肺脏超声异常征象在儿童肺炎诊断中的价值

doi:10.6040/j.issn.1671-7554.0.2018.465

摘要/Abstract

摘要： 目的分析比较肺脏超声异常征象在儿童肺炎诊断中的价值。方法回顾性分析91例接受肺脏超声检查的病例资料,将各超声征象的诊断结果与临床诊断相对照,分别计算其诊断效能,采用二元Logistic回归分析并构建受试者工作特征(ROC)曲线,比较各征象在儿童肺炎诊断中的价值。结果经临床诊断,91例中有56例肺炎、35例无肺炎。B线、A线异常、胸膜线异常、肺滑动征异常、肺实变、胸腔积液是儿童肺炎的主要超声征象;肺实变是儿童肺炎最相关的超声征象(P<0.001),ROC曲线下面积(AUC)为0.845(P<0.001),敏感性为80.4%,特异性为88.6%,准确性为83.5%。结论 B线、A线异常、胸膜线异常、肺滑动征异常、肺实变、胸腔积液对于诊断儿童肺炎具有重要意义,其中肺实变是最有价值的超声征象。

关键词: 儿童, 肺炎, 肺脏超声

Abstract: Objective To evaluate the diagnostic values of abnormal features of lung ultrasonography in childrens pneumonia. Methods The examination results of lung ultrasonography in 91 patients were analyzed retrospectively. The results of ultrasonography diagnosis and clinical diagnosis of childrens pneumonia were compared, and the diagnostic efficiency was calculated. The binary Logistic analysis and the receiver operating characteristic(ROC)curve were used to investigate the diagnostic values of these features. Results There were 56 cases with pneumonia and 35 cases without pneumonia. The main characteristics of childrens pneumonia were B line, A line abnormalities, pleural line abnormalities, lung sliding sign abnormalities, lung consolidation and pleural effusion. Lung consolidation was most correlated with pneumonia(P<0.001). The area under the ROC curve(AUC)of lung consolidation was 0.845(P<0.001). The sensitivity, specificity and accuracy of lung consolidation were 80.4%, 88.6%, and 83.5%, respectively. Conclusion Among all the abnormal features, including B line, A line abnormalities, pleural line abnormalities, lung sliding sign abnormalities, lung consolidation and pleural effusion, of lung ultrasonography in childrens pneumonia, lung consolidation is the most valuable feature with highest specificity and accuracy.

Key words: Child, Pneumonia, Lung ultrasonography

中图分类号:

R445

汝琦,孙文荣,杨暖. 肺脏超声异常征象在儿童肺炎诊断中的价值[J]. 山东大学学报 (医学版), 2019, 57(3): 91-95.

RU Qi, SUN Wenrong, YANG Nuan. Diagnostic values of abnormal features of lung ultrasonography in childrens pneumonia[J]. Journal of Shandong University (Health Sciences), 2019, 57(3): 91-95.

参考文献

[1] 曾学英,尹万红,康焰.肺部超声在肺炎诊断中的应用[J].中华结核和呼吸杂志, 2017, 40(2): 158-160.
[2] Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound[J]. Intensive Care Med, 2012, 38(4): 577-591.
[3] Chavez MA, Shams N, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis[J]. Respir Res, 2014, 15: 50. doi:10.1186/1465-9921-15-50.
[4] Jones BP, Tay ET, Elikashvili I, et al. Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children: a randomized controlled trial[J]. Chest, 2016, 150(1): 131-138.
[5] 袁鹏, 李娅, 张飞雪, 等. 肺脏超声在新生儿感染性肺炎诊断中的临床价值[J]. 山东大学学报(医学版), 2018, 56(6): 29-34. YUAN Peng, LI Ya, ZHANG Feixue, et al. Clinical value of lung ultrasound in the diagnosis of neonatal infectious pneumonia[J]. Journal of Shandong University(Health Sciences), 2018, 56(6): 29-34.
[6] 陈水文, 许煊, 刘敬. 肺脏超声对重症监护病房患儿应用价值分析[J]. 中国实用儿科杂志, 2016, 31(9): 681-685. CHEN Shuiwen, XU Xuan, LIU Jing. Application of findings of lung ultrasonography examinations in Pediatric Intensive Care Unit[J]. Chinese Journal of Practical Pediatrics, 2016, 31(9): 681-685.
[7] 樊伟, 高虹, 李雪娇, 等. 超声在肺部疾病诊断中的应用[J]. 中华临床医师杂志(电子版), 2016, 10(19): 2954-2957. doi:10.3877/cma.j.issn.1674-0785.2016.19.027. FAN Wei, GAO Hong, LI Xuejiao, et al. Ultrasound application in the diagnosis of lung disease[J]. Chinese Journal of Clinicians(Electronic Edition), 2016, 10(19): 2954-2957. doi:10.3877/cma.j.issn.1674-0785.2016.19.027.
[8] 李娅, 袁鹏, 张飞雪, 等. 肺脏超声在肺表面活性物质治疗早产儿呼吸窘迫综合征中的评价作用[J]. 山东大学学报(医学版), 2018, 56(2): 34-40. LI Ya, YUAN Peng, ZHANG Feixue, et al. Lung ultrasound for evaluating the effect of pulmonary surfactant replacement therapy in preterm infants with respiratory distress syndrome[J]. Journal of Shandong University(Health Science), 2018, 56(2): 34-40.
[9] 刘敬, 曹海英, 李静雅, 等. 新生儿肺部疾病的超声诊断[J]. 中华围产医学杂志, 2013, 16(1): 51-56. LIU Jing, CAO Haiying, LI Jingya, et al. Ultrasound scan for neonatal pulmonary diseases[J]. Chinese Journal of Perinatal Medicine, 2013, 16(1): 51-56.
[10] Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding[J]. Chest, 1995, 108(5): 1345-1348.
[11] Cattarossi L. Lung ultrasound: its role in neonatology and pediatrics[J]. Early Hum Dev, 2013, 89(Suppl 1): S17-S19.
[12] 李虹,吕秀章,李一丹,等.肺超声“彗星尾征"的关联性结构及相关定性定量研究[J].中华超声影像学杂志, 2017, 26(5): 458-460. LI Hong, LV Xiuzhang, LI Yidan, et al. Associated structure of “comet tail sign” in lung ultrasound and its related quantitative or qualitative researches[J]. Chinese Journal of Ultrasonography, 2017, 26(5): 458-460.
[13] Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome[J]. Cardiovasc Ultrasound, 2008, 6: 16. doi:10.1186/1476-7120-6-16.
[14] Gargani L, Volpicelli G. How I do it: lung ultrasound[J]. Cardiovasc Ultrasound, 2014, 12: 25. doi:10.1186/1476-7120-12-25.
[15] 任柳琼, 吕发勤, 冯聪, 等. 床旁超声在呼吸机相关性肺炎诊断中的临床应用研究[J]. 中华医学超声杂志(电子版), 2016, 13(7): 542-546. REN Liuqiong, LYU Faqin, FENG Cong, et al. Clinical diagnostic value of bedside ultrasound in ventilator-associated pneumonia[J]. Chinese Journal of Medical Ultrasound(Electronic Edition), 2016, 13(7): 542-546.
[16] 王陆豪, 管向东, 陈敏英, 等. 重症患者容量复苏后期肺部超声容量评估[J]. 中华医学杂志, 2016, 96(17): 1359-1363. WANG Luhao, GUAN Xiangdong, CHEN Minying, et al. Clinical value of lung ultrasound in the late goal-directed fluid removal in critically ill patients underwent fluid resuscitation[J]. National Medical Journal of China, 2016, 96(17): 1359-1363.
[17] 邹同娟, 尹万红, 秦瑶, 等. 改良肺超声失充气评分对重症医学科内休克患者预后的价值[J]. 中华医学杂志, 2017, 97(29): 2244-2247. ZOU Tongjuan, YIN Wanhong, QIN Yao, et al. Prognostic value of modified lung ultrasound aeration loss score in shock patient in intensive care unit[J]. National Medical Journal of China, 2017, 97(29): 2244-2247.
[18] 鲁正荣, 王莉, 金梅, 等. 儿童社区获得性肺炎肺部超声波检查的声像图特征分析[J]. 中国小儿急救医学, 2017, 24(9): 680-685. LU Zhengrong, WANG Li, JIN Mei, et al. Analysis of ultrasonographic features of pulmonary ultrasound in childrens community acquired pneumonia[J]. Chinese Pediatric Emergency Medicine, 2017, 24(9): 680-685.
[19] Ho MC, Ker CR, Hsu JH, et al. Usefulness of lung ultrasound in the diagnosis of community-acquired pneumonia in children[J]. Pediatr Neonatol, 2015, 56(1): 40-45.
[20] Reali F, Sferrazza Papa GF, Carlucci P, et al. Can lung ultrasound replace chest radiography for the diagnosis of pneumonia in hospitalized children?[J]. Respiration, 2014, 88(2): 112-115.
[21] 赵倩茹, 马红彪, 付大鹏. 肺超声评估儿童肺炎的研究进展[J]. 临床儿科杂志, 2016, 34(2): 154-157. doi:10.3969/j.issn.1000-3606.2016.02.018. ZHAO Qianru, MA Hongbiao, FU Dapeng. Progress on ultrasonography assessment of pneumonia in pediatric patients[J]. Journal of Clinical Pediatrics, 2016, 34(2): 154-157. doi:10.3969/j.issn.1000-3606.2016.02.018.
[22] Mong A, Epelman M, Darge K. Ultrasound of the pediatric chest[J]. Pediatr Radiol, 2012, 42(11): 1287-1297. doi:10.1007/s00247-012-2401-7.
[23] Coley BD. Chest sonography in children: current indications, techniques, and imaging findings[J]. Radiol Clin North Am, 2011, 49(5): 825-846.
[24] Hajalioghli P, Nemati M, Dinparast Saleh L, et al. Can chest computed tomography be replaced by lung ultrasonography with or without plain chest radiography in pediatric pneumonia?[J]. Thorac Imaging, 2016, 31(4): 247-252.

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