支气管肺发育不良早产儿的肺部超声成像特征。
Characterization of lung ultrasound imaging in preterm infants with bronchopulmonary dysplasia.
机构信息
Department of Ultrasound, Children's Hospital of Fudan University, Shanghai, China.
Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
出版信息
Clin Hemorheol Microcirc. 2022;80(2):83-95. doi: 10.3233/CH-211132.
BACKGROUND
Lung ultrasound (LUS) is a bedside technique that can be used on diagnosis and follow-up of neonatal respiratory diseases. However, there are rare reports on the ultrasound features of bronchopulmonary dysplasia (BPD) which is one of the most common chronic lung diseases in preterm infants.
OBJECTIVE
To describe the ultrasound features of different BPD levels, and to investigate the value of ultrasound in evaluating moderate-to-severe BPD.
METHODS
In this prospective cohort study, newborns of less than 37 weeks' gestational age in neonatal intensive care unit (NICU) were included. The LUS characteristics including pleural line, alveolar-interstitial syndrome (AIS), retrodiaphragmatic hyperechogenicity and diaphragmatic morphology were observed and recorded. The reliability of LUS in evaluating moderate and severe BPD were compared and calculated.
RESULTS
A total of 108 infants were enrolled in our study: 39, 24, 29, 16 infants had non, mild, moderate and severe BPD. The median(IQR) pleura thickness in the moderate-to-severe BPD group was 1.7(1.6-1.85) mm, which was thicker than that in the none-to-mild BPD infants (P < 0.001), meanwhile the proportions of rough pleural lines, diffuse AIS, retrodiaphragmatic hyperechogenicity, small cysts above the diaphragm and rough diaphragm in the moderate-to-severe BPD group were also higher than those in none-to-mild BPD group (86.7% vs 36.5, 57.8% vs 7.9%, 37.8% vs 0, 33.3% vs 0, P < 0.001). In evaluating moderate-to-severe BPD, rough pleura had 91.1% (95% confidence interval [CI]: 0.793-0.965) in sensitivity, 91.3% (95% CI: 0.797-0.966) in negative predictive value (NPV), and 66.7% (95% CI: 0.544-0.771) in specificity. Small cysts had 100% (95% CI: 0.941-1) in specificity, 100% (95% CI: 0.816-1) in positive predictive value (PPV), and 37.8% in sensitivity (95% CI: 0.251-0.524). Rough diaphragm had 100% (95% CI: 0.943-1) in sensitivity, 100% (95% CI: 0.796-1) in PPV and 33.3% (95% CI: 0.211-0.478) in specificity.
CONCLUSIONS
Depending on its unique advantages such as convenient, no radiation and repeatable, LUS is a valuable imaging method in assessing the severity of BPD, especially in moderate and severe BPD.
背景
肺部超声（LUS）是一种床边技术，可用于诊断和随访新生儿呼吸系统疾病。然而，关于支气管肺发育不良（BPD）的超声特征的报道很少，BPD 是早产儿中最常见的慢性肺部疾病之一。
目的
描述不同 BPD 程度的超声特征，并探讨超声在评估中重度 BPD 中的价值。
方法
本前瞻性队列研究纳入了新生儿重症监护病房（NICU）中胎龄小于 37 周的新生儿。观察并记录 LUS 特征，包括胸膜线、肺泡间质综合征（AIS）、膈肌后高回声和膈肌形态。比较并计算 LUS 在评估中重度 BPD 中的可靠性。
结果
共有 108 例婴儿入组本研究：39 例、24 例、29 例和 16 例婴儿患有非、轻度、中度和重度 BPD。中重度 BPD 组胸膜厚度的中位数（IQR）为 1.7（1.6-1.85）mm，比非-轻度 BPD 组厚（P＜0.001），同时中重度 BPD 组粗糙胸膜线、弥漫性 AIS、膈肌后高回声、膈肌上方小囊肿和粗糙膈肌的比例也高于非-轻度 BPD 组（86.7% vs 36.5%，57.8% vs 7.9%，37.8% vs 0，33.3% vs 0，P＜0.001）。在评估中重度 BPD 时，粗糙胸膜的灵敏度为 91.1%（95%CI：0.793-0.965），阴性预测值（NPV）为 91.3%（95%CI：0.797-0.966），特异性为 66.7%（95%CI：0.544-0.771）。小囊肿的特异性为 100%（95%CI：0.941-1），阳性预测值（PPV）为 100%（95%CI：0.816-1），灵敏度为 37.8%（95%CI：0.251-0.524）。粗糙膈肌的灵敏度为 100%（95%CI：0.943-1），PPV 为 100%（95%CI：0.796-1），特异性为 33.3%（95%CI：0.211-0.478）。
结论
肺部超声具有方便、无辐射和可重复等独特优势，是评估 BPD 严重程度的一种有价值的影像学方法，尤其在中重度 BPD 中。
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