肺部超声评分及血清PCT对新生儿感染性肺炎病情程度的评估价值

Value of lung ultrasound score and serum PCT in evaluating the severity of neonatal infectious pneumonia

目的分析肺部超声评分(LUS)及血清降钙素原(PCT)预测新生儿感染性肺炎(IPN)病情严重程度的价值,为临床诊断和治疗工作提供研究依据。方法选择2018月1月-2020年10月新余市妇幼保健部新生儿科收治的90例IPN患儿作为研究对象,对呼吸衰竭(RF)情况进行诊断,并将患儿分为RF组(42例)和非RF组(48例);根据新生儿危重症评分(NCIS)将其患儿分为危重患儿(35例)和非危重患儿(55例)。对患儿的一般资料及确诊IPN当日的LUS、血清PCT水平进行分析。结果RF组患儿的氧合指数(OI)、NCIS低于非RF组,呼吸指数(RI)高于非RF组。患儿的LUS与OI、NCIS呈正相关(P<0.05),与RI呈负相关(P<0.05),血清PCT水平与OI、NCIS呈负相关(P<0.05),与RI呈正相关(P<0.05)。在预测IPN合并RF和危重度IPN中,LUS、血清PCT水平的受试者工作特征曲线下面积(AUC~(ROC))分别为0.766、0.768和0.689、0.795(P<0.05),当将两者联合检测时,AUC~(ROC)分别提升至0.908和0.838(P<0.05)。结论IPN新生儿的血清PCT水平和LUS与其病情指标具有相关性,在预测患儿合并RF及发展至危重症方面均具有一定的价值,二者联合检测可提高预测效率。

OBJECTIVE To evaluate lung ultrasound score(LUS)and serum procalcitonin(PCT)in predicting the severity of neonatal infectious pneumonia(IPN),and to provide research basis for clinical diagnosis and treatment.METHODS Total of 90 children with IPN hospitalized in Neonatal Department of Xinyu Maternal and Child Health Care Department from Jan.2018 to Oct.2020 were recruited as the research subjects.According to the incidence of respiratory failure(RF),they were divided into the RF group(42 cases)and non-RF group(48 cases).According to the neonatal critical illness score(NCIS),the children were divided into the serous group(35 cases)and the non-serous group(55 cases).The general data of the children,as well as LUS and serum PCT levels on the day IPN was confirmed were detected and analyzed.RESULTS The oxygenation index(OI)and NCIS in the children of RF group were significantly lower than those in the non-RF group,and the respiratory index(RI)in the RF group was significantly higher than that in the non-RF group(P<0.05).LUS was positively correlated with OI and NCIS(P<0.05),and negatively correlated with RI(P<0.05).Serum PCT level was negatively correlated with OI and NCIS(P<0.05),and positively correlated with RI(P<0.05).In the prediction of IPN complicated with RF and serious IPN,the areas under receiver operating characteristic curve(AUCROC)of LUS and serum PCT levels were 0.766,0.768 and 0.689,0.795 respectively(P<0.05).Whereas AUCROC of the combined detection increased to 0.908 and 0.838(P<0.05).CONCLUSION The serum PCT level and LUS in IPN neonates are correlated with their disease severity,which may have certain value in predicting children with RF and developing to serious illness.The combined detection of the two indexes can improve the prediction efficiency.