Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
Department of Infectious Diseases, Ankang Central Hospital, 85 South Jinzhou Road, Ankang, 725000, Shaanxi, China.
Sci Rep. 2020 Feb 6;10(1):2023. doi: 10.1038/s41598-020-59041-z.
The objective of the present investigation was to explore the influencing factors and value of computed tomography (CT) for diagnosing severe chest lesions in active pulmonary tuberculosis (APTB). This retrospective investigation included 463 patients diagnosed with APTB. Relevant clinical features were collected. Patients were assigned to mild/moderate group or advanced group depending on the lesion severity on chest CT, severe chest CT lesion refers to the moderately dense or less diffuse lesion that exceeds the total volume of one lung, or the dense fusion lesion greater than one third of the volume of one lung, or the lesion with cavity diameter ≥4 cm. Independent risk factors for severe lesions were determined by univariate and multivariate logistic regression analyses, and the diagnostic efficiency of the risk factors was assessed by receiver operating characteristic curve (ROC). Chest CT demonstrated that there were 285 (61.56%) cases with severe lesions; multivariate Logistic regression analysis showed dust exposure [odds ratio (OR) = 4.108, 95% confidence interval (CI) 2.416-6.986], patient classification (OR = 1.792, 95% CI 1.067-3.012), age (OR = 1.018, 95% CI 1.005-1.030), and albumin-globulin ratio (OR = 0.179, 95% CI 0.084-0.383) to be independently correlated with severe lesions on chest CT. ROC curve analysis showed the cutoff values of age, albumin-globulin ratio and combined score to be 39 years, 0.918 and -0.085, respectively. The predictive value of combined score area under the curve 0.753 (95% CI 0.708-0.798) was higher than that of any single factor. The combined score of these four factors further improved the predictive efficacy.
本研究旨在探讨计算机断层扫描（CT）对活动性肺结核（APTB）严重胸部病变的诊断价值及其影响因素。回顾性分析 463 例 APTB 患者的临床资料，根据胸部 CT 病变严重程度分为轻症/中症组或重症组，重症胸部 CT 病变是指中密度或病变范围不弥散，超过单侧肺总量的 1/2，或高密度融合病变占单侧肺总量的 1/3 以上，或空洞直径≥4cm。采用单因素和多因素 logistic 回归分析确定严重病变的独立危险因素，并通过受试者工作特征曲线（ROC）评估危险因素的诊断效率。胸部 CT 显示 285 例（61.56%）患者存在严重病变；多因素 Logistic 回归分析显示，粉尘暴露（OR=4.108，95%CI 2.416-6.986）、患者分类（OR=1.792，95%CI 1.067-3.012）、年龄（OR=1.018，95%CI 1.005-1.030）和白蛋白-球蛋白比值（OR=0.179，95%CI 0.084-0.383）与 CT 严重病变独立相关。ROC 曲线分析显示，年龄、白蛋白-球蛋白比值和联合评分的截断值分别为 39 岁、0.918 和-0.085。联合评分的曲线下面积（AUC）为 0.753（95%CI 0.708-0.798），预测价值高于任何单一因素。这四个因素的联合评分进一步提高了预测效果。
