标题：气道内超声弹性成像诊断肺癌淋巴结转移的价值及其与微血管密度的相关性

      作者：何海艳，马航，朱杰，吕学东    南通市第一人民医院呼吸科，江苏 南通 226001

      卷次： 2019年30卷2期

      【摘要】 目的 探讨气道内超声弹性成像诊断肺癌淋巴结转移的价值及其与微血管密度(MVD)的相关性。方法 选取2017年1月至2018年6月在南通市第一人民医院就诊的共48例肺癌患者，行超声支气管镜检查及内镜下超声弹性成像检查，并在超声图像引导下行经支气管壁针吸活检术(EBUS-TBNA)。对穿刺标本行MVD计数。以病理结果为金标准，比较良恶性淋巴结的超声弹性成像特征及MVD的差异。分析超声弹性成像特征与MVD及患者临床资料的相关性。结果 恶性淋巴结组和良性淋巴结组患者的超声弹性评分[(3.27±0.77)分 vs (1.69±0.71)分]、应变率比值(SR)[(82.99±45.65) vs (29.32±27.51)]、MVD值[(31.04±9.68) vs (17.87±7.51)]比较，恶性淋巴结组均明显高于良性淋巴结组，差异均具有显著统计学意义(P<0.01)；恶性淋巴结组SR值与MVD值负相关(r=-0.547，P<0.01)；不同病理类型淋巴结的弹性评分、SR值及MVD值比较差异均无统计学意义(P>0.05)；淋巴结直径≥2 cm组的 SR值为(61.89±38.72)，明显低于淋巴结直径<2 cm组的(107.61±45.78)，而淋巴结直径≥2 cm组的MVD值为(33.55±9.76)，明显高于淋巴结直径<2 cm组的(27.85±8.95)，差异具有统计学意义(P<0.01或0.05)；随着临床分期的增加，SR值逐渐减少，MVD计数逐渐增多，各亚组间比较差异有统计学意义(P<0.05)。结论 气道内超声弹性成像可用于鉴别肺癌纵隔肺门淋巴结的良恶性；SR值随着MVD的增加及临床分期的增加逐渐减低，其对病情及预后的判断有指导作用，具有一定的临床应用价值。
      【关键词】 肺癌；淋巴结；超声支气管镜；超声弹性成像；微血管密度
      【中图分类号】 R734.2 【文献标识码】 A 【文章编号】 1003—6350（2019）02—216—04V

alue of endobronchial ultrasound elastography in the diagnosis of lymph node metastasis of lung cancer and itscorrelation with microvessel density.
HE Hai-yan, MA Hang, ZHU Jie, LV Xue-dong. Department of RespiratoryMedicine, First People's Hospital of Nantong, Nantong 226001, Jiangsu, CHINA
【Abstract】 Objective To explore the value of endobronchial ultrasound elastography in the diagnosis of lymphnode metastasis of lung cancer and its correlation with microvessel density (MVD). Methods A total of 48 patientswith lung cancer underwent ultrasonic bronchoscope examination. Elastography of lymph nodes were performed beforeEBUS-guided transbronchial needle aspiration (EBUS-TBNA). The expression of MVD in puncture specimens were de-tected. The elastography characteristics and MVD were compared between benign and malignant lymph nodes. The cor-relations between ultrasound elastography and MVD, clinical data were analyzed. Results The ultrasound elasticityscore, strain rate ratio (SR), and MVD in malignant lymph node group were 3.27±0.77, 82.99±45.65, 31.04±9.68, signifi-cantly higher than 1.69±0.71, 29.32±27.51, 17.87±7.51 in benign lymph node group (P<0.01). SR was negatively corre-lated with MVD value in malignant lymph nodes (r=-0.547, P<0.01). There was no significant difference in elasticscore, SR and MVD value among different pathological types of lymph nodes (P>0.05). The SR value of lymph node di-ameter>2 cm group was 61.89±38.72, which was significantly lower than 107.61±45.78 in lymph node diameter <2 cmgroup, and the MVD value of lymph node diameter >2 cm group was 33.55±9.76, which was significantly higher than27.85±8.95 in lymph node diameter <2 cm group, both with statistically significant difference (P<0.01 or 0.05). The SRand MVD value were related to clinical stage. With the increase of clinical stage, the SR decreased, and the MVD in-creased. The difference was statistically significant among the subgroups. Conclusion Endobronchial ultrasound elas-tography can be used in the diagnosis of lymph node metastasis of lung cancer. With the increase of MVD and clinicalstage, the SR value decreased gradually. It has a certain clinical value in judging the condition and prognosis.
      【Key words】 Lung cancer; Lymph node; Ultrasonic bronchoscope; Ultrasound elastography; Microvessel density