肠道超声在新生儿坏死性小肠结肠炎急性期手术中的预测价值

Bowel ultrasound for predicting acute surgery for necrotizing enterocolitis

目的探讨常用超声图像特征对新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)急性期手术的预测价值。方法回顾性分析2017年1月至2019年12月郑州大学第一附属医院新生儿科收治的68例NEC患儿的彩色多普勒超声图像特征。根据患儿是否接受了手术治疗,将其分为手术组(21例)与非手术组(47例)。对比两组患儿超声图像特征的差异,根据单因素分析结果行Logistic回归分析,计算联合预测因子。对联合预测因子和单因子进行ROC曲线分析,计算联合预测因子和单因子预测NEC手术的敏感度和特异度。结果超声检查结果显示,手术组腹腔积液深度为(17.9±11.0)mm,出现肠蠕动减弱18例、腹腔积液透声差14例、腹腔游离气体2例;非手术组腹腔积液深度为(3.0±5.1)mm,出现肠蠕动减弱19例、腹腔积液透声差1例,两组上述指标比较,差异均有统计学意义(P均<0.05)。根据Logistic回归分析结果,采用肠蠕动减弱、腹腔积液深度、腹腔积液透声差3个图像特征联合预测NEC手术的ROC曲线下面积(area under the curve,AUC)为0.948,敏感度为95.2%,特异度为85.1%,腹腔积液深度预测NEC手术的AUC为0.890,敏感度为66.7%,特异度为93.6%。结论肠道超声可评估肠蠕动、肠壁厚度及血供、腹腔积液等征象,其中肠蠕动、腹腔积液深度、腹腔积液性质3项指标联合应用对预测NEC患儿是否需要行急性期手术有临床实用价值。

Objective To explore the value of bowel ultrasound for predicting acute surgery for necrotizing enterocolitis(NEC).Methods From January 2017 to December 2019,68 NEC neonates were divided into two groups of operation(n=21)and non-operation(n=47).Ultrasonic characteristics were compared between two groups.Logistic regression analysis was performed based upon the results of single-factor analysis.The combined predictor was calculated according to the results of Logistic regression.And ROC curve analysis was performed for combined predictor and single factors.Results Ultrasound examination revealed that the depth of ascites was(17.9±11.0)mm in operation group.There were weakened peristalsis(n=18),poor ascites transmittance(n=14)and pneumoperitoneum(n=2);the depth of ascites was(3.0±5.1)mm in non-operation group.There were weakened peristalsis(n=19)and poor ascites transmittance(n=1).And the differences were statistically significant(P<0.05).According to the result of Logistic regression,when combining weakened peristalsis,ascites depth and poor ascites transmittance for predicating,the area under the ROC curve was 0.948,the corresponding sensitivity and specificity were 95.2%and 85.1%.The area under the ROC curve was 0.890 according to ascites depth and the corresponding sensitivity and specificity were 66.7%and 93.6%.Conclusions Bowel ultrasound could assess peristalsis,intestinal wall thickness&blood supply,ascites depth and ascites properties.Combining peristalsis,ascites depth and ascites properties has clinical practical values for predicting acute surgery of NEC.