摘要
目的回顾性分析类鼻疽胸部受累病人的临床特点、实验室结果及胸部CT特征,结合病人临床预后,探讨影响其预后不良的危险因素。方法回顾性收集经细菌培养证实为类鼻疽感染且胸部受累的病人67例,男61例,女6例,平均年龄(53.52±13.75)岁。根据病人出院时预后状态分为预后良好组(37例)及预后不良组(30例)。采用独立样本t检验、Mann-Whitney U检验和χ2检验,比较不同预后组间临床特点、实验室结果及胸部CT特征的差异;采用单因素及多因素logistic回归分析筛选与预后相关的危险因素,并绘制受试者操作特征(ROC)曲线,采用Delong检验比较不同危险因素预测效能的差异。结果与预后良好组相比,预后不良组入院时和入院1周时肾功能不良病人的占比较高,血红蛋白和血清总蛋白较低;CT上出现结节和空洞的占比较高,病灶累及肺段及肺叶数较多(均P<0.05)。单因素分析提示入院时及入院1周的肾功能不良,血清总蛋白、血红蛋白减低,胸部CT上可见结节、空洞、病灶累及肺段及肺叶数是类鼻疽胸部受累病人预后不良的危险因素(均P<0.05)。多因素分析显示,入院1周肾功能不良和累及肺段数,是预后不良的独立预测因素(P<0.05),累及肺段数的诊断效能更高(P=0.011);当累及肺段数为11个时诊断预后不良的敏感度为56.67%,特异度为97.3%。结论累及肺段数和入院1周时肾功能不良为类鼻疽胸部感染病人预后不良的独立危险因素,其中累及肺段数的特异度高、诊断效能最佳。
Objective To retrospectively analyze the clinical features,laboratory results and CT imaging features of melioidosis patients with thoracic involvement,and to explore the risk factors leading to poor prognosis.Methods Sixty-seven melioidosis patients,including 61 males and 6 females,with an average age of 53.52±13.75 years,confirmed by bacterial culture and thoracic involvement were retrospectively collected.Patients were divided into good prognosis group(37 cases)and poor prognosis group(30 cases)according to their condition at discharge.Independent sample t test,Mann-Whitney U and Chi-square test were used to compare the differences in clinical features,laboratory results and thoracic CT features between the groups.Univariate and multivariate logistic regression analysis were used to screen the risk factors related to prognosis,and the receiver operating characteristic(ROC)curve was plotted.Delong test was used to compare the difference in prediction efficacy of different risk factors.Results Compared with the good prognosis group,the proportion of renal dysfunction at admission and 1 week after admission was increased,hemoglobin and total serum protein were decreased;the proportion of nodules and voids was increased,and the lesion involved more lung segments and lobes in the good prognosis group(all P<0.05).Unifactorial analysis showed that renal dysfunction,decreased serum total protein and hemoglobin,nodules,cavities,and the number of lung segmental and lobular involvement on thoracic CT were risk factors for poor prognosis of melioidosis patients(all P<0.05).Multivariate analysis showed that renal dysfunction at 1 week after admission and the number of lung segmental involvement were independent predictors of poor prognosis(P<0.05).The sensitivity and specificity of the number of lung segmental involvement in the diagnosis of poor prognosis were 56.67%and 97.3%,respectively,when the cut-off value was 11 lung segments.The number of lung segmental involvement archived higher diagnostic efficacy(P=0.011).Conclusion The number of lung segmental involvement and renal dysfunction at 1 week after admission are independent risk factors for poor prognosis in melioidosis patients with thoracic infection,among which the number of lung segmental involvement has high specificity and the best diagnostic efficacy.
作者
郭珊熹
冀晓东
黄黎香
赵玉娇
陈丽华
周晓君
黄薇园
沈文
GUO Shanxi;JI Xiaodong;HUANG Lixiang;ZHAO Yujiao;CHEN Lihua;ZHOU Xiaojun;HUANGWeiyuan;SHENWen(Department of Radiology,The First Central Clinical School,Tianjin Medical University,Tianjin 300192,China;Department of Radiology,Tianjin First Central Hospital;Department of Laboratory Medicine,Hainan General Hospital(Hainan Affiliated Hospital of Hainan Medical University);Department of Radiology,Hainan General Hospital(Hainan Affiliated Hospital of Hainan Medical University))
出处
《国际医学放射学杂志》
北大核心
2023年第3期278-283,共6页
International Journal of Medical Radiology
