摘要
目的探讨肺动脉压力评分联合肺部超声评分早期诊断早产儿支气管肺发育不良(BPD)的临床价值。方法选取我院新生儿科收治的169例新生儿,根据BPD诊断标准分为BPD组92例和非BPD组77例,均于出生后4~7 d、8~14 d、15~21 d及22~28 d分别行超声心动图检测肺动脉压力变化,对出生后4~28 d肺动脉压力最大值进行评分;均于出生后24~28 d行肺部超声检查并进行肺部超声评分。应用单因素及多因素Logistic回归分析早期诊断BPD的预测因素;比较两组患儿临床资料和超声参数的差异;绘制受试者工作特征(ROC)曲线分析肺动脉压力评分联合肺部超声评分早期诊断BPD的效能;采用Kappa检验评价联合评分诊断结果与临床结果的一致性。结果单因素及多因素Logistic回归分析显示,肺动脉压力评分、肺部超声评分(胸膜粗糙肺野数、胸膜下实变和横膈粗糙改变)升高均是早期诊断BPD的预测因素(均P<0.05)。BPD组与非BPD组出生胎龄、出生体质量、肺动脉压力评分、肺部超声评分及联合评分比较,差异均有统计学意义(均P<0.01)。ROC曲线分析显示,肺动脉压力评分诊断BPD的曲线下面积为0.749(95%可信区间:0.675~0.823),截断值为1.5分;肺动脉压力评分联合肺部超声评分诊断BPD的曲线下面积为0.952(95%可信区间:0.925~0.980),截断值为4.0分,联合评分的曲线下面积高于肺动脉压力评分,差异有统计学意义(P<0.05)。联合评分诊断BPD与临床诊断结果的一致性好(Kappa=0.702,P<0.01)。结论肺动脉压力评分联合肺部超声评分在早期诊断早产儿BPD中具有重要的临床价值。
Objective To explore the clinical value of pulmonary artery pressure score combined with pulmonary ultrasound score in early diagnosis of bronchopulmonary dysplasia(BPD)in premature infants.Methods A total of 169 neonates admitted to the neonatal ward of our hospital were selected and divided into BPD group(92 cases)and non-BPD group(77 cases)according to the BPD diagnostic criteria.Echocardiography was performed to detect changes of pulmonary artery pressure at 4~7,8~14,15~21,and 22~28 d after birth,and the maximum value of pulmonary artery pressure was scored on day 4~28 after birth,ultrasonography of the lungs was performed on day 24~28 after birth and pulmonary ultrasound scores were performed.Univariate and multivariate Logistic regression was used to analyze the influencing factors of BPD,the differences of clinical data and ultrasound parameters were compared between the two groups,and the receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of pulmonary artery pressure score combined with pulmonary ultrasound score in early diagnosis of BPD.Kappa test was used to evaluate the consistency between combination score and clinical results.Results Both univariate and multivariate Logistic analysis showed that pulmonary artery pressure score and pulmonary ultrasound score(number of rough pleural lung field,subpleural consolidation and rough diaphragm)increased were influencing factors for BPD(all P<0.05).There were significant differences in gestational age,birth weight,pulmonary artery pressure score,pulmonary ultrasound score and combination score between BPD group and non-BPD group(all P<0.05).ROC curve analysis showed that area under the curve(AUC)of pulmonary artery pressure score in the diagnosis of BPD was 0.749(95%CI:0.675~0.823),and AUC of pulmonary artery pressure score combined with pulmonary ultrasound score in the diagnosis of BPD was 0.952(95%CI:0.925~0.980),the cutoff value were 1.5 for pulmonary artery pressure score and 4.0 for combination score,the AUC of combined score
作者
闫慧源
沈洁茹
周建国
陈超
孙颖华
YAN Huiyuan;SHEN Jieru;ZHOU Jianguo;CHEN Chao;SUN Yinghua(Department of Neonatology,Children’s Hospital of Fudan University,Shanghai 220958,China)
出处
《临床超声医学杂志》
CSCD
2023年第4期246-251,共6页
Journal of Clinical Ultrasound in Medicine
基金
国家自然科学基金项目(81801502)。
关键词
超声心动描记术
肺部超声
早产儿
支气管肺发育不良
Echocardiography
Pulmonary ultrasound
Premature infants
Bronchopulmonary dysplasia
