Properties of tracheobronchial foreign bodies based on CT images
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摘要:
目的探讨CT图像在气管支气管异物性质鉴别中的价值。 方法收集2014年8月~2019年4月诊断为气管支气管异物的患者69例，并将其根据异物种类分为花生组（n=36）与非花生组（n=33）。花生组男25例，女11例；非花生组男21例，女12例。分析两组间在临床（异物呛咳史、年龄、性别及居住地），纤维支气管镜下（异物部位、肉芽形成），胸部CT图像上（异物CT值、异物边界清晰度、支气管闭塞、异物长径、异物宽径、肺气肿、支气管狭窄、肺炎、纵隔偏移、纵隔气肿、肺不张及支气管扩张）的特征差异。 结果花生组的异物呛咳史较非花生组多见，两组间的异物呛咳史差异有统计学意义（P=0.044）；两组年龄、性别、居住地差异无统计学意义（P>0.05）；纤维支气管镜下，两组间的异物部位（P=0.361）和肉芽形成（P=0.543）差异均无统计学意义；胸部CT图像下，花生组CT值较非花生组低（P < 0.001），异物边界更模糊（P=0.005），支气管闭塞（P < 0.001）更多见，其余CT图像上的特征差异均无统计学意义（P>0.05）。 结论结合临床异物呛咳史，胸部CT图像可鉴别气管支气管异物的性质。 Abstract:ObjectiveTo explore the value of CT images in identifying the properties of tracheobronchial foreign bodies. MethodsSixty-nine patients with tracheobronchial foreign bodies diagnosed from August 2014 to April 2019 were collected. The patients were divided into peanut group(n=36) and non-peanut group (n=33) according to the type of foreign bodies. Peanut group includes 25 males and 11 females. The differences of clinical characteristics (the history of foreign body aspiration, age, gender and place of residence), features of fiberoptic bronchoscope (location of foreign bodies, granulation formation) and chest CT images(CT value, boundary definition of foreign bodies, bronchial occlusion, length and width of foreign bodies, emphysema, bronchoconstriction, pneumonia, mediastinal displacement, mediastinal emphysema, atelectasis, and bronchiectasis) between the two groups were compared. ResultsFor clinical characteristics, the history of foreign body aspiration in the peanut group was more common than that in the non-peanut group. The difference of the history of foreign body aspiration between the two groups was significant(P=0.044). The age, sex and place of residence were not found significant differences between both groups (P>0.05). For the fiberoptic bronchoscope, the differences of the location of foreign bodies (P=0.361) and granuloma formation (P=0.543) between the two groups were not significant. For the chest CT images, the CT value of the peanut group was lower than that of the non-peanut group (P < 0.001). The boundary of foreign bodies in the peanut group was more blurred than that in the non-peanut group (P=0.005). The bronchial occlusion was more common in the peanut group than that in the non-peanut group (P < 0.001). There were no significant differences in other features (P>0.05) on CT images. ConclusionCombined with the clinical history of foreign body aspiration, chest CT images can identify the properties of tracheobronchial foreign bodies. -
Key words:
- tracheobronchial foreign body /
- chest CT /
- fiberoptic bronchoscope
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图 1 胸部CT图像
13月男性患儿, 进食花生后咳嗽、气喘半天.A:纵隔窗图像, 右侧主支气管内见软组织密度影（黄色实心箭头）, 局部边界模糊, 右侧主支气管狭窄并闭塞; B:肺窗图像, 右侧肺野透亮度明显较左侧升高（红色空心箭头）, 左下肺野见局限性透亮度升高区（蓝色弧形箭头）, 右侧主支气管内亦可见密度增高影（黄色实心箭头）, 边界模糊
Figure 1. CT images of the chest
图 2 胸部CT图像
7月女性患儿, 咳嗽2 d，加重伴发热、气喘1 d. A:纵隔窗图像, 左侧主支气管内见明显高密度影（黄色实心箭头）, 边界清, 左侧主支气管稍狭窄; B:肺窗图像, 左侧肺野透亮度较右侧升高（红色空心箭头）, 左侧主支气管内见高密度影（黄色实心箭头）
Figure 2. CT images of the chest
表 1 花生组与非花生组气管支气管异物的临床特征比较（n）
Table 1. Comparison of clinical characteristics of tracheobronchial foreign bodies in peanut group and non-peanut group
因素 花生组（n=36） 非花生组(n=33) χ2 P 异物史呛咳（有/无） 35/1 26/7 4.051 0.044 性别（男/女） 25/11 21/12 0.261 0.609 居住地（城/乡） 7/29 9/24 0.592 0.441 
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表 2 花生组与非花生组气管支气管异物纤维支气管镜下的特征比较（n）
Table 2. Comparison of characteristics of tracheobronchial foreign bodies under the fiberoptic bronchoscope between peanut group and non-peanut group
指标 花生组（n=36） 非花生组(n=33) χ2 P 异物部位（气管/右/左） 2-18-16 5-13-15 2.040 0.361 肉芽形成(有/无) 19/17 15/18 0.369 0.543
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表 3 花生组与非花生组气管支气管异物胸部CT图像上的计量特征比较
Table 3. Comparison of measurement features on CT images of tracheobronchial foreign bodies in the peanut group and non-peanut group
指标 花生组（n=36） 非花生组(n=33) Z P 异物长径* 6.0 (5.0, 8.0) 5.0 (5.0, 7.5) -0.540 0.589 异物宽径* 3.0 (2.3, 4.0) 3.0 (3.0, 4.0) -0.682 0.495 CT值(Mean±SD) 44.4±23.1 72.0 (50.5, 97.0)* -4.187 < 0.001 *计量资料不符合正态分布, 以中位数（上下四分位数）表示.
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表 4 花生组与非花生组气管支气管异物胸部CT图像上的计数特征比较[n (%)]
Table 4. Comparison of counting features on chest CT images of tracheobronchial foreign bodies in peanut group and non-peanut group
指标 花生组（n=36） 非花生组(n=33) χ2 P 异物边界模糊 22 (61.1) 9 (27.3) 7.968 0.005 支气管闭塞 28 (77.8) 11 (33.3) 13.839 < 0.001 肺气肿 33 (91.7) 29 (87.9) 0.015 0.903 支气管狭窄 29 (80.6) 20 (60.6) 3.329 0.068 肺炎 14 (38.9) 10 (30.3) 0.560 0.454 纵隔偏移 10 (27.8) 9 (27.3) 0.002 0.963 纵隔气肿 1 (2.8) 0 (0.0) 0.917 0.338 肺不张 7 (19.4) 3 (9.1) 0.771 0.380 支气管扩张 1 (2.8) 0 (0.0) 0.917 0.338
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