血清炎症指标联合胸部CT对良恶性肺结节的鉴别诊断价值

doi:10.19983/j.issn.2096-8493.20250065

摘要/Abstract

摘要：

目的: 分析血清炎症指标联合胸部CT对良恶性肺结节的鉴别诊断价值。方法: 收取2022年8月至2024年8月在昆明市第三人民医院就诊的253例肺结节患者作为研究对象,所有研究对象均在入院后通过CT引导下经皮肺穿刺技术诊断,有明确的病理检查结果。127例肺癌患者作为恶性肺结节组,126例良性肺结节患者作为良性肺结节组。收集患者的病史资料、影像学资料、血清炎症标志物等数据,探讨细胞计数相关指标、细胞因子、急性期反应蛋白多项指标在两组之间的差异,进而以差异有统计学意义的指标为自变量,利用二元logistic回归分析筛选出肺癌的独立危险因素,最后应用受试者工作特征(receiver operating characteristic,ROC)曲线评价其在良恶性肺结节鉴别中的诊断价值。结果: 结节数量、结节直径、分叶征、毛刺征、血管集束征、CT值、中性粒细胞-淋巴细胞比值(NLR)、淋巴细胞-单核细胞比值(LMR)、系统性免疫-炎症指数(SII)、白细胞介素-5(IL-5)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、白细胞介素-10(IL-10)、γ-干扰素(IFN-γ)、白细胞介素-8(IL-8)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)、血清淀粉样蛋白A(SAA)在良恶性肺结节中差异均有统计学意义(P值均<0.05)。二元logistic回归分析结果显示,结节直径在8~15mm(OR=10.268, 95%CI: 1.719~61.321)、结节直径在15~30mm(OR=59.194, 95%CI: 11.155~314.124)、毛刺征为阳性(OR=27.373, 95%CI: 3.901~192.055)、LMR(OR=0.469, 95%CI: 0.282~0.779)、IL-5(OR=1.557, 95%CI: 1.145~2.118)、IL-2(OR=0.831, 95%CI: 0.748~0.924)、SAA(OR=2.625, 95%CI: 1.407~4.897)、PCT(OR=1.763, 95%CI: 1.240~2.507)是鉴别良性和恶性结节的相关因素。经ROC曲线分析,结节直径、毛刺征、LMR、IL-5、IL-2、SAA、PCT区分良恶性结节的AUC(95%CI)分别为0.732(0.669~0.795)、0.649(0.581~0.717)、0.398(0.532~0.672)、0.516(0.445~0.588)、0.380(0.311~0.450)、0.773(0.715~0.830)、0.821(0.767~0.874)。联合检测指标区分良恶性肺结节的AUC(95%CI)达到0.983(0.971~0.995)。结论: 血清炎症指标联合胸部CT检查对区分良恶性肺结节有着较好的鉴别诊断价值。

关键词: 结节病,肺, 中性粒细胞, 淋巴细胞, 单核细胞, C反应蛋白, 降钙素原, 体层摄影术,X线计算机

Abstract:

Objective: To analyze the value of serum inflammatory indexes combined with chest CT on differential diagnosis of benign and malignant pulmonary nodules. Methods: Two hundred and fifty-three patients with lung nodules who visited the Third People’s Hospital of Kunming from August 2022 to August 2024 were enrolled as study subjects, all of whom were diagnosed by CT-guided percutaneous lung puncture technique after admission to the hospital, with clear pathological examination results. Among them, 127 patients with lung cancer were deemed as the malignant lung nodule group, and 126 patients with benign lung nodules were deemed as the benign lung nodule group. The patients’ medical history, imaging data, serum inflammatory markers and other data were collected to explore the differences between the two groups in cell count-related indexes, cytokines, and acute-phase reactive proteins, and then these statistically significant different indexes were used as independent variables to be included in binary logistic regression analysis to screen out independent risk factors of lung cancer, and finally, receiver operating characteristic curve (ROC) was used to evaluate these risk factors’ diagnostic value in the differentiation of malignant and benign lung nodules. Results: The number of nodules, nodule diameter, lobular sign, burr sign, vascular bundle sign, CT value, NLR, LMR, SII, IL-5, IL-2, IL-6, IL-1β, IL-10, IFN-γ, IL-8, IL-17, TNF-α, CRP, PCT, and SAA were statistically significantly different in benign and malignant lung nodules (P<0.05). The result of binary logistic regression analysis showed the nodule diameter being 8-15 mm (OR=10.268, 95%CI: 1.719-61.321), nodule diameter being 15-30 mm (OR=59.194, 95%CI: 11.155-314.124), burr sign positive (OR=27.373, 95%CI: 3.901-192.055),LMR (OR=0.469, 95%CI: 0.282-0.779), IL-5(OR=1.557, 95%CI: 1.145-2.118), IL-2(OR=0.831, 95%CI: 0.748-0.924), SAA (OR=2.625, 95%CI: 1.407-4.897) and PCT (OR=1.763, 95%CI: 1.240-2.507) were related factors to differentiate benign and malignant nodules. Using ROC curve analysis, the AUC (95%CI) of nodule diameter, burr sign, LMR, IL-5, IL-2, SAA, and PCT for distinguishing benign and malignant nodules were 0.732 (0.669-0.795), 0.649 (0.581-0.717), 0.398 (0.532-0.672), 0.516 (0.445-0.588), 0.380 (0.311-0.450), 0.773 (0.715-0.830), and 0.821 (0.767-0.874), respectively. The AUC (95%CI) for distinguishing benign and malignant lung nodules by combined test metrics reached 0.983 (0.971-0.995). Conclusion: The combination of serum inflammatory index and chest CT examination has good differential diagnostic value in distinguishing benign and malignant nodules.

Key words: Sarcoidosis, pulmonary, Neutrophil, Lymphocyte, Monocyte, C-reactive protein, Procalcitonin, Tomography, X-ray computed

中图分类号:

R734.2

徐思芸, 陆霓虹. 血清炎症指标联合胸部CT对良恶性肺结节的鉴别诊断价值[J]. 结核与肺部疾病杂志, 2025, 6(5): 516-524. doi: 10.19983/j.issn.2096-8493.20250065

Xu Siyun, Lu Nihong. The value of serum inflammatory index combined with chest CT in differential diagnosis of benign and malignant pulmonary nodules[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(5): 516-524. doi: 10.19983/j.issn.2096-8493.20250065

图/表 6

表1

表2

良恶性肺结节患者血清炎症标志物的单因素分析

检测指标	良性组 (126例)	恶性组(127例)			Z值	P值
检测指标	良性组 (126例)	腺癌(87例)	鳞癌(25例)	小细胞癌(15例)	Z值	P值
NLR[M(Q₁,Q₃)]	2.50 (1.86,3.56)	2.59 (1.90,4.73)	4.04 (3.17,7.02)^ab	3.73 (2.31,6.25)	19.979	<0.001
LMR[M(Q₁,Q₃)]	3.34 (2.54,4.58)	3.06 (2.10,4.42)^a	2.27 (1.28,3.14)^ab	2.49 (1.33,2.93)	19.259	<0.001
PLR[M(Q₁,Q₃)]	165.52 (125.87,206.43)	165.58 (115.34,238.68)	227.52 (147.18,368.42)	150.89 (89.23,293.87)	6.166	0.104
SII[×10⁹g/L,M(Q₁,Q₃)]	582.06 (392.98,854.01)	640.19 (363.59,1155.42)	1390.96 (889.04,2486.67)^ab	711.47 (414.28,1384.94)	18.224	<0.001
IL-5[pg/ml,M(Q₁,Q₃)]	2.68 (1.93,4.37)	2.93 (2.03,4.04)	5.46 (2.57,10.13)^ab	2.20 (0.88,3.30)^c	15.235	0.002
IFN-α[pg/ml,M(Q₁,Q₃)]	2.81 (1.84,4.04)	2.52 (1.52,4.12)	2.67 (2.22,3.15)	2.09 (1.48,2.65)	4.386	0.223
IL-2[pg/ml,M(Q₁,Q₃)]	6.20 (2.67,21.61)	4.68 (2.21,8.09)^a	3.65 (2.15,4.87)^a	9.25 (4.69,16.81)^c	19.389	<0.001
IL-6[pg/ml,M(Q₁,Q₃)]	3.82 (1.46,9.08)	9.82 (4.46,18.02)^a	20.33 (6.04,34.15)^a	18.92 (11.94,72.95)^a	41.903	<0.001
IL-1β[pg/ml,M(Q₁,Q₃)]	5.48 (3.07,12.39)	9.72 (3.74,16.95)	6.76 (3.90,8.30)	23.28 (16.16,30.40)^abc	21.607	<0.001
IL-10[pg/ml,M(Q₁,Q₃)]	3.30 (2.44,4.88)	2.85 (1.96,4.53)	1.86 (1.67,2.26)^ab	4.86 (3.62,6.07)^bc	34.980	<0.001
IFN-γ[pg/ml,M(Q₁,Q₃)]	11.05 (5.48,17.78)	10.19 (5.69,19.60)	6.87 (5.31,7.60)^ab	9.27 (4.43,13.01)	15.529	0.001
IL-8[pg/ml,M(Q₁,Q₃)]	3.39 (1.73,9.41)	11.42 (4.41,19.77)^a	22.58 (8.55,29.34)^a	2.73 (1.69,4.51)^bc	31.181	<0.001
IL-17[pg/ml,M(Q₁,Q₃)]	4.13 (2.75,10.11)	2.90 (1.56,4.35)^a	4.45 (2.61,6.13)	7.12 (3.65,10.62)^b	29.143	<0.001
IL-12P70[pg/ml,M(Q₁,Q₃)]	2.01 (1.65,2.21)	2.00 (1.44,2.30)	1.53 (1.06,2.04)	2.05 (1.26,2.91)	4.878	0.197
TNF-α[pg/ml,M(Q₁,Q₃)]	2.64 (1.72,3.99)	4.00 (2.47,6.63)^a	2.33 (1.87,2.67)^b	2.32 (2.19,2.55)^ab	32.271	<0.001
CRP[mg/L,M(Q₁,Q₃)]	7.95 (1.64,28.03)	11.09 (2.77,24.43)	29.41 (11.46,67.74)^a	14.06 (8.60,43.37)	12.121	0.007
PCT[ng/ml,M(Q₁,Q₃)]	0.09 (0.04,0.16)	1.26 (0.45,2.41)^a	0.33 (0.10,0.98)^a	0.10 (0.06,0.12)^b	102.644	<0.001
SAA[mg/L,M(Q₁,Q₃)]	24.15 (3.40,101.77)	236.26 (75.62,322.80)^a	144.39 (36.70,254.35)^a	112.78 (73.08,129.19)	61.595	<0.001

表2

表3

表4

表5

图1

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特征	良性组(126例)	恶性组(127例)	统计检验值	P值
年龄(岁,$\overline{x}$±s)	58.51±10.44	61.09±11.97	t=1.831	0.068
性别[例,构成比(%)]			χ²=0.244	0.621
男性	87(69.0)	84(66.1)
女性	39(31.0)	43(33.9)
结节数量[例,构成比(%)]			χ²=28.389	<0.001
孤立性	18(14.3)	57(44.9)
≥2个	108(85.7)	70(55.1)
结节直径[例,构成比(%)]			χ²=55.453	<0.001
5~8mm	98(77.8)	47(37.0)
8~15mm	16(12.7)	14(11.0)
15~30mm	12(9.5)	66(52.0)
分叶征[例,构成比(%)]			χ²=36.969	<0.001
是	6(4.8)	45(35.4)
否	120(95.2)	82(64.6)
毛刺征[例,构成比(%)]			χ²=35.620	<0.001
是	6(4.8)	44(34.6)
否	120(95.2)	83(65.4)
血管束集征[例,构成比(%)]			χ²=5.772	0.016
是	10(7.9)	23(18.1)
否	116(92.1)	104(81.9)
CT值(HU,$\overline{x}$±s)	-306.41±248.614	-359.51±154.73	t=2.038	0.043

影响因素	β值	s${}_{\overline{x}}$值	Wald χ²值	OR值	95%CI值	P值
结节直径8~15mm	2.329	0.912	6.525	10.268	1.719~61.321	0.011
结节直径15~30mm	4.081	0.852	22.967	59.194	11.155~314.124	<0.001
毛刺征	3.310	0.994	11.085	27.373	3.901~192.055	0.001
LMR	-0.757	0.259	8.552	0.469	0.282~0.779	0.003
IL-5	0.443	0.157	7.962	1.557	1.145~2.118	0.005
Il-2	-0.185	0.054	11.830	0.831	0.748~0.924	0.001
SAA	0.965	0.318	9.201	2.625	1.407~4.897	0.002
PCT	0.567	0.180	9.970	1.763	1.240~2.507	0.002