摘要： 目的 探讨多层螺旋CT的CT值在鉴别胸腔积液性质中的应用价值。方法 纳入97例胸腔积液患者，患者在接受胸部CT检查后1周内行胸腔穿刺术。测量所有患者胸腔积液的平均CT值，检查胸水生化和血生化。根据Light's标准，将患者分为渗出液、漏出液2组。建立平均CT值的受试者操作特征曲线，计算曲线下面积。结果 97例胸腔积液患者中59例为渗出液，38例为漏出液。胸腔积液平均CT值与胸水总蛋白、胸水乳酸脱氢酶均呈显著正相关，胸水总蛋白与胸水乳酸脱氢酶亦呈显著正相关（P<0.01）。渗出液组平均CT值（中位数11.20 Hu，范围8.77~16.00 Hu）显著高于漏出液组（中位数5.12 Hu，范围0.29~6.53 Hu）（P<0.01）。受试者操作特征曲线分析结果显示，胸腔积液平均CT值对区分渗出液和漏出液具有较高的准确性（曲线下面积为0.913）。胸腔积液平均CT值最佳界值为≥ 8.62 Hu时，其敏感度为76.3%，特异度为92.1%。结论 多层螺旋CT的CT值在鉴别胸腔积液性质中有一定的价值。胸腔积液平均CT值≥ 8.62 Hu，提示为渗出液的可能性较大。

多层螺旋CT的CT值在鉴别胸腔积液性质中的应用价值

冯倩, 李侠, 石军年

兰州大学第二医院呼吸科, 兰州 730030

收稿日期:2019-04-09出版日期:2020-04-30发布日期:2020-04-18
通讯作者:石军年E-mail:shijn@lzu.edu.cn
作者简介:冯倩(1986-),女,主治医师,硕士研究生.
基金资助:甘肃省自然科学基金（1506RJZA248）


关键词: 胸腔积液, 渗出液, 漏出液, 多层螺旋CT, CT值
Abstract: Objective To assess the application of the multi-slice spiral computed tomography (CT) value in identifying the properties of pleural effusion. Methods This study included 97 patients with pleural effusion who underwent thoracentesis in the first week after chest CT. The mean CT values of pleural effusion,pleural laboratory markers,and serum laboratory markers were measured. Effusions were classified as transudates or exudates by using laboratory markers based on Light's criteria. A receiver operating characteristic (ROC) curve with the mean CT value was constructed,and the area under the curve (AUC) was calculated. Results Of pleural effusion from 97 patients,59 were exudates and 38 were transudates. There were significant positive relationships between average CT value and total pleural protein,between average CT value and pleural lactate dehydrogenase,and between total pleural fluid protein and lactate dehydrogenase (P<0.01). The mean CT value of the exudates (median,11.20 Hu;range,8.77 to 16.00 Hu) was significantly higher than that of the transudates (median,5.12 Hu;range,0.29 to 6.53 Hu) (P<0.01). The receiver operating characteristic curve illustrated that the overall accuracy of the mean CT value in identifying exudates was good (AUC=0.913). When the cutoff value for exudative effusion was accepted as ≥ 8.62 Hu,sensitivity and specificity were 76.3% and 92.1%,respectively. Conclusion The multi-slice spiral CT value can be applied to identify the properties of pleural effusion. An exudate can be considered when the average CT value is more than 8.62 Hu.
Key words: pleural effusion, exudate, transudate, multi-slice spiral CT, CT value
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