胸部CT联合血清PCT诊断小儿重症肺炎的价值观察

Value of Chest CT Combined with Serum PCT in Diagnosis of Severe Pneumonia in Children

目的探究胸部CT联合血清降钙素原(PCT)检测对小儿重症肺炎的诊断价值。方法选取2018年10月至2019年10月本院收治的45例重症肺炎患儿为重症组,57例普通肺炎患儿为对照组,对所有患儿的一般临床资料、胸部CT征象和血清学指标水平进行回顾性分析。总结重症肺炎患儿胸部CT图像特征,比较不同检查方法对小儿重症肺炎诊断的灵敏度、特异度。结果重症组患儿的血清PCT、C反应蛋白(CRP)和白细胞计数(WBC)水平明显高于对照组患儿(P<0.05);重症肺炎患儿的CT影像学特征肺部表现以肺实质改变为主,肺内可见稍高密度的斑片状、团簇状或结节状影,边缘模糊,强化均匀,病灶内见小空洞影或含气支气管影,纵膈内气肿,可见结节状影,边缘清晰;胸部CT联合PCT诊断小儿重症肺炎的灵敏度、阴性预测值均高于PCT和胸部CT单检(P<0.05),特异度高于PCT单检(P<0.05),三种检测方法的阳性预测值比较,差异无统计学意义(P>0.05)。结论重症肺炎患儿的血清PCT、CRP和WBC等生化指标及胸部CT表现具有一定特征性,胸部CT联合血清PCT可提高临床诊断小儿重症肺炎灵敏度和特异度,为小儿重症肺炎的临床诊疗工作提供依据。

Objective To explore the diagnostic value of chest CT combined with serum procalcitonin(PCT)in children with severe pneumonia.Methods 45 children with severe pneumonia who were treated in the hospital between October 2018 and October 2019 were selected as the severe group,and 57 children with common pneumonia were chosen as the control group.The general clinical data,chest CT signs,and serum indexes of all children were retrospectively analyzed.Chest CT image characteristics of the severe group were summarized,and the sensitivities and specificities of different examination methods for diagnosis of severe pneumonia in children were compared.Results Serum PCT,C-reactive protein(CRP),and white blood cell count(WBC)in the severe group were significantly higher than those in the control group(P<0.05).CT imaging features of children with severe pneumonia mainly showed lung parenchyma changes,patchy,slightly higher density of clustered or nodular shadows in lungs with blurred edges and homogeneous enhancement,small cavitation shadows or bronchial shadows containing air in the lesion,emphysema in the mediastinum,and nodular shadow with clear edges.The sensitivity and negative predictive value of chest CT combined with PCT in the diagnosis of severe pneumonia in children were higher than those of PCT or chest CT alone(P<0.05),and the specificity was higher than that of PCT(P<0.05).There was no statistically significant difference in the positive predictive value between the two methods(P>0.05).Conclusion Biochemical indexes such as serum PCT,CRP,and WBC and chest CT manifestations of children with severe pneumonia are characteristic.Chest CT combined with serum PCT can improve the sensitivity and specificity of clinical diagnosis of severe pneumonia in children,which is useful for clinical diagnosing and treating of severe pneumonia in children.