一。计算机辅助诊断系统对肺部CT图像进行自动分析后,可提示医生可疑肺结节,从而克服医生在诊断中的一些主观因素,为此本文提出了一种基于胸部CT图像的可疑肺结节自动检测算法。首先,根据胸部组织的特殊结构,利用一种新的分割算法提取出肺实质部分;在此基础上提取出灰度与结节相近的感兴趣区域,包括结节、肺血管、支气管;然后,以已标记的结节数据作为样本集,计算结节的面积、灰度均值、灰度方差、圆形度、形状矩、体积、球形度等特征值,利用最近邻法建立分类器判别函数;最后,计算测试集感兴趣区域的上述特征,对其进行判别、分类,并标记出结节。试验结果表明,该算法综合考虑了肺结节特征,具有较高的准确度。     

正常人肺与肺鳞癌间质中肥大细胞的比较研究

用正常人肺标本7例,肺鳞状细胞癌标本25例,对其间质中的肥大细胞进行光镜与电镜观察.结果表明,肺鳞癌间质肥大细胞比正常肺组织肥大细胞明显增多(P<0.002),每0.0169mm~2中肥大细胞均数分别为4.74±1.54和2.72±0.77.用Alcian蓝一藏红染色后,正常肺肥大细胞颗粒均为Alcian蓝阳性,而肺癌者则除Alcian蓝阳性外,还有藏红阳性的颗粒.电镜观察,正常肺中肥大细胞颗粒多为卷发状,而肺鳞癌中肥大细胞颗粒则多为细颗粒状,并伴有显著脱颗粒现象.以上提示,肥大细胞表型的变化与微环境有关,在肺癌中肥大细胞增多的同时,出现表型的变化,可能与抗肿瘤机制有关.     

周围型肺腺癌和周围型肺鳞癌的能谱CT表现

目的:观察周围型肺腺癌和周围型肺鳞癌的能谱CT表现。方法:回顾性分析经病理证实并行能谱CT扫描的周围 型肺腺癌122 例和周围型肺鳞癌89 例。测量病灶在动脉期及静脉期下的CT40 keV值、CT70 keV值、CT100 keV值、碘（水）浓度 （IC）、水（碘）浓度（WC）和有效原子序数（Zeff）,并计算能谱曲线斜率（K70 keV）。比较两组之间各能谱参数之间的差异。结 果:两组之间性别差异有统计学意义（P<0.05）,而其他临床特征和临床症状在两组之间差异无统计学意义（P>0.05）。动 脉期和静脉期,周围型肺腺癌的CT40 keV、CT70 keV、K70 keV、IC及Zeff均大于周围型肺鳞癌,差异具有统计学意义（P<0.05）;而 两组之间的WC和CT100 keV无统计学意义（P>0.05）。ROC曲线分析显示,动脉期各定量参数联合较静脉期各定量参数联 合的诊断效能好,曲线下面积、敏感性和特异性分别为86%、77%、83%。结论:周围型腺癌和周围型鳞癌的能谱CT表现 存在一定差异,可为二者的鉴别提供参考。     

Variations of pulmonary vessels: Some practical implications for lung resections

Anatomical variations of the bronchi and lung vessels may be important obstacles during lung resection if overlooked. We designed this study to determine the frequency and types of variations of lung vessels during lung resections. In a 3[1/2]‐year‐period, anatomical variations were recorded and registered by digital photography at the hilar and/or interlobar areas during lung resection surgery on 140 patients. Variations of the pulmonary blood vessels were observed in 23 patients. Of these, 12 patients had variations of the middle lobe vessels. Middle lobe veins emptying into the right inferior pulmonary vein, and middle lobe arteries originating from the artery for the basal segments, were observed in four patients each; two separate middle lobe arteries and a low origin of the middle lobe artery existed in three and one patient, respectively. Among seven patients with variations of the lingular vessels, the lingular artery originating from the artery for the basal segments was found in three patients; the remaining variations referred to absent or low origin of the lingular artery (in one patient each), and to an aberrant lingular vein, separate from the upper lobe vein (two patients). A single unilateral pulmonary vein and a left‐sided bronchial tree completely behind the pulmonary artery existed in three and one patient, respectively. Potential problems related to these variations during resectional lung surgery are discussed. Awareness of the most frequent variations is of utmost importance for safe lung resections. Clin. Anat. 22:698–705, 2009. © 2009 Wiley‐Liss, Inc.     

Branching of lung epithelium in vitro occurs in the absence of endothelial cells

Background: Early lung morphogenesis is driven by tissue interactions. Signals from the lung mesenchyme drive epithelial morphogenesis, but which individual mesenchymal cell types are influencing early epithelial branching and differentiation remains unclear. It has been shown that endothelial cells are involved in epithelial repair and regeneration in the adult lung, and they may also play a role in driving early lung epithelial branching. These data, in combination with evidence that endothelial cells influence early morphogenetic events in the liver and pancreas, led us to hypothesize that endothelial cells are necessary for early lung epithelial branching. Results: We blocked vascular endothelial growth factor (VEGF) signaling in embryonic day (E) 12.5 lung explants with three different VEGF receptor inhibitors (SU5416, Ki8751, and KRN633) and found that in all cases the epithelium was able to branch despite the loss of endothelial cells. Furthermore, we found that distal lung mesenchyme depleted of endothelial cells retained its ability to induce terminal branching when recombined with isolated distal lung epithelium (LgE). Additionally, isolated E12.5 primary mouse lung endothelial cells, or human lung microvascular endothelial cells (HMVEC‐L), were not able to induce branching when recombined with LgE. Conclusions: Our observations support the conclusion that endothelial cells are not required for early lung branching. Developmental Dynamics 244:553–563, 2015. © 2015 Wiley Periodicals, Inc.     

Time course of lung inflammatory and fibrogenic responses during protective mechanical ventilation in healthy rats

This study aimed to assess pulmonary inflammatory and fibrogenic responses and their impact on lung mechanics and histology in healthy rats submitted to protective mechanical ventilation for different experimental periods. Eighteen Wistar rats were randomized to undergo open lung-mechanical ventilation (OL-MV) for 1, 6 or 12 h. Following a recruitment maneuver, a decremental PEEP trial was performed and PEEP set according to the minimal respiratory system static elastance. Respiratory system, lung, and chest-wall elastance and gas-exchange were maintained throughout the 12 h experimental period. Histological lung injury score remained low at 1 and 6 h, but was higher at 12 h due to overinflation. A moderate inflammatory response was observed with a distinct peak at 6h. Compared to unventilated controls, type I procollagen mRNA expression was decreased at 1 and 12h, while type III procollagen expression decreased throughout the 12h experimental period. In conclusion, OL-MV in healthy rats yielded overinflation after 6 h even though respiratory elastance and gas-exchange were preserved for up to 12 h.     

肺灌注与通气显像诊断静注毒品者急性肺栓塞

为探讨肺灌注/通气显像对静脉注射毒品者肺栓塞的早期诊断,9例患败血症心内膜炎,急性脑梗塞患者用核素肺灌注、肺通显像进行观察,并与X线胸片、超声心动图结果进行对照,结果显示9例患者中,8例肺灌注呈双肺多节段稀蔬缺损,与通气显像不匹配,与通气显像不匹配,核医学诊断为急性肺栓塞1例溶栓治疗入病人肺灌注显像明显改善,与临床症状一致,从而证实灌注与肺通气显像联合运用对此类病人急性肺栓塞的早期诊断极有价值,并可做为溶栓治疗疗疗效的观察指标 另外也提示临床医师对静脉注射品者肺栓塞应有足够警惕.     

Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease

Introduction

The aim of this study was to assess the effects of preoperative pulmonary rehabilitation (PPR) on preoperative clinical status changes in patients with chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC), and net effects of PPR and cancer resection on residual pulmonary function and functional capacity.

Material and methods

This prospective single group study included 83 COPD patients (62 ±8 years, 85% males, FEV₁ = 1844 ±618 ml, Tiffeneau index = 54 ±9%) with NSCLC, on 2–4-week PPR, before resection. Pulmonary function, and functional and symptom status were evaluated by spirometry, 6-minute walking distance (6MWD) and Borg scale, on admission, after PPR and after surgery.

Results

Following PPR significant improvement was registered in the majority of spirometry parameters (FEV₁ by 374 ml, p < 0.001; VLC by 407 ml, p < 0.001; FEF₅₀ by 3%, p = 0.003), 6MWD (for 56 m, p < 0.001) and dyspnoeal symptoms (by 1.0 Borg unit, p < 0.001). A positive correlation was identified between preoperative increments of FEV₁ and 6MWD (r _s = 0.503, p = 0.001). Negative correlations were found between basal FEV₁ and its percentage increment (r _s = –0.479, p = 0.001) and between basal 6MWD and its percentage change (r _s = –0.603, p < 0.001) during PPR. Compared to basal values, after resection a significant reduction of most spirometry parameters and 6MWD were recorded, while Tiffeneau index, FEF₂₅ and dyspnoea severity remained stable (p = NS).

Conclusions

Preoperative pulmonary rehabilitation significantly enhances clinical status of COPD patients before NSCLC resection. Preoperative increase of exercise tolerance was the result of pulmonary function improvement during PPR. The beneficial effects of PPR were most emphasized in patients with initially the worst pulmonary function and the weakest functional capacity.     

基于边界逼近的肺实质分割方法

肺部CT图像的分割是计算机辅助诊断系统处理的一个重要环节,其分割的结果影响到医生的诊断与进一步的分析。由于胸膜结节的灰度与肺实质外围的灰度相近,运用传统的分割方法无法正确分割出此类病灶。将胸膜结节包含肺实质一起分割出来,使计算机辅助诊断系统能够对此类病灶做进一步的分析。提出一种结合Graham算法以及边界逼近的方法,对肺实质的轮廓进行修正,进而得到修正的二值模板;将该模板与原图像做乘运算,得到包含胸膜结节的肺实质。运用所提出的方法,对公开数据库LIDC中68张含病灶的CT样本图像做处理,通过与传统方法的对比以及对算法的过分割比例、欠分割比例以及准确性的分析,得到准确率为98.5%,平均过分割比例为1.35%,平均欠分割比例为0.51%,证明了该方法的有效性。