肺超声在儿童社区获得性肺炎中的诊断价值

Value of pulmonary ultrasound in the diagnosis of children with community-acquired pneumonia

目的探讨肺部超声(Lung Ultrasound,LUS)在儿童社区获得性肺炎(Community-acquired Pneumonia,CAP)的诊断价值。方法筛选上海交通大学医学院附属仁济医院南院儿科2019年5月至2019年10月期间疑似CAP的326名住院患儿进行前瞻性研究,所有患儿均在48h内完善LUS和胸片(Chest X Ray,CXR)检查,部分患儿根据病情需要完善胸部CT检查,分别根据临床诊断和胸部CT标准确诊CAP,探讨LUS在儿童CAP的诊断价值。结果326例疑似CAP的患儿中,最终临床诊断CAP的患儿221例,其中LUS有较高的诊断特异度(97.1%)、敏感度(91.4%)、阴性预测值(84.3%)和阳性预测值(98.5%),但与CXR相比均无统计学差异(P均>0.05)。同时进一步对单一LUS征象诊断CAP分析,融合B线和肺实变均具有较高的诊断特异度(71.5%和82.8%)和敏感度(100%和97.1%),且一致性高(Kappa=0.618和0.756)。此外,95例患儿因病情需要接受胸部CT检查,经CT诊断为CAP的患儿81例,以LUS诊断CAP的敏感度为97.5%,特异度87%,且LUS与胸部CT诊断一致性极高(Kappa=0.832),略低于CXR(Kappa=0.855)。结论LUS在诊断儿童CAP方面具有不亚于CXR的临床价值,且与胸部CT一致性极高,是诊断儿童CAP的可靠工具。

Objective To explore the diagnostic value of lung ultrasound(LUS)in children with community-acquired pneumonia(CAP).Methods A prospective study was conducted on 326 children with suspected CAP from the Department of Pediatrics,South campus of Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine.All children completed LUS and chest X-ray(CXR)examinations within 48 h.In some children,chest computed tomography(CT)examination was required due to their conditions.CAP was diagnosed according to clinical examination and chest CT standards.Results Among the 326 children with suspected CAP,221 were finally clinically diagnosed with CAP.Among them,LUS showed high diagnostic specificity(97.1%),sensitivity(91.4%),negative predictive value(84.3%),and positive predictive value(98.5%).However,no statistical difference was found between LUS and CXR with respect to the aforementioned parameters(P>0.05).Simultaneously,in a further analysis of the diagnostic value of LUS in the diagnosis of CAP,the confluent of B-line and lung consolidation had high diagnostic specificity(71.5%and 82.8%)and sensitivity(100%and 97.1%),and the consistency was good(Kappa=0.618 and 0.756).In addition,95 children required chest CT examinations due to their medical conditions.In 81 children diagnosed with CAP,LUS had a sensitivity of 97.5%and a specificity of 87%in the diagnosis of CAP.The consistency of LUS and chest CT diagnosis was good(Kappa=0.832),but it was slightly lower than CXR(Kappa=0.855).Conclusion LUS has a clinical value similar to that of CXR in diagnosing CAP in children,and it has extremely high consistency with chest CT.Thus,it is a reliable tool for diagnosing CAP in children.