新生儿肺炎的超声诊断与X线诊断的对照研究

Comparative Study of Ultrasound Diagnosis and X-ray Diagnosis of Neonatal Pneum-onia

目的观察比较X线诊断与超声诊断在新生儿肺炎中的准确性。方法将2017年10月-2019年1月期间在江西省儿童医院门诊部、住院部就诊的患儿81例纳入研究范围。对全体入选患儿进行临床诊断,对所有入选患儿均进行X线检查和超声检查。分析两种检测方法的诊断结果与临床的一致性、特异度、敏感度,比较两种检查手段的差异。结果超声检查阳性76例,真阳性74例,阴性5例,真阴性4例,与临床诊断一致率为92.50%(74/80),特异度为66.67%,灵敏度为98.66%;X线胸片检查阳性74例,真阳性70例,阴性7例,真阴性4例,与临床诊断一致率为87.50%(70/80),特异度为50.00%,灵敏度为95.89%。超声临床诊断的一致性与X线胸片组临床诊断的一致性比较,差异无统计学意义(P>0.05);与金标准检查结果作比较,74例超声检查阳性中有3例经金标准检查为阴性,超声误诊率为2.63%(2/76);超声检查阴性病例有4例,其中1例经金标检查结果为阳性,漏诊率为20.00%(1/5)。结论超声诊断在新生儿肺炎中的诊断特异度高、敏感度高、安全性高、误诊率低、漏诊率低,与金标准检查相比临床一致性无明显差异,建议临床进一步推广使用。

Objective To compare the accuracy of X-ray diagnosis and ultrasound diagnosis in neonatal pneumonia. Methods81 cases of children who were treated in the outpatient department and inpatient department of Jiangxi Children’s Hospital from October, 2017 to January, 2019 were included. Clinical diagnosis, X-ray examination and ultrasound examination of all selected children were done. Analysis of the diagnostic results and clinical consistency, specificity and sensitivity of the two detection methods was done. Differences of the two methods were compared. Results 76 cases were positive by ultrasound, 74 cases were true positive, 5 were negative, 4 were true negative, the consistency rate with clinical diagnosis was 92.50%(74/80), specificity was66.67%, and sensitivity was 98.66%;through X-ray chest examination, there were 74 cases of positive radiographs, 70 cases of true positives, 7 cases of negatives, and 4 cases of true negatives. The coincidence rate with the clinical diagnosis was 87.50%(70/80), the specificity was 50.00%, and the sensitivity was 95.89%. The consistency of ultrasound clinical diagnosis was consistent with the clinical diagnosis of the X-ray chest radiograph. There was no statistically significant difference(P> 0.05). Compared with the results of the gold standard examination, 3 out of 74 positive ultrasound examinations were negative by the gold standard examination, and the ultrasound misdiagnosis rate 2.63%(2/76);there were 4 negative cases through ultrasound examination, of which 1 case was positive by the gold standard test, and the missed diagnosis rate was 20.00%(1/5). Conclusion Ultrasound diagnosis has high specificity, high sensitivity, high safety and low misdiagnosis rate in neonatal pneumonia. The rate of missed diagnosis is low,and there is no obvious difference in clinical consistency compared with the gold standard examination. It is recommended to further promote clinical use.