超声灰阶强度定量分析在胸腔积液性质鉴别中的临床应用

The Value of Ultrasonic Grey Scale Intensity Quantitative Analysis in Identifying the Properties of Pleural Effusion

目的探讨超声灰阶强度定量分析在鉴别胸腔积液性质中的临床应用价值。方法采用前瞻性研究方法,纳入因临床需要行胸腔穿刺引流的患者120例。所有患者在穿刺前均行常规超声并测量超声灰阶强度(echo intensity,EI)值。并行胸水生化和血生化检测,测定胸水及血清的总蛋白(total protein,TP)、乳酸脱氢酶(lactate dehydrogenase,LDH)水平。根据临床检验结果将胸腔积液性质分别区分为渗出液、漏出液以及恶性胸腔积液、良性胸腔积液。建立超声强度EI值的受试者操作特征曲线(ROC曲线),计算曲线下面积及最佳截断值。结果120例胸腔积液中,渗出液90例[平均EI值为(-46.55±6.35)],漏出液30例[平均EI值为(-55.51±5.30)];恶性胸腔积液62例[平均EI值为(-47.24±5.37)],良性胸腔积液58例[平均EI值为(-50.46±7.92)]。渗出液组平均EI值明显高于漏出液组(P<0.05);良性胸腔积液组平均EI值低于恶性胸腔积液组(P<0.05)。ROC曲线分析结果显示EI值对区分渗出液和漏出液具有较高的准确性(曲线下面积为0.856),最佳截断值为-50.95,其灵敏度为80.0%,特异度为83.3%。胸腔积液超声EI值+TP值+LHD值对鉴别胸腔积液良恶性的诊断价值较高(曲线下面积为0.736),最佳截断值为89.10,其灵敏度为98.4%,特异度为46.6%。结论超声灰阶强度定量EI值对鉴别胸腔积液渗出液和漏出液具有较高的诊断价值,且胸腔积液EI值+TP值+LHD值对胸腔积液良恶性的鉴别价值较高。

Objective To research the clinical value of ultrasonic grey scale intensity in identifying the properties of pleural effusion.Methods A prospective study approach was used to collect data from patients who underwent puncture drainage due to clinical needs.We enrolled 120 patients for whom we performed routine ultrasonography and measured the ultrasonic grey scale intensity(echo intensity,EI)value.According to the clinical test results,pleural effusion was divided into exudate fluid,leakage fluid,malignant pleural effusion and benign pleural effusion.The subject operating characteristic curve(ROC curve)of the ultrasound intensity EI value was drawn,and the area under the curve and the optimal cut-off value was calculated.Results Of the 120 pleural effusions,there were 90 exudates[mean intensity EI value:(-46.55±6.35)],30 leaks[mean intensity EI value:(-55.51±5.30)],62 malignant pleural effusions[mean intensity EI value:(-47.24±5.37)],and 58 benign pleural effusions[mean intensity EI value:(-50.46±7.92)].The mean EI value of the exudate group was significantly higher than that of the leakage group(P<0.05),and that of the benign pleural effusion group was lower than that of the malignant pleural effusion group(P<0.05).ROC curve analysis revealed that the EI value had high accuracy in distinguishing exudate from leaking fluid(the area under the curve is 0.856),and the optimal cut-off value was-50.95,with a sensitivity of 80.0%and specificity of 83.3%.The area under the curve of the EI+TP+LDH value for distinguishing benign and malignant pleural effusion was 0.736,and the optimal cut-off was 89.10,with a sensitivity of 98.4%and a specificity of 46.6%.Conclusion The quantitative EI value of ultrasonic grey scale intensity has high diagnostic value in distinguishing pleural effusion from exudate or leakage.The EI+TP+LDH value has a moderate ability to identify benign and malignant pleural effusion.