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中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (03) : 399 -404. doi: 10.3877/cma.j.issn.1674-6902.2026.03.007

论著

基于CT影像形态学特征与凝血功能指标预测104例胸部创伤患者预后研究
李晓峰1, 吴怀敏2, 张玉1, 李军1,†()   
  1. 1519000　珠海，珠海市中西医结合医院急诊科
    2519000　珠海，珠海市中西医结合医院急诊科呼吸科
  • 收稿日期:2026-02-02 出版日期:2026-06-25
  • 通信作者: 李军
  • 基金资助:
    广东省医学科学技术研究基金项目(B2021164)

Study on CT imaging morphological features combined with coagulation function indicators in predicting the prognosis of 104 patients with chest trauma

Xiaofeng Li1, Huaimin Wu2, Yu Zhang1, Jun Li1,†()   

  1. 1Emergency Department, Zhuhai Integrated Traditional Chinese and Western Medicine Hospital, Zhuhai 519000, China
    2Emergency & Respiratory Department, Zhuhai Integrated Traditional Chinese and Western Medicine Hospital, Zhuhai 519000, China
  • Received:2026-02-02 Published:2026-06-25
  • Corresponding author: Jun Li
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引用本文：

李晓峰, 吴怀敏, 张玉, 李军. 基于CT影像形态学特征与凝血功能指标预测104例胸部创伤患者预后研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(03): 399-404.

Xiaofeng Li, Huaimin Wu, Yu Zhang, Jun Li. Study on CT imaging morphological features combined with coagulation function indicators in predicting the prognosis of 104 patients with chest trauma[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(03): 399-404.

目的

探讨肺部CT影像形态学特征联合凝血功能指标预测胸部创伤患者预后的临床意义。

方法

选取2020年6月至2025年6月我院收治的闭合性胸部创伤患者104例为研究对象，根据患者预后分为观察组41例和对照组63例。收集临床资料、实验室检测指标及胸部CT影像学，采用视觉半定量法判断肺部受累范围(≥50%或<50%)与损伤模式(磨玻璃影或实变)。采用多因素Logistic回归分析预后影响因素，绘制受试者工作特征(receiver operating characteristic, ROC)曲线分析指标单独及联合预测性能。

结果

对照组与观察组比较中性粒细胞计数[7.05(6.59，7.55)×109/L比5.02(4.56，5.46)×109/L]、淋巴细胞计数[1.01(0.87，1.85)×109/L比0.80(0.77，0.81)×109/L]、NLR[10.40(10.39，10.98)比7.99(7.68，8.22)]、CRP[80.94(76.87，85.95)mg/L比49.43(44.88，52.46)mg/L]、铁蛋白[902.25(791.01，996.27)mcg/dl比661.18(620.57，700.66)mcg/dl]及D-二聚体[2.17(2.09，2.22)mg/L比1.05(1.04，1.08)mg/L]水平升高，肺部受累范围≥50%比例(41.5%比20.6%)及实变型肺损伤比例(48.8%比23.8%)增高(P<0.05)。多因素Logistic回归分析显示，NLR(OR＝9.304，95%CI：1.328~65.186，P＝0.025)、D-二聚体(OR＝1.250，95%CI：1.099~1.422，P＝0.001)、肺部受累范围≥50%(OR＝3.048，95%CI：1.311~7.083，P＝0.010)及实变型肺损伤(OR＝2.724，95%CI：1.140~6.508，P＝0.024)是影响预后的危险因素。ROC曲线分析显示，D-二聚体、NLR、肺部受累范围及肺损伤模式联合预测曲线下面积(area under the curve, AUC)为0.863(95%CI：0.785~0.940)，灵敏度85.4%，特异度79.4%。胸部创伤患者104例中生存95例(91.35%)、死亡9例(8.65%)，死因为脓毒症并发多器官功能障碍综合征4例、急性呼吸窘迫综合征3例、静脉血栓栓塞症致肺栓塞2例。

结论

肺部CT影像形态学特征与凝血功能指标联合可有效预测胸部创伤预后，有助于早期识别高危患者和改善预后具有意义。

关键词: 胸部创伤, 肺部影像形态学, 凝血功能, 预后预测
Objective

To investigate the clinical significance of pulmonary CT imaging morphological features combined with coagulation function indicators in predicting the prognosis of patients with chest trauma.

Methods

A total of 104 patients with closed chest trauma admitted to our hospital from June 2020 to June 2025 were selected and divided into an observation group 41 cases and a control group 63 cases based on prognosis. Clinical data, laboratory indicators, and chest CT images were collected. Pulmonary involvement extent (≥50% or <50%) and injury pattern (ground-glass opacity or consolidation) were assessed using a visual semi-quantitative method. Multivariate logistic regression was used to analyze prognostic factors, and receiver operating characteristic (ROC) curves were drawn to evaluate the predictive performance of individual and combined indicators.

Results

Compared with the control group, the observation group had significantly higher neutrophil count [7.05(6.59, 7.55) ×109/L vs. 5.02(4.56, 5.46)×109/L], lymphocyte count [1.01(0.87, 1.85)×109/L vs. 0.80(0.77, 0.81)×109/L], NLR[10.40(10.39, 10.98) vs. 7.99(7.68, 8.22)], CRP[80.94 (76.87, 85.95)mg/L vs. 49.43(44.88, 52.46)mg/L], ferritin [902.25 (791.01, 996.27) mcg/dl vs. 661.18(620.57, 700.66)mcg/dl], and D-dimer [2.17(2.09, 2.22)mg/L vs. 1.05(1.04, 1.08)mg/L], as well as a higher proportion of pulmonary involvement ≥50% (41.5% vs. 20.6%) and consolidation pattern (48.8% vs. 23.8%) (P<0.05). Multivariate logistic regression analysis revealed that NLR (OR=9.304, 95%CI: 1.328~65.186, P=0.025), D-dimer (OR=1.250, 95%CI: 1.099~1.422, P=0.001), pulmonary involvement extent ≥50% (OR=3.048, 95%CI: 1.311~7.083, P=0.010), and consolidation-type lung injury (OR=2.724, 95%CI: 1.140~6.508, P=0.024) were independent risk factors for poor prognosis. ROC curve analysis showed that the combined prediction of D-dimer, NLR, pulmonary involvement extent, and lung injury pattern yielded an area under the curve (AUC) of 0.863 (95%CI: 0.785~0.940), with a sensitivity of 85.4% and a specificity of 79.4%. Among the 104 patients, 95 survived (91.35%) and 9 died (8.65%). Causes of death included sepsis complicated by multiple organ dysfunction syndrome in 4 cases, acute respiratory distress syndrome in 3 cases, and pulmonary embolism due to venous thromboembolism in 2 cases.

Conclusion

Pulmonary CT imaging morphological features combined with coagulation function indicators can effectively predict the prognosis of chest trauma, facilitating early identification of high-risk patients.

Key words: Chest trauma, Pulmonary imaging morphology, Coagulation function, Prognostic prediction
表1 两组胸部创伤患者临床资料结果比较
临床资料 观察组(n＝41) 对照组(n＝63) t/Z/χ2值 P值
合并症[n(%)]        
高血压 10(24.39) 5(7.93) 5.557 0.020
肥胖 10(24.39) 3(4.79) 8.749 0.003
2型糖尿病 13(31.71) 4(6.35) 11.679 0.000
其他 8(19.51) 8(12.70) 0.886 0.347
实验室指标[M(Q25，Q75)]        
WBC(×109/L) 7.26(6.18，8.06) 7.01(6.24，7.97) －0.293 0.770
中性粒细胞(×109/L) 7.05(6.59，7.55) 5.02(4.56，5.46) －8.328 0.000
淋巴细胞(×109/L) 1.01(0.87，1.85) 0.80(0.77，0.81) －7.215 0.000
Hb[L,(±s)] 127.15±15.02 132.35±13.67 －1.828 0.070
PLT[s,(±s)] 10.36±1.25 10.87±1.36 －1.963 0.053
RDW[fl，(±s)] 15.36±1.02 14.99±1.78 1.345 0.182
NLR 10.40(10.39，10.98) 7.99(7.68，8.22) －8.135 0.000
CRP(mg/L) 80.94(76.87，85.95) 49.43(44.88，52.46) －8.584 0.000
铁蛋白(mcg/dl) 902.25(791.01，996.27) 661.18(620.57，700.66) －7.028 0.000
D-D(mg/L) 2.17(2.09，2.22) 1.05(1.04，1.08) －8.648 0.000
肺部受累范围[n(%)]     5.250 0.022
<50% 24(58.54) 50(79.37)    
≥50% 17(41.46) 13(20.63)    
肺损伤[n(%)]     6.936 0.008
磨玻璃影 21(51.22) 48(76.19)    
肺实变 20(48.78) 15(23.81)    
表2 胸部创伤患者预后多因素Logistic回归分析
自变量 β 标准误 Wald P值 OR 95%CI
下限 上限
BMI 0.104 1.075 0.009 0.923 1.110 0.135 9.126
铁蛋白 0.004 18.508 0.000 1.019 1.010 1.028 0.019
中性粒细胞 0.857 1.035 0.686 0.408 2.357 0.310 17.936
淋巴细胞 －0.060 0.050 1.429 0.232 0.942 0.854 1.039
NLR 2.230 0.993 5.042 0.025 9.304 1.328 65.186
D-D 0.223 0.066 11.597 0.001 1.250 1.099 1.422
WBC 0.003 0.005 0.298 0.585 1.003 0.994 1.012
肥胖 －0.010 0.874 0.000 0.991 0.990 0.179 5.492
高血压 0.158 0.919 0.029 0.864 1.171 0.193 7.093
2型糖尿病 －0.827 0.796 1.081 0.298 0.437 0.092 2.080
CRP(mg/L) 0.731 0.459 2.540 0.111 2.077 0.845 5.103
肺部受累范围≥50% 1.114 0.430 6.708 0.010 3.048 1.311 7.083
肺损伤为实变 1.002 0.444 5.088 0.024 2.724 1.140 6.508
表3 胸部创伤患者预后ROC曲线分析
自变量 最佳截断值 灵敏度 特异度 约登指数 符合率 AUC SE P值 渐近95%置信区间
下限 上限
D-D 1.075 1.000 0.524 0.524 0.762 0.734 0.049 0.000 0.638 0.829
NLR 9.14 0.976 0.079 0.055 0.528 0.704 0.053 0.000 0.600 0.809
肺部受累范围 － 0.659 0.794 0.453 0.727 0.726 0.053 0.000 0.623 0.829
肺损伤模式 － 0.659 0.762 0.421 0.711 0.710 0.053 0.000 0.606 0.815
联合 0.617 0.854 0.794 0.648 0.824 0.863 0.040 0.000 0.785 0.940
NLR＋D-D 0.437 0.659 0.794 0.453 0.727 0.735 0.052 0.000 0.634 0.836
肺部受累范围＋肺损伤模式 － 0.805 0.762 0.567 0.784 0.834 0.040 0.000 0.756 0.912
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