Clinical values of lung ultrasound in diagnosis of acute lung injury/acute respiratory distress syndrome in full-term infants

doi:10.3877/cma.j.issn.1673-5250.2019.02.012

Objective

To evaluate the clinical values of lung ultrasound in diagnosis of acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) in full-term infants.

Methods

A total of 59 cases of full-term infants with ALI/ARDS who were admitted into the Department of Neonatology of Chengdu Women′s and Children′s Central Hospital were consecutively recruited into study group over a 30-month period from January 2016 to June 2018. And they were divided in ALI subgroup (n=21) and ARDS subgroup (n=38), respectively according to ALI or ARDS. Another 62 cases of healthy full-term infants who were born in our hospital during the same period were selected as control group. All the infants underwent arterial blood gas analysis to obtain the ratio of arterial oxygen partial pressure to fraction of inspired oxygen (Pa_O2/Fi_O2). All the infants were examined by lung ultrasound to observe the ultrasonic manifestations, and lung ultrasound score was conducted to evaluate the degree of lung injury. The incidence of lung ultrasonic abnormal manifestations such as A-line disappearance, comet tail sign, lung edema, lung consolidation, pleural effusion, and alveolar-interstitial syndrome (AIS) between study group and control group was compared chi-square test. Pa_O2/Fi_O2 values and lung ultrasound scores of the infants in ALI subgroup, ARDS subgroup and control group were compared by Kruskal-Wallis H rank sum test and one-way ANOVA, respectively. The sensitivity and specificity of lung ultrasonic manifestations and lung ultrasound scores in diagnosis of ARDS in full-term infants were calculated, and Kappa value was used to evaluate the consistency of diagnostic results of lung ultrasound scores with golden diagnostic criteria of ARDS. There were no significant differences between two groups in gender ratio, gestational age and birth weight (P>0.05). The procedures followed in this study were in line with the ethical standards formulated by the Human Trials Committee of Chengdu Women′s and Children′s Central Hospital, and were approved by the committee (Approval No. [2014]5). The informed consent for clinical research was signed with the guardians of every infant.

Results

①The incidences of A-line disappearance, comet tail sign, lung edema, lung consolidation, pleural effusion, and AIS in the study group were 84.7% (50/59), 100.0% (59/59), 67.8% (40/59), 96.6% (57/59), 91.5% (54/59), 88.1% (52/59), respectively, which were significantly higher than those in control group 0 (0/62), 6.5% (4/62), 0 (0/62), 0 (0/62), 4.8% (3/62), 8.1% (5/62), and all the differences were statistically significant (χ²=89.544, 106.007, 62.791, 113.245, 91.176, 77.790; all P<0.001). ②There were statistically significant differences among ALI subgroup, ARDS subgroup and control group in Pa_O2/Fi_O2 values and lung ultrasound scores (χ²=76.992, P<0.001; F=78.721, P<0.001). The results of further comparison showed that the Pa_O2/Fi_O2 value of ARDS subgroup was significantly lower than those of ALI subgroup and control group, and Pa_O2/Fi_O2 value of ALI subgroup was significantly lower than that of control group, while lung ultrasound score of ARDS subgroup was significantly higher than those of ALI subgroup and control group, and lung ultrasound score of ALI subgroup was significantly higher than that of control group, and the above differences were statistically significant (P<0.017). ③Compared with the golden diagnostic criteria of ARDS, the sensitivity and specificity of the combination of comet tail sign, pleural effusion, and lung consolidation these three lung ultrasonic manifestations in diagnosis of full-term infants with ARDS both were 100.0%. ④The sensitivity and specificity of lung ultrasound score for diagnosis of ARDS were 78.9% and 95.2%, respectively. The positive likelihood ratio was 16.4 and the negative likelihood ratio was 0.2. Kappa value was 0.764, indicating high diagnostic consistency.

Conclusions

Lung ultrasound plays an important role in the diagnosis of ARDS in full-term infants. It has the advantages of high sensitivity and specificity, timeliness and without site limitation. It is expected to be an effective method for clinical diagnosis of ARDS in full-term infants.

Key words: Acute lung injury, Respiratory distress syndrome, newborn, Diagnostic techniques and procedures, Ultrasonography, Blood gas monitoring, transcutaneous, Pleural effusion, Infant, newborn

图1 ALI/ARDS足月儿肺部超声声像图[图1A：彗星尾征(箭头所示)；图1B：胸腔积液(箭头所示)；图1C：肺实变(箭头所示)]

表1 研究组和对照组足月儿肺部超声表现比较[例数(%)]

组别		例数	A线消失	彗星尾征	肺水肿	肺实变	胸腔积液	AIS
研究组		59	50(84.7)	59(100.0)	40(67.8)	57(96.6)	54(91.5)	52(88.1)
?	ALI亚组	21	15(71.4)	21(100.0)	10(47.6)	19(90.5)	16(76.2)	17(81.0)
?	ARDS亚组	38	35(92.1)	38(100.0)	30(78.9)	38(100.0)	38(100.0)	35(92.1)
对照组		62	0(0)	4(6.5)	0(0)	0(0)	3(4.8)	5(8.1)
χ²值^a		?	89.544	106.007	62.791	113.245	91.176	77.790
P值^a		?	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表1 研究组和对照组足月儿肺部超声表现比较[例数(%)]

组别		例数	A线消失	彗星尾征	肺水肿	肺实变	胸腔积液	AIS
研究组		59	50(84.7)	59(100.0)	40(67.8)	57(96.6)	54(91.5)	52(88.1)
?	ALI亚组	21	15(71.4)	21(100.0)	10(47.6)	19(90.5)	16(76.2)	17(81.0)
?	ARDS亚组	38	35(92.1)	38(100.0)	30(78.9)	38(100.0)	38(100.0)	35(92.1)
对照组		62	0(0)	4(6.5)	0(0)	0(0)	3(4.8)	5(8.1)
χ²值^a		?	89.544	106.007	62.791	113.245	91.176	77.790
P值^a		?	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表2 ALI亚组、ARDS亚组和对照组足月儿的Pa_O2/Fi_O2值与肺部超声评分比较

组别		例数	Pa_O2/Fi_O2值[mmHg，M(P₂₅～P₇₅)]	肺部超声评分(分，±s)
ALI亚组		21	229(206～256)	13.0±8.7
ARDS亚组		38	132(68～187)	22.3±7.0
对照组		62	310(277～360)	8.9±5.4
总体比较		?	?	?
?	检验值	?	χ²＝76.992	F＝78.721
?	P值	?	<0.001	<0.001
ALI亚组vs ARDS亚组		?	?	?
?	检验值	?	Z＝5.602	t＝－5.057
?	P值	?	<0.001	<0.001
ALI亚组vs对照组		?	?	?
?	检验值	?	Z＝－5.933	t＝3.051
?	P值	?	<0.001	0.008
ARDS亚组vs对照组		?	?	?
?	检验值	?	Z＝－14.363	t＝12.079
?	P值	?	<0.001	<0.001

表2 ALI亚组、ARDS亚组和对照组足月儿的Pa_O2/Fi_O2值与肺部超声评分比较

组别		例数	Pa_O2/Fi_O2值[mmHg，M(P₂₅～P₇₅)]	肺部超声评分(分，±s)
ALI亚组		21	229(206～256)	13.0±8.7
ARDS亚组		38	132(68～187)	22.3±7.0
对照组		62	310(277～360)	8.9±5.4
总体比较		?	?	?
?	检验值	?	χ²＝76.992	F＝78.721
?	P值	?	<0.001	<0.001
ALI亚组vs ARDS亚组		?	?	?
?	检验值	?	Z＝5.602	t＝－5.057
?	P值	?	<0.001	<0.001
ALI亚组vs对照组		?	?	?
?	检验值	?	Z＝－5.933	t＝3.051
?	P值	?	<0.001	0.008
ARDS亚组vs对照组		?	?	?
?	检验值	?	Z＝－14.363	t＝12.079
?	P值	?	<0.001	<0.001

表3 彗星尾征、胸腔积液、肺实变肺部超声表现联合诊断足月儿ARDS的结果(例)

彗星尾征、胸腔积液、肺实变肺部超声表现联合诊断	足月儿ARDS诊断金标准		合计
彗星尾征、胸腔积液、肺实变肺部超声表现联合诊断	ARDS	非ARDS	合计
ARDS	38	0	38
非ARDS	0	83	83
合计	38	83	121

表3 彗星尾征、胸腔积液、肺实变肺部超声表现联合诊断足月儿ARDS的结果(例)

彗星尾征、胸腔积液、肺实变肺部超声表现联合诊断	足月儿ARDS诊断金标准		合计
彗星尾征、胸腔积液、肺实变肺部超声表现联合诊断	ARDS	非ARDS	合计
ARDS	38	0	38
非ARDS	0	83	83
合计	38	83	121

表4 肺部超声评分法诊断足月儿ARDS的结果(例)

肺部超声评分法	足月儿ARDS诊断金标准		合计
肺部超声评分法	ARDS	非ARDS	合计
ARDS	30	4	34
非ARDS	8	79	87
合计	38	83	121

表4 肺部超声评分法诊断足月儿ARDS的结果(例)

肺部超声评分法	足月儿ARDS诊断金标准		合计
肺部超声评分法	ARDS	非ARDS	合计
ARDS	30	4	34
非ARDS	8	79	87
合计	38	83	121

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