Correlation Analysis Of Tongue Image And Some Risk Factors With High-Risk Pulmonary Nodules

Objective:To summarize the characteristics of tongue image of the high-risk pulmonary nodules,explore the law of tongue image of the high-risk pulmonary nodules,analyze the risk factors related to the malignant occurrence of pulmonary nodules,and establish the probability prediction model of malignant occurrence based on the characteristics of clinical data,in order to provide certain reference information for the identification of benign and malignant pulmonary nodules,early screening and early intervention of lung cancer.Method:This study adopted a cross-sectional study method to collect patients with high-risk pulmonary nodules found by chest CT and biopsied with informed consent from thoracic Surgery Department of Kunming Fourth People’s Hospital,Respiratory Department of Yunnan First People’s Hospital,Department of Geriatrics and Department of pulmonary disease of Yunnan Hospital of Traditional Chinese Medicine from December 2021 to January 2023.Tongue images were taken with a mobile phone with more than 8 million pixels,and tongue images were interpreted by the Chinese Medicine Huilian-Smart Tongue Mirror Application(APP).Meanwhile,clinical data including age,gender,smoking history,previous history of lung diseases,environmental or occupational exposure history,and family history of tumors were collected for subsequent analysis.Chi-square test was used to analyze the distribution of tongue image features and clinical data features among the high-risk groups of benign and malignant pulmonary nodules,and then univariate and multivariate logistic regression analysis was used to study the correlation between tongue image features and clinical data features and malignant pulmonary nodules,so as to screen out independent influencing factors related to malignant pulmonary nodules,and establish the malignant probability prediction model.Result:1.Among 266 patients with high-risk pulmonary nodules,the tongue color distribution of red tongue(39.47%),dark red tongue(23.68%),light red tongue(17.67%)was more common,followed by light purple tongue(11.28%),and light tongue(7.90%)was the least.In the distribution of color of tongue coating,white(75.56%)was the main color,followed by yellow(19.92%),yellow and white(2.26%),gray and black(2.26%).Petechial tongue,curdy tongue coating,spotted tongue and cracked tongue accounted for20.30%,1.50%,7.14%and 32.33%,respectively.Thick tongue coating,greasy tongue coating more seen,accounted for 72.93%,75.19%respectively.2.Among 266 patients with high-risk pulmonary nodules,57(21.43%)were benign and 209(78.57%)were malignant.3.In the correlation analysis between tongue image features and malignant occurrence of high-risk pulmonary nodules,Tongue color:χ~2=22.789,P<0.01;tongue color:χ~2=7.971,P=0.047<0.05;thickness:χ~2=10.362,P=0.001<0.01;greasy coating:χ~2=9.389,P=0.002<0.01.Tongue color,coating color,thickness and greasy coating distribution were different between the benign and malignant groups.Single factor logistic regression results:tongue color(dark red):OR=8.485,P=0.001<0.01;Thickness:OR=2.693,P=0.002<0.01,greasy moss:OR=2.611,P=0.003<0.01.Tongue color(dark red):OR=10.704,P=0.001<0.05;Thickness:OR=2.801,P=0.003<0.01;Greasy coating:OR=3.038,P=0.003<0.01.Tongue color was correlated with malignant pulmonary nodules,and dark red tongue was the highest risk.Thick coating and greasy coating can be independent risk factors of malignant pulmonary nodules.4.In the correlation analysis of clinical data characteristics and malignancy,smoking history:χ~2=4.702,P=0.030<0.05,environmental or occupational exposure history:χ~2=5.550,P=0.018<0.05,smoking history,environmental or occupational exposure history were different between the benign and malignant groups.The results of single factor logistic regression:smoking history:OR=2.064,P=0.035<0.05;environmental or occupational exposure history:OR=2.230,P=0.020<0.05;Multivariate logistic regression results were consistent with univariate logistic regression results:smoking history:OR=2.053,P=0.035<0.05,environmental OR occupational exposure history:OR=2.218,P=0.022<0.05.Smoking history and environmental or occupational exposure history were independent risk factors for malignant pulmonary nodules.5.Based on the tongue features(tongue color,thickness,greasy coating)screened by multi-factor logistic regression combined with clinical data(smoking history,environmental or occupational exposure history),the probability prediction model of malignant pulmonary nodules was established.The subjects’working characteristic curve(ROC curve)was used for analysis,and the area under the characteristic curve of the prediction model was 0.796,and the maximum Danjorden index was 0.480.The sensitivity of the model was 0.761 and the specificity was 0.719,indicating that tongue image combined with clinical data features had a certain accuracy in the evaluation of malignant pulmonary nodules.Conclusion:1.Tongue color was correlated with malignant pulmonary nodules,and dark red tongue had the highest risk.Thick coating and greasy coating are also correlated with malignant pulmonary nodules,and can be used as independent risk factors for malignant pulmonary nodules.2.Among the clinical data characteristics,smoking history,environmental or occupational exposure history are independent risk factors for malignant pulmonary nodules.3.The probabilistic prediction model based on tongue image combined with clinical data has certain accuracy in the evaluation of malignant pulmonary nodules.