肺部超声是否能取代胸部X线检查?一项前瞻性多中心研究  

Can lung ultrasound replace the chest X-ray?A prospective multicenter study

作　　者：曲洋明 司姝宇 孙慧清[2] 陈平洋[3] 张谦慎 马莉[5] 尹兆青 肖敏[7] 汪吉梅[8] 高喜容[9] 刘玲[10] 冯晋兴[11] 朱艳萍[12] 金笛 张静[1] Shoo K.Lee 武辉[1] Qu Yangming;Si Shuyu;Sun Huiqing;Chen Pingyang;Zhang Qianshen;Ma Li;Yin Zhaoqing;Xiao Min;Wang Jimei;Gao Xirong;Liu Ling;Feng Jinxing;Zhu Yanping;Jin Di;Zhang Jing;Shoo K.Lee;Wu Hui(Department of Neonatology,The First Hospital of Jilin University,Changchun 130012,China;Department of Neonatology,Affiliated Children′s Hospital of Zhengzhou University,Zhengzhou 450066,China;Department of Neonatology,The Second Xiangya Hospital of Central South University,Changsha 410008,China;Department of Neonatology,The University of Hong Kong-Shenzhen Hospital,Shenzhen 518058,China;Department of Neonatology,Children′s Hospital of Hebei Province,Shijiazhuang 050031,China;Department of Neonatology,People′s Hospital of Dehong Dai and Jingpo Autonomous Region,Yunnan Province,Dehong Dai and Jingpo Autonomous Region 678499,China;Department of Neonatology,Cangzhou Central Hospital,Cangzhou 061017,China;Department of Neonatology,Maternity Hospital of Fudan University,Shanghai 200433,China;Department of Neonatology,Hunan Children′s Hospital,Changsha 410007,China;Department of Neonatology,Guiyang Maternal and Child Health Hospital,Guiyang 550003,China;Department of Neonatology,Shenzhen Children′s Hospital,Shenzhen 518034,China;Department of Neonatology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;The Maternal Infant Care Research Center(MiCARE),Mount Sinai Hospital,Toronto M5G 1X5,Canada)

机构地区：[1]吉林大学第一医院新生儿科,长春130012 [2]郑州大学附属儿童医院新生儿科,450066 [3]中南大学湘雅二医院新生儿科,长沙410008 [4]香港大学深圳医院新生儿科,518058 [5]河北省儿童医院新生儿科,石家庄050031 [6]云南省德宏傣族景颇族自治州人民医院新生儿科,678499 [7]沧州市中心医院新生儿科,061017 [8]复旦大学附属妇产科医院新生儿科,上海200433 [9]湖南省儿童医院新生儿科,长沙410007 [10]贵阳市妇幼保健院新生儿科,550003 [11]深圳市儿童医院新生儿科,518034 [12]新疆医科大学第一附属医院新生儿科,乌鲁木齐830011 [13]加拿大西奈山医院母婴健康研究中心,多伦多M5G 1X5

出　　处：《中国小儿急救医学》2023年第11期834-839,共6页Chinese Pediatric Emergency Medicine

基　　金：吉林省科技厅科研基金项目(20190701050GH)。

摘　　要：目的分析肺部超声和胸部X线在新生儿肺部疾病诊断中的准确性。方法前瞻性地纳入2019年6月至2020年4月全国12个新生儿重症监护病房需要进行胸部X线检查以诊断肺部疾病的新生儿。每例新生儿在接受胸部X线检查后的2 h内接受肺部超声检查。所有的胸部X线和肺部超声图像分别在不了解临床病史的情况下由放射科医师和超声医师独立判读。当胸部X线和肺部超声结果存在分歧时,由两名有经验的医师组成的专家组根据临床病史、胸部X线和肺部超声图像做出最终诊断。结果共有1100例新生儿参与了本研究。胸部X线和肺部超声之间的诊断一致性较差(Cohen′s kappa系数=0.347)。肺部超声在诊断湿肺(曲线下面积0.778,95%CI 0.753~0.803)时诊断价值明显优于胸部X线(曲线下面积0.513,95%CI 0.483~0.543)(P<0.001)。肺部超声和胸部X线对新生儿呼吸窘迫综合征、肺炎、胎粪吸入综合征和新生儿肺不张的诊断准确性相似。结论肺部超声做为一种低成本、简单、无辐射的辅助检查方法,诊断准确率接近或优于胸部X线,可替代胸部X线诊断新生儿肺部疾病。需要注意的是,胸部X线和肺部超声都应结合病史和临床表现来使用。Objective To analyze the accuracy of lung ultrasound and chest X-ray in the diagnosis of neonatal pulmonary disease.Methods We prospectively collected newborns that needed chest X-ray examination to diagnose pulmonary disease from twelve neonatal intensive care units across the country between June 2019 and April 2020.Each newborn was examined by lung ultrasound within two hours after chest X-ray examination.All chest X-ray and lung ultrasound images were independently read by a radiologist and a sonographer.When there was a disagreement,a panel of two experienced physicians made a final diagnosis based on the clinical history,chest X-ray and lung ultrasound images.Results A total of 1100 newborns were enrolled in our study.The diagnostic agreement between chest X-ray and lung ultrasound(Cohen′s kappa coefficient=0.347)was fair.Lung ultrasound(area under the curve=0.778;95%CI 0.753-0.803)performed significantly better than chest X-ray(area under the curve=0.513;95%CI 0.483-0.543)in the diagnosis of transient tachypnea of the newborn(P<0.001).The accuracy of lung ultrasound in diagnosing neonatal respiratory distress syndrome,meconium aspiration syndrome,pneumonia and neonatal pulmonary atelectasis was similar to that of chest X-ray.Conclusion Lung ultrasound,as a low-cost,simple and radiation-free auxiliary examination method,has a diagnostic accuracy close to or even better than that of chest X-ray,which may replace chest X-ray in the diagnosis of some neonatal lung diseases.It should be noted that both chest X-ray and lung ultrasound can only be used as auxiliary means for the diagnosis of lung diseases,and it is necessary to combine imaging with the clinical history and presentation.

关 键 词：肺超声 胸部X线 诊断 

分 类 号：R722.1[医药卫生—儿科] R445.1[医药卫生—临床医学]