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中华肺部疾病杂志(电子版) ›› 2021, Vol. 14 ›› Issue (03) : 293 -296. doi: 10.3877/cma.j.issn.1674-6902.2021.03.006

论著

超声肺实变在儿童重症社区获得性肺炎中的应用
苗小倩1, 张碧玉1, 李亚琴1, 李小燕1, 于清1, 卢燕鸣1,†()   
  1. 1. 201112　上海，上海交通大学医学院附属仁济医院南院儿科
  • 收稿日期:2020-12-15 出版日期:2021-06-25
  • 通信作者: 卢燕鸣

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

Xiaoqian Miao1, Biyu Zhang1, Yaqin Li1, Xiaoyan Li1, Qing Yu1, Yanming Lu1,†()   

  1. 1. Department of Pediatric, South campus of Ren Ji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 201112, China
  • Received:2020-12-15 Published:2021-06-25
  • Corresponding author: Yanming Lu
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苗小倩, 张碧玉, 李亚琴, 李小燕, 于清, 卢燕鸣. 超声肺实变在儿童重症社区获得性肺炎中的应用[J]. 中华肺部疾病杂志(电子版), 2021, 14(03): 293-296.

Xiaoqian Miao, Biyu Zhang, Yaqin Li, Xiaoyan Li, Qing Yu, Yanming Lu. Application value of ultrasound lung consolidation in severe community acquired pneumonia in children[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(03): 293-296.

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
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