肺部CT和普通胸片在体检人群病灶筛查中的成本效果比较

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摘要目的评价健康体检人群中常规进行胸部普通X线检查或者胸部CT检查的临床和卫生经济学意义。方法分析解放军总医院体检中心2005年10月～2014年2月接受胸部普通X线检查或者胸部CT的人群检查结果。结果共65 465例体检者接受普通胸片检查，阳性发现者共10 874例（16.61%），阳性发现总频次为12 991例次。共46 406例体检者接受胸部CT检查，阳性发现者共21 583例（46.51%），阳性发现总频次为33 172例次。胸部CT检查阳性率高于普通胸片（46.51%比16.61%，P ＜ 0.05）。不同年龄层胸部CT中，阳性发现率均高于普通胸片，其中40～＜50岁（42.42%比12.29%）和50～＜60岁（53.44%比22.87%）两个年龄段相差最为明显，阳性率差别达30%以上。胸部CT对肺部病变（16 072例比3335例）、纵隔病变（276例比98例）、胸膜病变（6692例比3148例）、淋巴结病变（3172例比190例）、腹部病变（3172例比26例）发现频次均高于普通胸片。普通胸片对胸廓病变（2798例比129例）和心脏、血管病变（3095例比1837例）发现频次高于胸部CT（P ＜ 0.05）。每1次阳性发现的平摊费用胸部CT低于普通胸片（433.67元比554.32元）。结论对于健康体检人群，不论是检出疾病的临床意义方面，还是相对减少费用的卫生经济学方面，胸部CT检查均优于普通胸片。

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	陆峰郑延松

关键词 ：胸片, 胸部CT平扫, 健康体检, 临床意义, 卫生经济学

Abstract：Objective To evaluate the clinical value and health economics of chest X-ray and chest CT scan in health examination people. Methods The results of chest X-ray and chest CT scan in patients who received health examinations in Healthy Science Center of Chinese PLA General Hospital from October 2005 to February 2014 were analyzed. Results A total of 65 465 patients underwent chest X-ray examination, 10 874 patients had positive findings (positive rate was 16.61%), the total positive findings were 12 991 cases. A total of 46 406 patients underwent chest CT scanning, 21 583 patients had positive findings (positive rate was 46.51%), the total positive findings were 33 172 cases. Chest CT scanning was more effective in detecting the lesions compared with chest X-ray (46.51% vs. 16.61%, P < 0.05). In every different age group, chest CT showed higher positive findings rate than chest X-ray examination, the most obvious differences were in 40-＜50 years group (42.42% vs. 12.29%) and 50-＜60 years group (53.44% vs. 22.87%). Chest CT scan detected more lung lesions (16 072 cases vs. 3335 cases), more mediastinal lesions (276 cases vs. 98 cases), pleural lesions (6692 cases vs. 3148 cases), lymph node lesions (3172 cases vs. 190 cases) and abdominal diseases (3172 cases vs. 26 cases) than chest X-ray examination. Chest X-ray examination detected more spinal and thoracic lesions (2798 cases vs. 129 cases), heart and vascular diseases (3095 cases vs. 1837 cases) than chest CT (P < 0.05). The cost of chest CT scan for every single positive reporting was less than chest X-ray (433.67 yuan vs. 554.32 yuan). Conclusion For health examination, chest CT scan is more effective and more economic than chest X-ray examination.

Key words： Chest X-ray Chest CT Health examination Clinical value Health economics

通讯作者: 郑延松（1971.11-），男，博士，副主任医师，解放军总医院健康管理科主任；研究方向：老年冠心病和健康管理。

引用本文:

陆峰郑延松. 肺部CT和普通胸片在体检人群病灶筛查中的成本效果比较[J]. 中国医药导报, 2018, 15(14): 177-180.
LU Feng ZHENG Yansong. Comparison of the cost-effectiveness of the lung CT and common chest radiographs in the screening of the patients in the physical examination. 中国医药导报, 2018, 15(14): 177-180.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I14/177

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