超声检查对儿童胸部结核诊断及治疗效果评估的价值

The value of ultrasound examination in the diagnosis and treatment evaluation of chest tuberculosis in children

目的:探讨超声检查对儿童胸部结核的诊断及治疗效果评估的价值。方法:采用回顾性分析方法,选取2023年5月至2024年5月于长沙市中心医院学生儿童结核科住院的胸部结核病患儿作为研究对象,共计131例。收集研究对象的一般信息(性别、年龄)、临床诊断结果、胸部影像学检查结果。对比超声检查与CT扫描对胸部结核的诊断价值;对于超声可显示的病灶,随访时探讨超声在治疗疗效评估中的价值。结果:131例研究对象中,胸部CT扫描及超声检查的总阳性率分别为100.0%(131/131)和75.6%(99/131),差异有统计学意义(χ^(2)=36.450,P<0.001)。85例(64.9%)患儿肺实质病变累及胸膜能被超声探及,表现为胸膜下片状不规则低回声区,不含支气管充气征,其余46例(35.1%)肺实质病变在CT上多表现为未累及胸膜的纤维条索样、斑点状、结节状病灶。超声对肺空洞及纵隔淋巴结肿大的显示率分别是33.3%(5/15)和21.7%(5/23)。43个肺实质病变病灶及19个胸膜结核瘤病灶进行了超声随访,随访中,5个肺实质病变病灶及1个胸膜结核瘤病灶出现增大,5例患儿出现了新发的胸膜病灶。随访1个月时,胸膜结核瘤病灶的缩小率[(14±4)%]明显低于肺实质病变病灶的缩小率[(43±11)%],差异有统计学意义(t=2.512,P=0.020)。随访3个月内15个(34.9%)肺实质病变病灶完全恢复,19个胸膜结核瘤病灶完全恢复为0个,两者差异有统计学意义(χ^(2)=6.940,P=0.008)。结论:在儿童胸部结核的诊断中,对于累及胸膜的肺实质病灶及胸膜病灶,超声与CT的诊断价值相当;在治疗随访中超声具有不可替代的作用,可作为大部分胸部结核患儿随访复查的首选检查方法。

Objective:This study aims to evaluate the diagnostic value and therapeutic efficacy of ultrasound in pediatric chest tuberculosis.Methods:A retrospective analysis was performed on 131 confirmed pediatric chest tuberculosis cases admitted to the Student and Pediatric Tuberculosis Ward at the Changsha Central Hospital from May 2023 to May 2024.Demographic data(e.g.,gender and age),clinical diagnoses,and chest imaging findings were collected.The diagnostic accuracy of ultrasound was compared with that of chest computed tomography(CT)for detecting chest tuberculosis.For lesions identifiable via ultrasound,the utility of ultrasound in therapeutic response evaluation was further assessed during follow-up.Results:Of the 131 pediatric patients,the detection rates for chest CT and ultrasound were 100.0%(131/131)and 75.6%(99/131),respectively,showing a statistically significant difference(χ^(2)=36.450,P<0.001).Among the cases with lung parenchymal lesions,85(64.9%)involved the pleura and were detected by ultrasound,appearing as irregular hypoechoic areas adjacent to the pleura without evidence of bronchial air sign.The remaining 46 cases(35.1%)presented on CT as fibrous,cord-like,spotted,or nodular lesions,without pleural involvement,and were undetectable by ultrasound.The detection rates of pulmonary cavities and mediastinal lymph node enlargement by ultrasound were 33.3%(5/15)and 21.7%(5/23),respectively.A total of 43 pulmonary parenchymal lesions and 19 pleural tuberculosis lesions were monitored by ultrasound during follow-up.Of these,5 pulmonary parenchymal lesions and 1 pleural tuberculosis lesion showed enlargement,and 5 new pleural lesions were detected in other children during the follow-up period.At the one-month follow-up,the reduction rate of pleural tuberculosis lesions((14±4)%)was significantly lower than that of pulmonary parenchymal lesions((43±11)%),with statistical significance(t=2.512,P=0.020).After three months of follow-up,15(34.9%)pulmonary parenchymal lesions fully resolved,whereas none(0/19)of the pleural tuberculosis lesions showed complete resolution,demonstrating a statistically significant difference(χ^(2)=6.940,P=0.008).Conclusion:Ultrasound demonstrates comparable diagnostic value to CT in detecting lung parenchymal and pleural lesions involving the pleura in pediatric chest tuberculosis.Moreover,ultrasound offers an irreplaceable advantage in treatment monitoring,making it a preferred modality for follow-up evaluation in most pediatric chest tuberculosis cases.