肺超声联合白细胞、降钙素原对儿童获得性肺炎的诊断价值

Diagnostic value of lung ultrasound combined with white blood cells and procalcitonin in pediatric community-and hospital-acquired pneumonia

目的:探讨肺超声联合白细胞(WBC)、降钙素原(PCT)对儿童获得性肺炎的诊断价值。方法:选取疑似获得性肺炎患儿153例,根据最终临床确诊结果将其分为肺炎组(n=78)与非肺炎组(n=75),对所有患者均行肺超声、WBC、PCT检查,观察比较肺超声联合WBC、PCT检查与单独行肺超声检查诊断儿童获得性肺炎的敏感度、特异性、准确度、阳性预测值、阴性预测值、Kappa值。再根据肺炎组患儿病情严重程度分为重度组(n=36)与非重度组(n=42),用ROC曲线分析WBC、PCT对获得性肺炎患儿病情严重程度的诊断价值。结果:肺超声联合WBC、PCT检查与单独行肺超声检查诊断儿童获得性肺炎的敏感度分别为96.2%、71.8%,特异性分别为97.3%、69.3%,准确度分别为96.7%、70.6%,阳性预测值分别为97.4%、70.9%,阴性预测值分别为96.1%、82.9%,Kappa值分别为0.935、0.411,差异均具有统计学意义(P<0.05)。ROC曲线分析结果显示,WBC、PCT及WBC联合PCT对获得性肺炎患儿病情严重程度均具有一定的诊断价值(P<0.05),且WBC联合PCT的AUC大于WBC、PCT,差异均具有统计学意义(P<0.05)。结论:肺超声联合WBC、PCT可提高获得性肺炎患儿的诊断效能,同时有助于诊断其病情严重程度。

Objective To explore the value of lung ultrasound combined with white blood cells(WBC)and procalcitonin(PCT)in diagnosing pediatric community-and hospital-acquired pneumonia.Methods A total of 153 pediatric patients with suspected community-and hospital-acquired pneumonia were enrolled.According to the final clinical diagnosis results,they were divided into pneumonia group(n=78)and non-pneumonia group(n=75).All patients underwent lung ultrasound,WBC and PCT examinations.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa value of lung ultrasound alone and lung ultrasound combined with WBC and PCT in the diagnosis of acquired pneumonia were compared.According to the severity of pneumonia in pneumonia group,pediatric patients were divided into severe group(n=36)and nonsevere group(n=42);and the diagnostic value of WBC and PCT in the severity of acquired pneumonia was analyzed by ROC curves.Results The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa value of lung ultrasound combined with WBC and PCT in diagnosing acquired pneumonia were significantly higher than those of lung ultrasound alone,with statistical significance(96.2%vs 71.8%,97.3%vs 69.3%,96.7%vs 70.6%,97.4%vs 70.9%,96.1%vs 82.9%,and 0.935 vs 0.411,respectively;all P<0.05).The results of ROC curve analysis showed thatWBC,PCT and their combination were of certain diagnostic value for the severity of acquired pneumonia(P<0.05),and that the AUC of WBC combined with PCT was greater than that of WBC alone and PCT alone(P<0.05).Conclusion Lung ultrasound combined withWBC and PCT can improve the diagnostic efficiency of pediatric community-and hospital-acquired pneumonia,and meanwhile it is beneficial to the diagnosis of disease severity.