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[1]赵延军,张红军,贾丽娟,等.疑难肺部阴影临床与病理分析[J].中华肺部疾病杂志,2023,(01):26-30.[doi:10.3877/cma.j.issn.1674-6902.2023.01.006 ]
　Zhao Yanjun,Zhang Hongjun,Jia Lijuan,et al.Clinical and pathological analysis of difficult pulmonary shadow[J].,2023,(01):26-30.[doi:10.3877/cma.j.issn.1674-6902.2023.01.006 ]
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疑难肺部阴影临床与病理分析(PDF)

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2023年01期
页码:
26-30
栏目:
论著
出版日期:
2023-02-20

文章信息/Info

Title:
Clinical and pathological analysis of difficult pulmonary shadow
作者:
赵延军1; 张红军1; 贾丽娟1; 顾 兴1; 李文洁1; 柴雅琴1; 冯 斐1; 张海涛2
710100 西安,西安市胸科医院1 710038 西安,空军军医大学第二附属医院2
Author(s):
Zhao Yanjun1;  Zhang Hongjun1;  Jia Lijuan1;  Gu Xing1;  Li Wenjie1;  Chai Yaqin1;  Feng Fei1;  Zhang Haitao2.
1Department of Respiratory and Critical Care Medicine, Xi'an Chest Hospital, Xi'an 710100, China; 2Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi'an 710038, China
关键词:
疑难肺部阴影;  肺恶性肿瘤;  肺结核
Keywords:
Difficult pulmonary shadows;  Pulmonary malignant tumor;  Pulmonary tuberculosis
分类号:
R563
DOI:
10.3877/cma.j.issn.1674-6902.2023.01.006
摘要:
目的 分析CT引导下经皮肺穿刺活检诊断的疑难肺部阴影患者临床资料,提高临床与病理诊断相关性。方法 选择2021年5月至 2022年8月我院呼吸与危重症医学科行CT引导下经皮肺穿刺活检诊断的疑难肺部阴影患者25例,对临床资料、肺恶性肿瘤和肺结核进行分析。结果 疑难肺部阴影活检结果中,肺恶性肿瘤和肺结核23例(92.0%)。肺恶性肿瘤13例(56.5%),其中腺癌9例(69.2%)、鳞癌2例(15.4%)、小细胞癌和腺样囊性癌各1例(7.6%); 肺结核10例(43.4%),其中肉芽肿性病变9例(36%)、慢性炎+坏死+多核巨细胞1例(4%)。2例(8.0%)为慢性炎伴碳末沉积。肺恶性肿瘤和肺结核在性别、年龄、基础病、病程、病变部位、病灶大小和影像学高危征象及结核菌素试验(PPD)、结核菌感染T细胞斑点实验(T-SPOT)、全自动医用PCR分析系统(Gene-Xpert)、结核菌聚合酶链式反应(TB-PCR)、结核菌核糖核酸(TB-RNA)和结核抗体等结核相关参考指标进行分析,无统计学差异(P>0.05)。两者在肺部肿瘤标志物,癌胚抗原(CEA)、鳞状细胞癌相关抗原(SCC)、胃泌素释放肽前肽(Pro-GRP)和细胞角蛋白19片段(CYFRA21-1)的阳性率差异明显,肺恶性肿瘤组阳性率高于肺结核组(P<0.001)。结论 疑难肺部阴影多伴为肺恶性肿瘤和肺结核,需借助肺部肿瘤标志物和组织病理进行鉴别,肺结核的诊断和鉴别诊断有时难于肺恶性肿瘤,临床应更多关注。
Abstract:
Objective The clinical data of patients with difficult pulmonary shadows by CT guided percutaneous lung biopsy diagnosed were retrospectively analyzed, to improve the correlation between clinical and pathological diagnosis. Methods All of 25 patients with difficult pulmonary shadows by CT guided percutaneous lung biopsy diagnosed were recruited in the Department of Respiratory and Critical Care Medicine of our hospital. The general clinical data, pulmonary malignant tumor group and pulmonary tuberculosis group were analyzed from May 2021 to August 2022. Results In difficult lung shadow biopsy results, 23 cases(92.0%)were pulmonary malignant tumors and tuberculosis. 13 cases(56.5%)were malignant tumors of the lung, including 9 cases(69.2%)of adenocarcinoma, 2 cases(5.4%)of squamous cell carcinoma, 1 case(7.6%)of small cell carcinoma and 1 case(7.6%)of adenoid cystic carcinoma; 10 cases(43.4%)were pulmonary tuberculosis, including 9 cases(90.0%)of granulomatous lesions, 1 case(10.0%)of chronic inflammation+necrosis+multinuclear giant cells. 2 cases(8.0%)of chronic inflammation with carbon deposition. Sex, age, underlying disease, course of disease, lesion location, lesion size and imaging high-risk signs, tuberculosis related reference indicators, such as tuberculin test(PPD), T-SPOT test of tuberculosis infection, automated medical PCR analysis system(Gene Xpert), tuberculosis polymerase chain reaction(TB-PCR), tuberculosis ribonucleic acid(TB-RNA)and tuberculosis antibody, were analyzed. There was no significant difference(P>0.05)in the analysis. The positive rates of lung tumor markers, such as carcinoembryonic antigen(CEA), squamous cell carcinoma associated antigen(SCC), gastrin releasing peptide prepreptide(Pro GRP)and cytokeratin 19 fragment(CYFRA21-1), were significantly different between the two groups. The positive rates of pulmonary malignant tumor group were significantly higher than those of and pulmonary tuberculosis group(P<0.001). Conclusion Most of the difficult lung shadows are pulmonary malignant tumors and pulmonary tuberculosis, which need to be differentiated with the help of lung tumor markers and puncture biopsy. Diagnosis and differential diagnosis of the pulmonary tuberculosis are sometimes more difficult compared with the pulmonary malignant tumor, which requires more attention from clinicians.

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备注/Memo

备注/Memo:
基金项目: 国家自然科学基金资助项目(82103537)
通信作者: 冯 斐, Email: 18909189550@163.com
更新日期/Last Update: 2023-02-20