胃液稳定微泡实验早期诊断早产儿肺透明膜病价值探讨  

Investigation of the value of stable micro bubble test for early diagnosis of hyaline membrane disease in premature infants

作　　者：付扬喜[1] 唐振 欧阳志翠 程光清[1] 

机构地区：[1]陕西省安康市中心医院新生儿科,725000 [2]中南大学湘雅三医院新生儿科

出　　处：《天津医药》2017年第10期1068-1071,共4页Tianjin Medical Journal

摘　　要：目的探讨胃液稳定微泡实验(SMT)早期诊断早产儿肺透明膜病(HMD)的价值,为早期干预早产儿肺透明膜病提供临床诊断方法。方法选取2013年1月1日—2016年1月1日在我院新生儿重症监护病房(NICU)住院的288例早产儿作为研究对象,生后30 min内抽取初次胃液1~2 m L行SMT检查,低倍镜下数出每mm^2中直径<15μm的稳定微泡数,以临床症状及生后6 h内胸X线片结果作为诊断早产儿肺透明膜病的金标准,将早产儿分为病例组及对照组。比较2组一般资料情况,通过受试者工作特征(ROC)曲线确定诊断最佳临界稳定微泡数值。并分别以微泡数<5个/mm^2,<10个/mm^2,<15个/mm^2及<20个/mm^2作为界值,计算诊断HMD的敏感度、特异度、阳性预测值和阴性预测值。结果 288例早产儿中确诊为肺透明膜病者91例(31.6%),非肺透明膜病者197例(68.4%);病例组较对照组胎龄小、出生体质量低、男婴所占比例较高(P<0.05),2组产前激素使用、胎膜早破、剖宫产的比例以及5 min Apgar评分差异均无统计学意义;微泡数为15个/mm^2是诊断早产儿肺透明膜病最佳临界值,曲线下面积(AUC)为0.80(0.73~0.84)。以微泡数<5个/mm^2诊断新生儿肺透明膜病符合者最多,为38例;以10~15个/mm^2诊断新生儿肺透明膜病符合者16例。胃液微泡数<15个/mm^2预测早产儿肺透明膜病的敏感度、特异度、阳性预测值、阴性预测值及约登指数分别为89.0%、91.4%、82.7%、94.7%及80.4%,可作为预测HMD的指标。结论 SMT法简便、快速、经济,敏感度高,特异性好,能有效预测并早期诊断早产儿肺透明膜病,具备较高的临床应用价值。Objective To explore the value of stable micro bubble test(SMT) for early diagnosis of hyaline membranedisease(HMD), and to provide early intervention for clinical diagnosis method of hyaline membrane disease in prematureinfants. Methods A total of 288 premature infants admitted to neonatal intensive care unit(NICU) of Ankang City CentralHospital from January 1 st, 2013 to January 1 st, 2016 were involved into the study. The primary gastric juice 1-2 m L wasextracted for SMT test within 30 minutes after the birth. The number of the stable micro bubble with diameter < 15 μm wascounted by low magnification. The clinical symptoms and X-ray results within 6 h after the birth were used as the goldstandard of diagnosis of HMD. The premature infants were divided into the case group and control group. The generalinformation was compared between two groups. The optimal critical stable micro bubble value was determined by the ROCcurve. The number of micro bubbles <5/mm^2, <10/mm^2, <15/mm^2 and <20/mm^2 were used as the threshold, and thesensitivity, specificity, positive and negative predictive values were calculated for HMD diagnosis. Results Among the 288 cases of premature infants, 91 cases(31.6%) were diagnosed as HMD, 197 cases(68.4%) were diagnosed as non HMD.There were lower gestational age, lower birth weight and more proportion of male babies in the case group compared withthose of control group(P<0.05). There were no significant differences in prenatal usage of hormones, premature rupture ofmembranes, the proportion of cesarean section and 5-min Apgar scores between two groups. The number of micro bubbles of15/mm^2 was the optimal threshold for diagnosis of HMD, and AUC was 0.80(0.73-0.84). When the number of micro bubblesof 5/mm^2 was used for the diagnosis, 38 cases were in line with the diagnosed as HMD. When the number of micro bubbles of10-15/mm^2 was used for the diagnosis, 16 cases were in line with diagnosed as HMD. The number of micro bubbles of <15/mm^2 was used as boundary value of HMD. The sensitivi

关 键 词：透明膜病 婴儿 早产 疾病 肺疾病 早期诊断 ROC曲线 胃液稳定微泡实验 

分 类 号：R722.6[医药卫生—儿科]