摘要
目的建立并验证用于急性呼吸窘迫综合征(ARDS)诊断的肺部超声(LUS)-ARDS评分模型,并将其性能与胸部CT比较。方法回顾性将2019年3月至2023年3月马鞍山市人民医院急诊或ICU收治的325例接受有创呼吸机治疗的患者按照3∶1的比例分别纳入训练集243例和验证集82例,以专家团队诊断结果为“参考”,将患者分为ARDS组(训练集63例,验证集37例)和非ARDS组(训练集180例,验证集45例),患者均接受LUS检查,检查方法为肺部12分区法,然后采用Logistic回归模型构建LUS-ARDS评分系统,采用受试者工作特征(ROC)曲线分析LUS-ARDS评分对ARDS的诊断效能,获得诊断截断值,并计算曲线下面积(AUC)。结果243例(26.03%)ARDS和82例(45.12%)ARDS患者分别被纳入训练集和验证集;将肺左侧LUS通气评分、肺右侧LUS通气评分和前外侧胸膜线异常数构建LUS-ARDS评分为LUS-ARDS评分=LUS-ARDS评分=2.6×左侧LUS通气评分+1×右侧LUS通气评分+3.4×前外侧区域胸膜线异常数,该评分系统在训练集中的ROC曲线下面积(AUC)为0.90(95%CI:0.85~0.95),验证集中的ROC的AUC为0.85(95%CI:0.77~0.93);在有胸部CT的患者中,LUS-ARDS评分的ROC的AUC为0.85(95%CI:0.78~0.90)。结论LUS-ARDS评分可用于准确诊断ARDS,其可能是诊断ARDS的一个有用的辅助工具。其诊断性能与胸部CT(金标准)相当。
Objective To develop and validate a lung ultrasound(LUS)-acute respiratory distress syndrome(ARDS) score model for diagnosis of ARDS and compare its performance with that of chest CT.Methods A total of 325 patients who received invasive ventilator treatment in the emergency department or ICU of Ma'anshan People's Hospital from March 2019 to March 2023 were included in this retrospective study,and then were divided into the training set 243 cases and the validation set 82 cases at a ratio of 3∶1.With the diagnosis results of the expert team as the "reference",the patients were divided into the ARDS group(63 cases in the training set,37 cases in the validation set)and the non ARDS group(180 cases in the training set,45 cases in the validation set).All patients received LUS examination and the examination method was the lung 12 partition method,and then the Logistic regression model was used to build the LUS-ARDS scoring system.The diagnostic efficacy of LUS-ARDS score on ARDS using ROC was analyzed,and then obtain diagnostic cutoff values,and calculate the area under the curve(AUC).Results 233 cases(26.03%) ARDS and 82 cases(45.12%) ARDS were included in the training and validation sets,respectively.LUS-ARDS score was constructed by the left and right LUS aeration scores and anterolateral pleural line abnormalities,LUS-ARDS score=2.6×left LUS aeration score+1× right LUS aeration score +3.4× no.of anterolateral regions with an abnormalpleural line.LUS-ARDS score had an area under the receiver operating characteristic(ROC)curve of 0.90(95%CI:0.85-0.95) in the training set,and 0.85(95%CI:0.77-0.93).In patients with chest CT,the AUC of the LUS-ARDS score ROC was 0.85(95%CI:0.78-0.90).Conclusion The LUS-ARDS score can be used for accurate diagnosis of ARDS,and it may be a useful auxiliary tool for diagnosing ARDS.Its diagnostic performance is comparable to that of chest CT(gold standard).
作者
林海
姚明明
秦子文
付诗琳
汪红友
LIN Hai;YAO Ming-ming;QIN Zi-wen(Department of Emergency,Ma'anshan People's Hospital,Ma'anshan Anhui 243000,China)
出处
《临床和实验医学杂志》
2024年第3期249-253,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省医学会急诊医学临床研究项目(编号:Ky2021010)。
关键词
肺部超声
预测
急性呼吸窘迫综合征
诊断
Lung ultrasound
Prediction
Acute respiratory distress syndrome
Diagnosis
