肺超声评分联合生化指标在小儿重症肺炎诊断中的评估价值  

Evaluation value of lung ultrasound score combined with biochemical indexes in diagnosing severe pneumonia in children

作　　者：周进娥 文静 ZHOU Jin'e;WEN Jing(School of Medical Imaging,Guizhou Medical University,Guiyang 550004,Guizhou,China;Ultrasound Center,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学影像学院,贵州贵阳550004 [2]贵州医科大学附属医院超声中心,贵州贵阳550004

出　　处：《贵州医科大学学报》2025年第4期571-579,共9页Journal of Guizhou Medical University

基　　金：贵州省科技计划项目(黔科合基础-ZK〔2022〕一般440)。

摘　　要：目的分析肺超声(lung ultrasound,LUS)评分联合生化指标在小儿重症肺炎诊断中的评估价值。方法将154例肺炎患儿分为重症组(96例)和非重症组(58例),对比两组临床资料、LUS评分及生化指标差异,通过logistic回归筛选重症肺炎的危险因素,ROC曲线评估预测重症肺炎的效能。结果两组患者在年龄、起病症状(发热、咳嗽、咳痰、气促、肺部湿啰音)、并发症(心力衰竭)比较,差异有统计学意义(P<0.05);与非重症组比较,重症组LUS评分、肺泡动脉氧分压差、呼吸指数、血小板升高,氧分压、肌酐(Cr)、肌酸激酶(CK)降低(P<0.05);多因素分析显示,肺泡动脉氧分压差(OR=1.205)和LUS评分(OR=1.094)是独立危险因素;绘受试者工作曲线(ROC)曲线显示,LUS评分预测效能最佳[曲线下面积(AUC)=0.865,灵敏度93.8%],联合肺泡动脉氧分压差后AUC提升至0.875,灵敏度达99.0%。结论LUS能够准确识别出大部分的重症肺炎患儿,同时排除非重症患儿,LUS联合肺泡动脉氧分压差可进一步提高预测效能。Objective To analyze the evaluation value of lung ultrasound score(LUS)combined with biochemical indexes in diagnosing severe pneumonia in children.Methods A total of 154 children with pneumonia were divided into severe group(96 cases)and non-severe group(58 cases).The differences in clinical data,LUS,and biochemical indexes between two groups were compared.The risk factors of severe pneumonia were screened by logistic regression.ROC curve was used to evaluate the efficacy in predicting severe pneumonia.Results There were statistically significant differences in age,onset symptoms(fever,cough,sputum production,shortness of breath and pulmonary crackles)and complications(heart failure)between two groups(P<0.05).LUS,alveolar-arterial oxygen partial pressure difference,respiratory index and platelets in severe group were significantly higher than those in non-severe group(P<0.05),while the partial pressure of oxygen,creatinine(Cr),and creatinine kinase(CK)were significantly decreased(P<0.05).Multivariate analysis showed that alveolar-arterial oxygen partial pressure difference(OR=1.205)and LUS(OR=1.094)were independent risk factors.Receiver operating characteristic(ROC)curves revealed that LUS score had the best predictive performance(AUC=0.865,sensitivity 93.8%),and AUC was increased to 0.875 and the sensitivity reached 99.0%after combining alveolar-arterial oxygen partial pressure difference.Conclusion LUS can accurately identify most children with severe pneumonia and exclude children with non-severe pneumonia.The combination of LUS and alveolar-arterial oxygen partial pressure difference can further improve predictive efficiency.

关 键 词：肺超声检查 肺超声评分 重症肺炎 诊断 评估 

分 类 号：R445.1[医药卫生—影像医学与核医学] R725.1[医药卫生—诊断学]