不同类型的肺部磨玻璃结节患者术前免疫炎症指标和癌胚抗原的比较

目的：比较不同病理类型的肺部磨玻璃结节（GGO）患者术前中性粒细胞与淋巴细胞比率（NLR）、血小板与淋巴细胞比率（PLR）、淋巴细胞与单核细胞比率（LMR）和血清癌胚抗原（CEA）的差异及其临床意义。方法：收集接受手术治疗的494例患者的NLR、PLR、LMR,其中浸润性腺癌176例,微浸润性腺癌150例,腺体前驱病变117例,良性病变51例。仅收集到150例浸润性腺癌、127例微浸润性腺癌、95例腺体前驱病变和45例良性病变的血清CEA数值。分别比较各组之间的NLR、PLR、LMR、CEA。结果：腺体前驱病变组的NLR(2.32±1.59)较良性病变组（1.82±0.64）高（P<0.05）。肺腺癌组的PLR(141.19±53.14)、腺体前驱病变组的PLR(145.94±51.92)较良性病变组（124.90±37.04）高（均P<0.05）。肺腺癌组的CEA [1.83(1.18,2.73)ng/mL]较腺体前驱病变+良性病变组[1.49(1.03,2.08)ng/mL]高（P<0.01）。浸润性腺癌组的CEA [2.14(1.29,2.92)ng/mL]分别...     

IMPROVED MARKING AND CHARACTERIZING OF PULMONARY NODULES ON DIGITAL RADIOGRAPHS USING A COMPUTER-AIDED DIAGNOSIS SYSTEM

Objective To evaluate and reduce inter-observer variations in the detection and characterization of pulmonary nodules on digital radiograph (DR) chest images. Methods Two hundreds and thirty-two new posterior-anterior DR chest images were collected from out-patient screening patients. Consensus was reached by two experienced radiologists on the marking, rating, and segmentation of small actionable nodules ranged from 5 to 15 mm in diameter using a computer-aided diagnosis (CAD) system. Both their own nodule findings and the computer's automatic nodule detection results were analyzed to make the consensus. Nodules identified together with corresponding likelihood rating and segmentation results were referred as "Gold Standard". Two un-experienced radiologists were asked to first mark and characterize suspicious nodules independently, then were allowed to consult the computer nodule detection results and change their decisions. Results Large inter-observer variations in pulmonary nodule identification and characterization on DR chest images were observed between un-experienced radiologists. Un-experienced radiologists could greatly benefit from the CAD system, including substantial decrease of inter-observer variation and improvement of nodule detection rates. Moreover, radiologists with different levels of skillfulness could achieve similar high level performance after using the CAD system. Conclusion The CAD system shows a high potential for providing a valuable assistance to the examination of DR chest images.     

微血流成像模式鉴别甲状腺结节良恶性的价值

目的 评价微血流成像(MFI)对甲状腺结节良恶性的鉴别诊断价值。方法 选取2020年5至12月在中国人民解放军总医院第一医学中心行常规超声、MFI和超声造影检查并获得明确组织学或细胞学病理结果的甲状腺结节患者50例,回顾性分析患者的临床资料和超声声像图,构建二分类Logistic回归模型,评价该模型预测甲状腺结节良恶性的能力。结果 Logistic回归分析显示成分和“S-W-C征”是预测恶性甲状腺结节的独立危险因素。Logistic回归模型对甲状腺结节良恶性预测的灵敏度、特异度、约登指数分别为73.33%、80.00%、0.53,受试者工作特征曲线下面积为0.799(95%CI=0.662~0.899)。结论 MFI模式有助于鉴别甲状腺结节良恶性,具有潜在应用价值。     

喉良性病变嗓音声学参数变化比较

目的探讨慢性喉炎、声带小结、声带息肉病人嗓音声学参数的变化，评价嗓音声学参数对喉良性病变的诊断意义。方法采用Dr．Speech软件对85例喉良性病变病人进行嗓音声学检测，并与正常嗓音检测结果进行比较分析。结果声带小结声门嗓声能量（NNE）值与慢性喉炎比较，差异有显著性（F=13．10，q=3．72，P＜0．05）。声带息肉基频微扰（jitter）、振幅微扰（shimmer）、NNE声学参数值与慢性喉炎参数值比较，差异有显著性（F=5．96～13．10，q=4．48～7．13，P＜0．05）。声带息肉shimmer、NNE的声学参数值与声带小结比较差异有显著性（q=3．85、3．68，P＜0．05）。结论嗓音声学分析对诊断慢性喉炎、声带小结、声带息肉有较大的价值。     

X线透视引导下经纤维支气管镜检查对肺孤立性病变的诊断价值

目的:比较有和无X线透视引导下经纤维支气管镜(纤支镜)检查对肺孤立性病灶的诊断率。方法:236例有孤立性肺结节和肿块(SPN/M)的患者分为两组:Ⅰ组(166例)在X线透视引导下行经纤支镜肺活检,Ⅱ组(70例)根据影像学解剖定位,无X线透视引导下行经纤支镜肺活检,比较两组的诊断阳性率,分析影响阳性率的相关因素。结果:Ⅰ组和Ⅱ组经纤支镜检查的阳性率分别为71.1%和52.9%(2χ=3.96,P<0.05)。两组中病灶直径>4cm亚组患者纤支镜诊断阳性率均明显高于直径<2 cm亚组(2χ=6.76,P<0.01和2χ=9.08,P<0.005)。在直径≤2cm和2.1~4 cm的肺恶性病灶患者中,Ⅰ组纤支镜检查的阳性率均明显高于Ⅱ组(2χ=4.06,P<0.05和2χ=4.72,P<0.05)。位于距离肺门较远的肺外周区和中间区的恶性和良性病灶,Ⅰ组的阳性率要明显高于Ⅱ组(2χ=4.67,P<0.05和2χ=8.28,P<0.005)。结论:对于直径在2~4 cm范围,位于肺外周和中间区的SPN/M,选用X线透视引导下经纤支镜肺活检有助于提高诊断阳性率。     

鼻咽癌古文献研究

按鼻咽癌临床表现特点确立古代鼻咽癌文献纳入标准,从古代文献中筛选出类似鼻咽癌的文献,并设立排弃标准除外有关颈淋巴结核、淋巴瘤等的内容。以此为基础,研究关于鼻咽癌的病因、病机及防治方法的古代鼻咽癌文献资料。结果显示,对鼻咽癌的病因病机有正气虚弱、寒客经络,或肝气郁结、火毒痰凝血瘀等几种认识;在防治上则强调预防为主,并以调理情志、益气和营为治疗大法。     

Sublingual Nodules: Diagnostic Markers of Metastatic Breast Cancer

Objective: To evaluate the diagnostic significance of sublingual nodules for metastasis of patients with breast cancer and further to explore the mechanisms of sublingual nodules. Methods: The image data of 117 in-patients with breast cancer in stage Ⅰ–Ⅳ in Tianjin Medical University Cancer Institute and Hospital from December 2009 to September 2011 were assessed retrospectively. All photos of patients' tongue were recorded by the digital camera of uniform type within 1 month after serological examination and regular re-examined by computed tomography(CT), magnetic resonance imaging and positron emission tomography CT. The presence of sublingual nodules was the positive standard. Chi square test and two-independent-sample test were used to determine the diagnostic value between the status of sublingual nodules and Clinico-pathological characteristics. The optimal cut-off of uric acid(UA) level to diagnose sublingual nodules was determined by receiver operating curve(ROC) analysis. Results: Breast cancer patients with sublingual nodules had a higher risk of recurrence and/or metastasis than patients without it(P0.001). Sublingual nodules was significantly correlated with increased serum UA level(P=0.001). The optimal cut-off value of UA level to diagnose sublingual nodules was 290 μmol/L. Furthermore, the elevated serum UA level( 290 μmol/L) was significantly related to breast cancer recurrence and/or metastasis(P0.001). Conclusions: Sublingual nodules were potential diagnostic markers for metastatic breast cancer. The formation of sublingual nodules was associated with elevated level of serum UA.     

孤立性肺结节良恶性危险因素研究进展

孤立性肺结节的检出率随着CT影像技术的进步,有着显著的上升,并且当代人们对健康的意识也越来越强,而早期结节的性质由于多种因素的影响较难鉴别,因此,肺结节的良恶性如果能够在初期得到全面的评估,将具有积极的意义。本文对良恶性孤立性肺结节患者的年龄、性别、血清肿瘤标志物、CT影像学特点、吸烟史、既往肿瘤史等相关因素的价值做一综述。     

动态CT增强对结节样肺癌与结节样肺炎的鉴别诊断价值

目的研究动态CT增强扫描对结节样肺癌与结节样肺炎的定性价值。方法随机选择83例SPN患者,先行薄层（3．0-5．0mm）平扫,再静脉注射对比剂（优维显）100mL后,对选定的结节中心行动态CT增强扫描,测量其增强前后的CT值,并对其中47例行三维表面重建。结果肺炎性结节以重度强化为主,净增值〉60HU,动态曲线呈持续上升型;肺癌性结节以轻。中度强化为主,净增值为20-60HU,动态曲线呈缓慢持续升高型;三维重建成像显示：恶性结节以Ⅰ、Ⅱ型血管异常为主;良性结节以Ⅳ型血管异常为主。结论动态CT增强扫描中追加三维重建对孤立结节的鉴别诊断有较高价值。     

多层螺旋CT对肺内孤立性结节的诊断价值

目的 分析肺内炎性结节与周围型肺癌的CT征象,以提高肺孤立性结节定性诊断的准确率.方法 回顾性分析30例经病理或CT随访证实的肺炎性结节和40例经病理证实的周围型肺癌的CT扫描征象.结果 对病变的形态及边缘特征、胸膜凹陷征、毛刺征、病变周边的征象进行鉴别分析,能提高炎性结节及周围型肺癌定性诊断的准确率.结论 多层螺旋CT对肺部孤立性结节的定性诊断有重要价值.