肺部超声在儿童社区获得性肺炎中的诊断价值研究

doi:10.3760/cma.j.cn112140-20231201-00403

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题名	肺部超声在儿童社区获得性肺炎中的诊断价值研究
其他题名	The diagnostic value of lung ultrasound in children with community-acquired pneumonia
作者	蔡书静; 张乐乐; 陈思悦; 朱婷婷; 徐铭; 郑仰明; 张海邻
发表日期	2024-04-02
发表期刊	中华儿科杂志影响因子和分区
语种	中文
原始文献类型	Periodical
关键词	超声检查肺社区获得性肺炎儿童
其他关键词	Ultrasonography ; Lung ; Community-acquired pneumonia ; Child
摘要	目的:探讨肺部超声在儿童社区获得性肺炎（CAP）中的诊断价值。方法:横断面研究，收集2021年2月至2022年8月温州医科大学附属第二医院育英儿童医院儿童呼吸科因CAP住院且入院后48 h内完成肺部超声检查的422例患儿的临床特征、肺部超声和胸部CT等资料，对接受胸部CT检查的患儿按CT有无肺炎征象分为两组，用最小绝对收缩和选择算子（Lasso）回归筛选出有诊断价值的肺部超声征象。按病情分为重症组和轻症组，比较两组患儿肺部超声征象差异。组间比较选择Kruskal-Wallis检验、Fisher确切概率法。运用随机森林分类器评估肺部超声在儿童CAP诊断和重症肺炎预测中的价值。使用受试者工作特征曲线评价预测效果。使用DeLong检验比较曲线下面积。结果:422例CAP患儿中男258例、女164例，发病年龄2.8（1.3，4.3）岁。肺部超声融合B线、实变、胸腔积液检出例数分别为309例（73.2%）、232例（55.0%）、16例（3.8%），实变大小3.0（0，11.0）mm。110例（26.1%）CAP患儿完成胸部CT检查，肺炎征象组90例，无肺炎征象组20例。Lasso回归筛选出肺实变（ OR=2.46）、双侧肺实变（ OR=1.16）及融合B线（ OR=1.34）3个变量，随机森林模型全参数和筛选后参数模型准确度分别为0.79（95% CI 0.70~0.86）和0.79（95% CI 0.70~0.86），曲线下面积分别为0.87（95% CI 0.81~0.94， P<0.001）和0.84（95% CI 0.76~0.91， P<0.001），灵敏度均为0.81，特异度分别为0.75和0.70。重症组97例、轻症组325例。重症组实变、多发实变、实变大小、体表面积调整后的实变大小（实变大小/体表面积）均高于轻症组［66例（68.0%）比166例（51.1%），42例（43.3%）比93例（28.6%），8.0（0，17.0）比1.0（0，9.0）mm，12.5（0，24.6）比2.1（0，17.6）， χ2=8.59、9.98， Z=14.40、12.79，均 P<0.05］。利用肺部超声肺实变大小和实变大小/体表面积预测重症CAP的最佳截断值分别为6.7 mm和10.2，准确度为0.80（95% CI 0.75~0.83）和0.89（95% CI 0.86~0.92），曲线下面积为0.66（95% CI 0.60~0.72， P<0.001）和0.76（95% CI 0.70~0.83， P<0.001），灵敏度均为0.99，特异度为0.14和0.56。实变大小/体表面积的曲线下面积高于实变大小（ Z=5.50， P<0.001）。结论:实变和融合B线是肺部超声诊断儿童CAP的重要征象。实变大小/体表面积预测重症CAP的价值优于单纯实变大小。
其他摘要	Objective:To investigate the diagnostic value of lung ultrasound in hospitalized children with community-acquired pneumonia (CAP).Methods:In the cross-sectional study, a total of 422 children with CAP who were hospitalized in the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, from February 2021 to August 2022 and completed lung ultrasound examination within 48 hours after admission were enrolled. The clinical characteristics, lung ultrasound and chest CT were collected. The patients were divided into two groups according to the signs of pneumonia indicated by chest CT, and the signs of lung ultrasound with diagnostic value were screened according to the signs of pneumonia indicated by chest CT by least absolute shrinkage and selection operator (Lasso) regression. According to severity of the disease, the children were divided into the severe group and the mild group, and the differences of lung ultrasound signs between the two groups were compared. Kruskal-Wallis test, Fisher′s exact test was selected for comparison between groups. Random forest classifier wes used to evaluate the value of lung ultrasound in the diagnosis of CAP and prediction of severe pneumonia in children. The receiver operating characteristic curve was used to evaluate the prediction effect. Use DeLong test to compare the area under the curve.Results:Among the 422 cases of CAP, there were 258 males and 164 females, and the age of onset was 2.8 (1.3, 4.3) years. The confluent B-line, consolidation and pleural effusion detected by lung ultrasound were 309 cases (73.2%), 232 cases (55.0%) and 16 cases (3.8%), respectively, and the size of consolidation was 3.0 (0, 11.0) mm. One hundred and ten children (26.1%) with CAP completed chest CT. There were 90 cases with signs of pneumonia in chest CT and 20 cases without signs of pneumonia. Lasso was used for feature selection.Lung consolidation ( OR=2.46), bilateral lung consolidation ( OR=1.16) and confluent B-line ( OR=1.34) were the main index. With random forest classifier, the accuracy of models using full variables and Lasso-selected variables were 0.79 (95% CI 0.70-0.86) and 0.79 (95% CI 0.70-0.86), the sensitivity were 0.81 and 0.81, and the specificity were 0.75 and 0.70, and the area under curve were 0.87 (95% CI 0.81-0.94, P<0.001) and 0.84 (95% CI 0.76-0.91, P<0.001), respectively. There were 97 cases in severe group and 325 cases in mild group. Compared with the mild group, the detection rate of consolidation, multiple consolidation, the size of consolidation and the size of consolidation was adjusted by body surface area (consolidation size/body surface area) in severe group were higher (66 cases (68.0%) vs. 166 cases (51.1%), 42 cases (43.3%) vs. 93 cases (28.6%), 8.0 (0, 17.0) vs. 1.0 (0, 9.0) mm, 12.5 (0, 24.6) vs. 2.1 (0, 17.6), χ2=8.59, 9.98, Z=14.40, 12.79, all P<0.05). Using lung ultrasound lung consolidation size and consolidation size/body surface area to predict the severe CAP, the optimal cut-off value were 6.7 mm and 10.2, the accuracy was 0.80 (95% CI 0.75-0.83) and 0.89 (95% CI 0.86-0.92), the sensitivity was 0.99 and 0.99, the specificity was 0.14 and 0.56, respectively, and the area under the curve was 0.66 (95% CI 0.60-0.72, P<0.001) and 0.76 (95% CI 0.70-0.83, P<0.001), respectively. The area under the curve of consolidation size/body surface area was higher than that of consolidation size ( Z=5.50, P<0.001). Conclusions:Consolidation and confluent B-line, are important index for lung ultrasound diagnosis of CAP in children. The actual consolidation size adjusted by body surface area is superior to the size of consolidation in predicting severe CAP.
ISSN	0578-1310
卷号	62 期号:4 页码:331-336
DOI	10.3760/cma.j.cn112140-20231201-00403
页数	6
收录类别	万方 ; 维普 ; CSCD ; ISTIC ; 北大核心
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引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/211334
专题	第二临床医学院、附属第二医院、育英儿童医院附属第二医院附属第二医院_新生儿科附属第二医院_儿童呼吸科
作者单位	温州医科大学附属第二医院　育英儿童医院儿童呼吸科，温州　325027蔡书静现在金华市妇幼保健院新生儿科，金华　321000
第一作者单位	附属第二医院; 第二临床医学院，附属第二医院、育英儿童医院; 新生儿科; 儿童呼吸科
第一作者的第一单位	附属第二医院
推荐引用方式 GB/T 7714	蔡书静,张乐乐,陈思悦,等. 肺部超声在儿童社区获得性肺炎中的诊断价值研究[J]. 中华儿科杂志,2024,62(4):331-336.
APA	蔡书静., 张乐乐., 陈思悦., 朱婷婷., 徐铭., ... & 张海邻. (2024). 肺部超声在儿童社区获得性肺炎中的诊断价值研究. 中华儿科杂志, 62(4), 331-336.
MLA	蔡书静,et al."肺部超声在儿童社区获得性肺炎中的诊断价值研究".中华儿科杂志 62.4(2024):331-336.