肺超声A线伪像定性及定量新指标对肺气肿的诊断价值及特征分析  

The diagnostic value and characteristics of new qualitative and quantitative indicators of lung ultrasound A-line artifacts in emphysema

作　　者：赵浩天[1] 白杨 姚光耀 刘元琳 李丽[1] 薛红元[1] Zhao Haotian;Bai Yang;Yao Guangyao;Liu Yuanlin;Li Li;Xue Hongyuan(Department of Ultrasound,Hebei General Hospital,Hebei Province,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院超声科,石家庄050000 [2]河北省人民医院呼吸与危重症医学科,石家庄050000 [3]承德医学院附属医院超声科,承德067000

出　　处：《疑难病杂志》2023年第7期714-718,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究计划项目(20211264,20211228)。

摘　　要：目的分析肺超声A线的多种定性及定量新指标对肺气肿患者和健康肺的鉴别诊断价值。方法选取2021年12月—2022年8月于河北省人民医院诊断为肺气肿患者26例纳入肺气肿组,同期年龄相近的无肺疾病的受试者30例为健康对照组,对2组受试者进行肺超声检查,测量右侧前胸壁处胸膜线与第1条A线的垂直距离(dP-A1),第1、2条A线间的垂直距离(dA1-A2),测量右侧腋中线胸膜滑动度(PSD)和膈肌移动度(DD);切换M模式观察是否为“海岸征”或“平流层征”。绘制受试者工作特征曲线(ROC)分析各超声指标对肺气肿的诊断效能。结果肺气肿组的dP-A1、dA1-A2、PSD和DD显著低于健康对照组(t/U=4.631、4.435、4.264、2.038,P<0.01或0.05),肺气肿组M模式显示平流层征比例高于健康对照组(χ^(2)=9.231,P=0.002);dP-A1、dA1-A2、PSD和DD分别以17.7 mm、16.7 mm、12.13 mm和14.05 mm为截断值,诊断肺气肿的曲线下面积(AUC)值分别为0.790、0.787、0.833和0.659。结论肺超声对肺气肿具有良好的诊断价值,肺超声的A线间距和胸膜滑动度指标优于膈肌移动度指标。Objective To analyze the value of various qualitative and quantitative new indicators of lung ultrasound A-line in the differential diagnosis of Emphysema patients and healthy lungs.Methods From December 2021 to August 2022,26 patients diagnosed as Emphysema in the People's Hospital of Hebei Province were included in the Emphysema group,and 30 subjects with similar age and no lung disease in the same period were selected as the healthy control group.Two groups of subjects were examined by lung ultrasound,and the vertical distance between the pleural line at the right front chest wall and the first A-line(d P-A1),and the vertical distance between the first and second A-lines(d A1-A2)were measured,Measure the pleural sliding degree(PSD)and diaphragm movement degree(DD)of the right midaxillary line;Switch the M mode to observe whether it is a"coastal sign"or"stratospheric sign".Draw the receiver operating characteristic curve(ROC)to analyze the diagnostic efficacy of each ultrasonic index for Emphysema.Results The d P-A1,d A1-A2,PSD and DD in the Emphysema group were significantly lower than those in the healthy control group(t/U=4.631,4.435,4.264,2.038,P<0.01 or 0.05),with a higher proportion of stratospheric signs compared to the control group(χ^(2)=9.231,P=0.002);The cutoff values of d P-A1,d A1-A2,PSD and DD were 17.7 mm,16.7 mm,12.13 mm and 14.05 mm respectively,and the AUC values for diagnosis of Emphysema were 0.790,0.787,0.833 and 0.659 respectively.Conclusion Lung ultrasound has a good diagnostic value for Emphysema.The A-line spacing and pleural slip index of lung ultrasound are better than the index of diaphragm mobility.

关 键 词：肺气肿 肺超声 胸膜滑动症 A线间距 诊断 

分 类 号：R563.3[医药卫生—呼吸系统]