【作者】 王莉；

【导师】 张华；

【作者基本信息】 山西医科大学 ， 放射影像学（专业学位）， 2024， 硕士

【摘要】 目的:探讨CT阈值分割法联合肺功能指标对早期煤工尘肺(coal workers’pneumoconiosis,CWP)诊断的临床价值。方法:回顾性分析了2023年3月至7月经山西省职业病防治所诊断的Ⅰ期CWP组133例和无尘肺组64例煤矿工人的临床、肺功能及肺部HRCT影像资料,基于密度阈值分割法得到CT值分别≤-950HU、-950Ha U--700HU、-700HU--200HU、>-200HU的肺容积比(%AA)及所占肺体积、肺总容积(TLV);比较两组间临床资料、肺功能指标和HRCT定量参数的差异,将有意义的指标纳入多因素分析并采用ROC曲线分析其对早期CWP的诊断价值。结果:多因素Logistic回归分析结果显示接尘年限、肺功能指标MMEF、HRCT定量参数%AA-700--200是煤矿接尘人群发生早期CWP的独立影响因素(P<0.05)。接尘年限联合肺功能指标MMEF、HRCT定量参数%AA-700--200以及接尘年限、肺功能指标联合HRCT定量参数诊断早期CWP的AUC分别为0.957(95%CI 0.930-0.984)、0.807(95%CI 0.867-0.747)和0.926(95%CI 0.890-0.963),最终三者联合诊断的效能显著优于单独诊断(P<0.05),其敏感度和特异度分别为88.0%和95.3%。结论:接尘年限、肺功能指标MMEF联合HRCT定量参数%AA-700--200对早期CWP的诊断具有重要意义。更多还原

【Abstract】 Objective:To explore the clinical value of CT threshold segmentation combined with pulmonary function indexes in the diagnosis of early coal workers’ pneumoconiosis(CWP).Methods:The clinical,pulmonary function and HRCT imaging data of 133 coal miners in the phase I CWP group and 64 coal miners in the pneumoconiosis group diagnosed at the Shanxi Provincial Institute of Occupational Disease Prevention and Control from March to July 2023 were retrospectively analyzed,and the lung volume ratio(%AA)and lung volume of ≤-950 HU,-950HU--700 HU,-700HU--200 HU,and >-200 HU,respectively,were obtained based on the density threshold segmentation method.Total lung volume(TLV),the differences in clinical data,pulmonary function indexes and quantitative parameters of HRCT between the two groups were compared,and meaningful indicators were included in multivariate analysis,and ROC curves were used to analyze their diagnostic value for early CWP.Results:The results of multivariate logistic regression analysis showed that the dust exposure years,pulmonary function index MMEF and HRCT quantitative parameters %AA-700--200 were the independent influencing factors for the early occurrence of CWP in coal mine dust exposure population(P<0.05).The AUC of early CWP in the diagnosis of early CWP by the dust age combined with pulmonary function indexes MMEF and HRCT quantitative parameters %AA-700--200 and the dust exposure years and pulmonary function indexes combined with HRCT quantitative parameters were 0.945(95%CI 0.913-0.977),0.807(95%CI 0.867-0.747)and 0.931(95%CI 0.896-0.965),the final combined diagnosis of the three was significantly better than that of the single diagnosis(P<0.05),and its sensitivity and specificity were 85.70% and 96.90%.Conclusion:The age of dust exposure and pulmonary function index MMEF combined with HRCT quantitative parameter %AA-700--200 are of great significance for the diagnosis of early CWP.更多还原