肺脏超声评分对新生儿呼吸窘迫综合征病情严重程度的预测价值

Predictive value of lung ultrasound score on the severity of neonatal respiratory distress syndrome

目的探讨肺脏超声评分对新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)病情严重程度的预测价值。方法回顾性分析温州市人民医院2021年7月至2022年7月新生儿监护病房确诊的NRDS患儿65例临床资料,将65例患儿纳入NRDS组,同期选择其他常见肺部疾病(如新生儿湿肺、感染性肺炎)患儿40例作为其他肺部疾病组,所有患儿均经肺脏超声及X线检查,观察两组患儿肺部情况:胸膜线异常、A线消失、孤立B线、融合B线、弥漫性B线、肺实变、伴或不伴有支气管充气征等肺脏超声表现。比较两组患儿肺脏超声评分,分析NRDS组患儿X线分级分布情况,采用Pearson相关性分析肺脏超声评分与X线分级的相关性。受试者操作特征(receiver operator characteristic,ROC)曲线图分析肺脏超声评分鉴别诊断NRDS及病情严重程度的临床价值。结果NRDS组患儿胸膜线异常、A线消失、融合B线、弥漫性B线、肺实变、支气管充气征比例明显高于其他肺部疾病组,孤立B线、双肺点检出比例明显低于其他肺部疾病组,差异有统计学意义(P<0.05)。NRDS组患儿双肺、左肺、右肺、双侧肺、双肺底肺部超声评分明显高于其他肺部疾病组(P<0.05)。随着X线分级的增加,肺超声评分逐渐升高,各级别组间比较差异有统计学意义(P<0.05),经Pearson相关性分析结果显示,肺超声评分与X线分级呈明显正相关(r=0.704,P<0.05)。肺超声评分鉴别诊断NRDS与常见肺部疾病的曲线下面积(areaundercurve,AUC)为0.907,敏感度、特异性分别为89.0%、92.5%;肺超声评分鉴别诊断NRDS轻度与中度、中度与重度的AUC分别为0.914、0.933,均具有较高的临床价值。结论肺脏超声评分在鉴别NRDS方面具有一定的价值,可量化评估NRDS的病情变化,与X线分级具有较好的一致性,具有无辐射、快速、直观等优点,可作为早期诊断NRDS及评估病情严重程度的有效方法。

Objective To explore the predictive value of lung ultrasound score on the severity of neonatal respiratory distress syndrome(NRDS).Methods The clinical data of 65 children with NRDS in our NICU from July 2021 to July 2022 were retrospectively analyzed,and 65 children were included in the NRDS group,while 40 children with other common pulmonary diseases(neonatal wet lung and infectious pneumonia)were selected as the other pulmonary disease group during the same period,and all children were examined by pulmonary ultrasound and X-ray to observe the children in both groups.The lung conditions of the two groups of children were observed:abnormal pleural line,disappearance of A line,isolated B line,fused B line,diffuse B line,lung consolidation,with or without bronchial inflation sign,and other lung ultrasound manifestations.The lung ultrasound scores of the two groups of children were compared,and the X-ray grading distribution of children in the NRDS group was analyzed,correlation between lung ultrasound scoring and X-ray grading was used by Pearson correlation analysis.The clinical value of lung ultrasound score in the differential diagnosis of NRDS and the severity of the disease was analyzed by receiver operator characteristic(ROC)curve.Results The proportion of solid lung,abnormal pleural line,disappearance of A-line,white lung detection,fused B-line,and bronchial inflation sign was significantly higher in the NRDS group than in the other lung disease groups,and the proportion of isolated B-line and double lung point detection was significantly lower than in the other lung disease groups,with statistically significant differences(P<0.05).The lung ultrasound scores of both lungs,left lung,right lung,bilateral lung,and base of both lungs were significantly higher in the NRDS group than in the other lung disease groups(P<0.05).With the increase of X-ray grading,the lung ultrasound score gradually increased,and there was a statistically significant difference between groups at each grade(P<0.05).Pearson correlation analysis showed that there was a significant positive correlation between lung ultrasound score and X-ray grade(r=0.704,P<0.05).The area under curve(AUC)of lung ultrasound score in differentiating NRDS from common lung diseases was 0.907,with sensitivity and specificity of 89.0%and 92.5%,respectively;the AUC of mild and moderate,moderate and severe NRDS in the differential diagnosis by lung ultrasound score was 0.914 and 0.933,respectively,which had high clinical value.Conclusion The lung ultrasound score has certain value in identifying NRDS.The lung ultrasound score can quantitatively assess the changes in the condition of NRDS,and the lung ultrasound and X-ray grading have good consistency,it has the advantages of radiation free,fast,and intuitive,and can be used as an effective method for early diagnosis of NRDS and evaluation of the severity of the disease.