比较不同肺超声评分法在预测早产儿支气管肺发育不良中的应用价值

The application value of different lung ultrasound scores in predicting bronchopulmonary dysplasia of premature infants

目的探讨比较不同肺超声评分法(LUS)在预测早产儿支气管肺发育不良(BPD)中的应用价值。方法选取94例患呼吸窘迫综合征(NRDS)早产儿于出生后1~2天及第1,2,3,4周行肺脏超声检查,并采用改良LUS法、LUS法、Brat-LUS法进行评分。按照出院时有无合并BPD分成BPD组(54例)和无BPD组(40例)。分析三种LUS方法在预测NRDS早产儿BPD中的价值并比较其优劣。结果应用改良LUS法及LUS法,出生后第1,2,3,4周以及将5次评分相加时预测NRDS早产儿BPD有价值,且改良LUS法曲线下面积(AUC)较大,分别为0659,0.710,0.750,0.839,0.770,与LUS法相比,在第2周及5次评分相加时,两法AUC差异具有统计学意义(P<0.05);Brat-LUS法仅在出生后第4周及5次评分相加时有预测价值,其AUC最小,与改良LUS法和LUS法AUC进行差异性比较,差异均具有统计学意义(P<0.05)。出生后BPD组的LUS维持在一个较高的水平,无BPD组则持续下降。结论改良LUS法、LUS法、Brat-LUS法均可在一定程度上预测NRDS早产儿BPD,且改良LUS法最优。

Objective To compare the application value of different lung ultrasound scores(LUS)in the prediction of bronchopulmonary dysplasia(BPD)in preterm infants.Methods 94 premature infants with neonatal respiratory distress syndrome(NRDS)were examined by lung ultrasonography at the first 24 and 48 hours,1 week,2 weeks,3 weeks,4 weeks of life,and the scores were evaluated by modified LUS,LUS andBrat-LUS methods.We divided the cases into two groups BPD group(54 cases)and non-BPD group(40 cases),then analyzed and compared the value of three LUS methods in predicting BPD.Results We used modified LUS method and LUS method to predict BPD of premature infants with NRDS at their 1 week,2 weeks,3 weeks,4 weeks of life.And it was considered that the total score of modified LUS method and LUS method getting by adding 5 time scores can also predict BPD.The area under the curve(AUC)of modified LUS method was larger,which was 0.659(1 week),0.710(2 weeks),0.750(3 weeks),0.839(4 weeks)and 0.770(total score),respectively.Compared with the LUS method,the difference of AUC between the two methods was statistically significant(P<0.05);Brat-LUS method had predictive value only at 4 weeks of life and the time obtainning total scores,and its ACU was the smallest.When compared with the modified LUS method and LUS method,both of them had significant difference(P<0.05).In NRDS premature infants with BPD,the LUS maintained at a high level during these 4 weeks of life,whereas among subjects without BPD,the LUS decreased continuously.Conclusion To a certain extent,the modified LUS method,LUS method and Brat-LUS method can predict BPD in NRDS premature infants,and the modified LUS method is the best one.