超声肺实变在儿童重症社区获得性肺炎中的应用

doi:10.3877/cma.j.issn.1674-6902.2021.03.006

目的

探讨超声肺实变在儿童重症社区获得性肺炎(CAP)中的应用价值。

方法

筛选上海交通大学医学院附属仁济医院南院儿科2018年5月至2019年10月期间确诊CAP的121例住院患儿进行回顾性分析，根据病情将其分为重症组和普通组，对两组患儿的临床资料和实验室指标进行组间单因素分析，并进一步多因素Logistic回归分析。

结果

单因素分析结果显示，两组患儿在发热天数、住院天数、超声肺实变横轴、纵轴、矢状轴尺寸、病灶数目以及中性粒细胞百分比NEU%、C反应蛋白(CRP)、D-二聚体(D-D)、乳酸脱氢酶(LDH)水平的差异有统计学意义(P<0.05)。采用Pearson或Spearman系数相关性分析，发现肺实变横轴、纵轴、矢状轴尺寸大小均与发热天数、住院天数、NEU%、CRP、D-D呈一定正相关(P<0.05)。矢状轴与LDH呈正相关性(P<0.05)。多因素Logistic回归分析显示，横轴尺寸、矢状轴尺寸、多发肺实变及发热天数是儿童重症CAP的危险因素。结果显示超声实变的横轴、纵轴、矢状轴尺寸大小的曲线下面积为0.857、0.806和0.826，取敏感度、特异度之和的最高值所对应的截断值分别为29.5 mm、23.5 mm和25.5 mm，对重症CAP的诊断有一定参考价值。

结论

超声肺实变大小及数目与CAP病情有一定相关性，且对识别重症CAP具有一定的参考价值。

关键词: 肺部超声, 重症社区获得性肺炎, 炎症, 肺实变

Objective

To investigate the application value of ultrasound lung consolidation in severe community acquired pneumonia (CAP) in children.

Method

The clinical data of 121 children with CAP were analyzed from May 2018 to October 2019 retrospectively. According to the severity of pneumonia was divided into severe group and normal group. The univariate analysis of clinical and laboratory parameters was performed between two groups. Then the multifactor logistic regression was performed further.

Results

The results of univariate analysis showed that there were statistically significant differences in fever days, length of stay, the number of lesions, the percentage of neutrophils, CRP, D-dimer, LDH between the two groups (P<0.05). Pearson or Spearman coefficient correlation analysis showed that the size of the transverse and longitudinal sagittal axes of lung consolidation was positively correlated with fever days, hospital days, NEU%, CRP and D-D (P<0.05). In addition, sagittal axis was positively correlated with LDH(P<0.05). The multifactor Logistic regression showed that transverse axis size, sagittal axis size, multiple pulmonary consolidation) and fever days were risk factors for severe CAP in children. Vertical and sagitar axes of ultrasonic consolidation were 0.857, 0.806 and 0.826, and When the cut-off value corresponding to the highest value of the sum of sensitivity and specificity was 29.5 mm, 23.5 mm and 25.5 mm, respectively CAP, It has certain reference value for the diagnosis of severe CAP.

Conclusion

The size and number of lung consolidation are correlated with the condition of CAP, and have certain reference value for identification of severe CAP.

Key words: Lung ultrasound, Severe community acquired pneumonia, Inflammation, Lung consolidation

表1 两组患儿基线资料、实验室指标和超声表现比较

临床资料	重症组(n＝52)	普通组(n＝69)	T/Z/χ²	P值
年龄(岁)	6.18±3.30	5.40±3.13	1.801	0.073
男/女(n)	20/32	30/39	0.717	0.397
发热天数(d)	6.77±1.97	3.63±2.5	10.090	0.000
住院时间(d)	8.55±1.89	7.05±1.67	6.239	0.015
横轴(mm)	47.07±17.31	23.64±14.86	10.889	0.000
纵轴(mm)	34.10±19.75	15.24±11.97	8.195	0.000
矢状轴(mm)	33.93±15.75	15.96±10.96	8.195	0.000
多发病灶[(%)]	37.9	22.9	5.988	0.014
双侧病变[(%)]	12.6	10.7	0.205	0.651
WBC(×10⁹/L)	6.63±2.11	9.14±4.93	5.194	0.000
NEU%	60.66±11.60	55.70±15.47	2.742	0.007
CRP(mg/L)	14.78(8.23，31.59)	8.02(3.21，19.78)	4.106	0.000
PCT(μg/L)	0.12(0.09，0.18)	0.11(0.07，0.19)	0.554	0.580
LDH(U/L)	312.92±136.13	280±53.77	2.203	0.030
D-D(mg/L)	0.59(0.44，0.89)	0.40(0.26，0.65)	4.524	0.000

表1 两组患儿基线资料、实验室指标和超声表现比较

临床资料	重症组(n＝52)	普通组(n＝69)	T/Z/χ²	P值
年龄(岁)	6.18±3.30	5.40±3.13	1.801	0.073
男/女(n)	20/32	30/39	0.717	0.397
发热天数(d)	6.77±1.97	3.63±2.5	10.090	0.000
住院时间(d)	8.55±1.89	7.05±1.67	6.239	0.015
横轴(mm)	47.07±17.31	23.64±14.86	10.889	0.000
纵轴(mm)	34.10±19.75	15.24±11.97	8.195	0.000
矢状轴(mm)	33.93±15.75	15.96±10.96	8.195	0.000
多发病灶[(%)]	37.9	22.9	5.988	0.014
双侧病变[(%)]	12.6	10.7	0.205	0.651
WBC(×10⁹/L)	6.63±2.11	9.14±4.93	5.194	0.000
NEU%	60.66±11.60	55.70±15.47	2.742	0.007
CRP(mg/L)	14.78(8.23，31.59)	8.02(3.21，19.78)	4.106	0.000
PCT(μg/L)	0.12(0.09，0.18)	0.11(0.07，0.19)	0.554	0.580
LDH(U/L)	312.92±136.13	280±53.77	2.203	0.030
D-D(mg/L)	0.59(0.44，0.89)	0.40(0.26，0.65)	4.524	0.000

表2 肺实变大小与临床及实验室指标相关性分析(r，P)

因　素	横轴(mm)	纵轴(mm)	矢状轴(mm)
发热天数(d)	(0.293, 0.000)	(0.253, 0.000)	(0.281，0.000)
住院时间(d)	(0.298, 0.000)	(0.219, 0.000)	(0.339，0.000)
WBC(×10⁹/L)	(-0.136，0.043)	(-0.198, 0.003)	(-0.185，0.005 )
NEU%	(0.241，0.000)	(0.250, 0.000)	(0.166, 0.013)
CRP(mg/L)	(0.264, 0.000)	(0.234, 0.001)	(0.256, 0.000)
LDH(U/L)	(0.128, 0.058)	(0.045, 0.516)	(0.161, 0.017)
D-D(mg/L)	(0.224, 0.002)	(0.194, 0.007)	(0.238, 0.000)

表2 肺实变大小与临床及实验室指标相关性分析(r，P)

因　素	横轴(mm)	纵轴(mm)	矢状轴(mm)
发热天数(d)	(0.293, 0.000)	(0.253, 0.000)	(0.281，0.000)
住院时间(d)	(0.298, 0.000)	(0.219, 0.000)	(0.339，0.000)
WBC(×10⁹/L)	(-0.136，0.043)	(-0.198, 0.003)	(-0.185，0.005 )
NEU%	(0.241，0.000)	(0.250, 0.000)	(0.166, 0.013)
CRP(mg/L)	(0.264, 0.000)	(0.234, 0.001)	(0.256, 0.000)
LDH(U/L)	(0.128, 0.058)	(0.045, 0.516)	(0.161, 0.017)
D-D(mg/L)	(0.224, 0.002)	(0.194, 0.007)	(0.238, 0.000)

表3 重症CAP影响因素的多因素分析

因　素	B值	Wald值	P值	OR	95%CI
横轴(mm)	0.079	14.338	<0.001	1.082	1.039～1.127
矢状轴(mm)	0.071	11.673	<0.001	1.074	1.031～1.118
多发病灶	1.487	6.634	0.010	4.423	1.427～13.713
发热天数(d)	0.731	25.167	<0.001	2.077	1.561～2.764

表3 重症CAP影响因素的多因素分析

因　素	B值	Wald值	P值	OR	95%CI
横轴(mm)	0.079	14.338	<0.001	1.082	1.039～1.127
矢状轴(mm)	0.071	11.673	<0.001	1.074	1.031～1.118
多发病灶	1.487	6.634	0.010	4.423	1.427～13.713
发热天数(d)	0.731	25.167	<0.001	2.077	1.561～2.764

1	Walter J, Haller S, Quinten C, et al. Healthcare-associated pneumonia in acute care hospitals in european union/european economic area countries: an analysis of data from a point prevalence survey, 2011 to 2012[J]. Euro Surveill, 2018, 23(32): 1700843.
2	Von der Weid L, Gehri M, Camara B, et al. Clinical signs of hypoxaemia in children aged 2 months to 5 years with acute respiratory distress in switzerland and senegal[J]. Paediatr Int Child Health, 2018, 38(2): 113-120.
3	Maya HS, Mamadou D, Sabeena S, et al. Emergency department resource use in pediatric pneumonia: point-of-care lung ultrasonography versus chest radiography[J]. J Ultrasound Med, 2019, 38(2): 407-414.
4	Iorio G, Capasso M, Giuseppe DL, et al. Lung ultrasound in the diagnosis of pneumonia in children: proposal for a new diagnostic algorithm[J]. Peer J, 2015, 10(3): e1374.
5	Alzahrani SA, Al-Salmah MA, Al-Madani WH, et al. Systematic Review and Meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia[J]. Crit Ultrasound J, 2017, 9(1): 6.
6	Pereda MA, Chavez MA, Hooper-Miele CC, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis[J]. Pediatrics, 2015, 135(4): 714-722.
7	Liu J, Liu F, Liu Y, et al. Lung Ultrasonography for the diagnosis of severe neonatal pneumonia[J]. Chest, 2014, 146(2): 383-388.
8	Musolino AM, Paolo T, Supino MC, et al. Lung ultrasound features of children with complicated and noncomplicated community acquired pneumonia: A prospective study [J]. Pediatric Pulmonology, 2019, 54(9): 1479-1486.
9	中华人民共和国国家健康委员会，国家中医药局. 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志，2019, 12(1): 6-13.
10	中国医药教育协会超声医学专业委员会重症超声学组. 感染性肺炎超声诊断专家建议[J/CD]. 中华医学超声杂志(电子版), 2020, 17(3): 244-250.
11	Ma Y, Guo S, Wang HS, et al. Cause of death among infants in rural Western China: a community-based study using verbal autopsy[J]. J Pediatr, 2014, 165(3): 577-584.
12	Rudan C, Boschi-Pinto Z, Biloglav K, et al. Epidemiology and etiology of childhood pneumonia[J]. Bull World Health Organ, 2008, 86(5): 408-416.
13	Najgrodzka P, Buda N, Zamojska Anna. Lung Ultrasonography in the diagnosis of pneumonia in Children-A Meta analysis and a review of pediatric lung imaging[J]. Ultrasound Q, 2019, 35(2): 157-163.
14	Shah SN, Bachur RG, Simel DL, et al. Does this child have pneumonia? The rational clinical examination systematic review[J]. JAMA, 2017, 318: 462-471.
15	Ellington LE, Gilman RH, Chavez MA, et al. Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings[J]. Respir Med, 2017, 128: 57-64.
16	Yilmaz HL, Ozkaya AK, Sari GS, et al. Point-of-care lung ultrasound in children with community acquired pneumonia[J]. Am J Emerg Med, 2017, 35: 964-969.
17	于红奎，刘　晓，陈嘉坤，等. 肺超声评分对儿童重症肺炎定量评估及预后判断的价值[J]. 中国超声医学杂志，2019, 35(3): 229-231.
18	周忠霞，王　霆，王　辉. 乳酸脱氢酶在成人社区获得性肺炎严重程度诊断中的价值[J]. 临床肺科杂志，2017, 22(6): 1026-1029.
19	Chalmers JD, Singanayagam A, Scally C, et al. Admission D-dimer can identify low-risk patients with community-acquired pneumonia[J]. Ann Emerg Med, 2009, 53(5): 633-638.
20	黄宏佳，罗海清，郑文枝，等. 血浆D-二聚体、C反应蛋白水平及白细胞计数在评价社区获得性肺炎严重程度及预后中的价值[J]. 中国实用医药，2017, 12(20): 26-28.
21	Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children [J]. Radiol Med, 2008, 113(2): 190-198.
22	Urbankowska E, Katarzyna K, ukasz D, et al. Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children[J]. Respir Med, 2015, 109(9): 1207-1212.

[1]	韩圣瑾, 周正武, 翁云龙, 黄鑫. 碳酸氢钠林格液联合连续性肾脏替代疗法对创伤合并急性肾损伤患者炎症水平及肾功能的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 376-381.
[2]	魏徐, 张鸽, 伍金林. 新生儿脓毒症相关性凝血病的监测和治疗[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 379-386.
[3]	陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[4]	贾成朋, 王代宏, 陈华, 孙备. 可切除性胰腺癌预后术前预测模型的建立及应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 566-570.
[5]	伍学成, 李远伟, 袁武雄, 王建松, 石泳中, 卢强, 李卓, 陈佳, 刘哲, 滕伊漓, 高智勇. 炎症介质谱联合降钙素原在尿源性脓毒血症中的诊断价值[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 476-480.
[6]	王可, 范彬, 李多富, 刘奎. 两种疝囊残端处理方法在经腹腹膜前腹股沟疝修补术中的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 692-696.
[7]	许磊, 孙杰, 陈先志, 张家泉, 李旺勇, 冯其柱, 王琦. 血液净化治疗在高血脂性重症胰腺炎中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 464-468.
[8]	苗软昕, 乔晞. Toll样受体在脓毒症性急性肾损伤中的作用[J]. 中华肾病研究电子杂志, 2023, 12(04): 210-214.
[9]	郝然, 魏姗珊, 吴倩如, 李学民, 翟长斌. 干燥综合征血清微量元素变化及其与疾病严重程度的相关性研究[J]. 中华眼科医学杂志(电子版), 2023, 13(04): 215-220.
[10]	邹勇, 顾应江, 丁昊, 杨呈浩, 陈岷辉, 蔡昱. 基于Nrf2/HO-1及NF-κB信号通路探讨葛根素对大鼠脑出血后早期炎症反应及氧化应激反应的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 271-277.
[11]	屈霄, 王靓, 陆萍, 何斌, 孙敏. 外周血炎症因子及肠道菌群特征与活动性溃疡性结肠炎患者病情的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 466-470.
[12]	朱风尚, 舍玲, 丁永年, 杨长青. 警惕炎症性肠病与少见肠道疾病的鉴别诊断[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 273-276.
[13]	张赟辉, 罗军, 刘栗丽, 汪宏, 耿克明. 腹膜透析与血液透析对老年终末期肾病患者营养状况及炎症反应的影响[J]. 中华临床医师杂志(电子版), 2023, 17(04): 419-423.
[14]	刘感哲, 艾芬. MiRNA-210通过抑制HIF-1α的表达改善大鼠血管性认知功能障碍[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 489-494.
[15]	刘天姿, 王宝军. Toll样受体4在阿尔茨海默病中的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 404-409.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Application value of ultrasound lung consolidation in severe community acquired pneumonia in children

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Application value of ultrasound lung consolidation in severe community acquired pneumonia in children