改良经胸肺部超声评分法对间质性肺疾病的诊断价值

Diagnostic value of refined transthoracic lung ultrasound scoring method in interstitial lung diseases

目的评价改良经胸肺部超声(TLUS)评分法对间质性肺疾病(ILD)的诊断价值。方法对2019年3月至2020年2月福建医科大学附属第二医院呼吸内科、免疫内科住院怀疑为ILD的50例患者采用高分辨率CT(HRCT)与TLUS进行检查,所得超声结果采用改良超声评分法与Buda超声评分法进行评估,分析改良超声评分法、Buda超声评分法与HRCT评分法对ILD的诊断效能,评价改良超声评分与Buda超声评分及HRCT评分的相关性,并评估两种超声评分方法在不同病情程度ILD间的差异。再以Warrick评分作为判断ILD严重程度的标准,采用ROC曲线对改良超声评分进行不同程度肺间质病变截点值的预测。结果①改良超声评分法、Buda超声评分法及HRCT评分法评估ILD的敏感性分别为92.3%、87.2%、97.4%,特异性分别为92.3%、87.2%、97.4%,ROC曲线下面积(AUC)分别为0.978(95%CI=0.941~1.000)、0.950(95%CI=0.892~1.000)、0.999(95%CI=0.994~1.000)。②改良超声评分值与HRCT评分值、Buda超声评分值呈强正相关(r=0.929、0.920,P<0.001);Buda超声评分值与HRCT评分值呈较强正相关(r=0.862,P<0.001)。③随着ILD严重程度的增加,改良经胸肺部超声评分值及Buda超声评分值均明显增加;在改良肺部超声方面,轻度组、中度组与重度组两两之间差异有统计学意义(均P<0.05)。④ROC曲线计算改良超声评分预测轻度和重度肺间质病变临界值分别为34分(其敏感性100%,特异性87.5%,AUC=0.891,95%CI=0.686~1.000)和64.5分(其敏感性91.3%,特异性87.5%,AUC=0.954,95%CI=0.877~1.000)。结论改良超声评分法可反映肺间质病变的严重程度,可用于半定量评估ILD。

Objective To evaluate the diagnostic value of refined transthoracic lung ultrasound(TLUS)scoring method in interstitial lung diseases(ILD).Methods The TLUS was performed in 39 ILD patients in respiratory department and immunology department of the Second Affiliated Hospital of Fujian Medical University from March 2019 to February 2020.The ultrasonic recordings were evaluated by Buda ultrasound scoring method and refined ultrasound scoring method.The diagnostic efficacies of the refined ultrasound scoring method,Buda ultrasound scoring method and high resolution computed tomography(HRCT)scoring method for ILD were analyzed.The correlations between refined ultrasound score and Buda ultrasound score/HRCT score were evaluated.The difference of diagnostic efficacy between refined ultrasound scoring method and Buda ultrasound scoring method were analyzed in different severity of ILD.Then,the HRCT Warrick scoring method was used as the criterion to judge the severity of ILD,and the receiver operator characteristic(ROC)curve was plotted to predict the cutoff values of the fefined ultrasound score for different degrees of ILD.Results①The sensitivity of the refined ultrasound scoring method in diagnosing ILD was 92.3%,specificity was 92.3%,area under ROC curve(AUC)=0.978,95%CI=0.941-1.000.The sensitivity of Buda ultrasound scoring method in diagnosing ILD was 87.2%,specificity was 87.2%,AUC=0.950,95%CI=0.892-1.000.The sensitivity of HRCT scoring method in diagnosing ILD was 97.4%,specificity was 97.4%,AUC=0.999,95%CI=0.994-1.000.②The correlations between the refined ultrasound score,the HRCT Warrick score and the Buda ultrasound score were high(r=0.929,0.920,0.862 respectively,P<0.001).③The values of refined ultrasound scoring method and Buda ultrasound scoring method consistently and significantly increased with the increasing severity of ILD.With regards to the former one,there were significant differences among mild group,moderate group and severe group(P<0.05).④The ROC curve confirmed that refined ultrasound score cut-off points for predicting mild and severe interstitial lung diseases,were 34[sensitivity of 100%,specificity of 87.5%respectively,AUC=0.891,95%CI=0.686-1.000]and 64.5[sensitivity of 91.3%,specificity of 87.5%respectively,AUC=0.954,95%CI=0.877-1.000].Conclusions The severity of the interstitial lung diseases could be evaluated by the refined ultrasound scoring method,which is useful in the semi-quantitative evaluation of ILD.