Ramos-Hernández Cristina, Botana-Rial Maribel, Núñez-Fernández Marta, Lojo-Rodríguez Irene, Mouronte-Roibas Cecilia, Salgado-Barreira Ángel, Ruano-Raviña Alberto, Fernández-Villar Alberto
Hospital Alvaro Cunqueiro, Department of Pneumology, Neumo Vigo I + i, Institute of Health Research Galicia South (IISGS), 36312 Vigo, Spain.
Methodology and Statistics Unit, Galicia Sur Health Research Institute (IISGS), 36312 Vigo, Spain.
J Clin Med. 2021 May 25;10(11):2292. doi: 10.3390/jcm10112292.
There is debate as to whether lung-ultrasound (LUS) can replace lung-auscultation (LA) in the assessment of respiratory diseases.
The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. Standard formulas were used to calculate the diagnostic sensitivity, specificity, and accuracy. The interobserver agreement with respect to the LA and LUS findings was evaluated based on the Kappa coefficient (ᴋ).
A total of 115 patients were studied. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs. 77.02%; = 0.001) and more specifically in the case of decompensated obstructive airway diseases (95.6% vs. 19.10%; = 0.001). The diagnostic accuracy of LUS was also greater in the case of pulmonary infections (75.65% vs. 60.90%; = 0.02). The sensitivity and specificity of the combination of LA and LUS was 95.95%, 50% in pulmonary infections, 76.19%, 100% in case of decompensated obstructive airway diseases, and (100%, 88.54%) in case of interstitial diseases. (ᴋ) was 0.71 for an A-pattern, 0.73 for pathological B-lines, 0.94 for condensations, 0.89 for pleural-effusion, 0.63 for wheezes, 0.38 for rhonchi, 0.68 for fine crackles, 0.18 for coarse crackles, and 0.29 for a normal LA.
There is a greater interobserver agreement in the interpretation of LUS-findings compared to that of LA-noises, their combined use improves diagnostic performance in all diseases examined.
关于在呼吸系统疾病评估中肺超声（LUS）是否能取代肺部听诊（LA）存在争议。
在一项前瞻性研究中，对因失代偿性阻塞性气道疾病、失代偿性间质性疾病和肺部感染入住肺病病房的患者分析LA和LUS的诊断有效性、安全性和可靠性。使用标准公式计算诊断敏感性、特异性和准确性。基于Kappa系数（κ）评估观察者间关于LA和LUS结果的一致性。
共研究了115例患者。LUS在评估肺部感染方面比LA更敏感（93.59%对77.02%；P = 0.001），在失代偿性阻塞性气道疾病情况下更具特异性（95.6%对19.10%；P = 0.001）。在肺部感染情况下，LUS的诊断准确性也更高（75.65%对60.90%；P = 0.02）。LA和LUS联合使用的敏感性和特异性在肺部感染中分别为95.95%、50%，在失代偿性阻塞性气道疾病中为76.19%、100%，在间质性疾病中为（100%，88.54%）。A线的κ值为0.71，病理性B线为0.73，实变为0.94，胸腔积液为0.89，哮鸣音为0.63，粗湿啰音为0.38，细湿啰音为0.68，粗爆裂音为0.18，正常LA为0.29。
与LA声音的解读相比，观察者间对LUS结果的解读一致性更高，它们的联合使用提高了所有所检查疾病的诊断性能。
