改良经胸肺超声评分法在间质性肺疾病中的诊断价值研究
A study of the diagnostic value of a modified transthoracic lung ultrasound scoring method in interstitial lung disease.
作者信息
Zhang Ying, Lian Xihua, Huang Shunfa, Li Liya, Zhao Yanping, Lai Hongwei, Lyu Guorong
机构信息
Department of Ultrasound Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
出版信息
Quant Imaging Med Surg. 2023 Feb 1;13(2):946-956. doi: 10.21037/qims-22-153. Epub 2023 Jan 14.
BACKGROUND
Interstitial lung disease (ILD) is a serious complication of connective tissue disease (CTD) with significant morbidity and mortality. Lung ultrasound (LUS) has been widely used in the diagnosis of a variety of lung diseases. However, there is no standard ultrasound scanning method or scoring method for connective tissue disease associated with interstitial lung disease (CTD-ILD); therefore, it is necessary to establish a set of standard evaluation methods.
METHODS
A total of 60 consecutive patients with clinically confirmed CTD and suspected ILD were prospectively included in this study. LUS and high-resolution computed tomography (HRCT) were used to examine all patients. The time between HRCT and LUS examinations was less than 2 weeks. The ultrasonographic results were evaluated with the modified scoring method and the Buda scoring method. The imaging results were evaluated with the HRCT Warrick scoring method. The primary aim was to evaluate the diagnostic value of a modified ultrasound scoring method in CTD-ILD.
RESULTS
The results of the Youden index for the diagnosis of CTD-ILD by the modified method, the Buda method, and the HRCT method were 0.845, 0.711, and 0.911, respectively, with areas under the receiver operating characteristic (ROC) curve (AUC) of 0.982 [95% confidence interval (CI): 0.945-1.000], 0.950 (95% CI: 0.851-0.990), and 0.985 (95% CI: 0.949-1.000), respectively. With a clinical diagnosis as the gold standard, the consistency of the modified method and the HRCT method for CTD-ILD was high (Kappa values =0.872 and 0.913, respectively). The values of the modified method and the Buda method consistently and significantly increased with the increasing severity of CTD-ILD. For the former, there were significant differences between the mild, moderate, and severe groups (P<0.05). The ROC curve used to calculate the modified ultrasound score predicted the critical values of mild and severe pulmonary fibrotic lesions at 34 points (sensitivity, 100%; specificity, 92.9%; AUC =0.933; 95% CI: 0.807-1.000) and 64.5 points (sensitivity, 92.0%; specificity, 85.3%; AUC =0.972; 95% CI: 0.929-1.000).
CONCLUSIONS
The modified ultrasound method has a higher diagnostic value than the Buda method for CTD-ILD.
背景
间质性肺疾病（ILD）是结缔组织病（CTD）的严重并发症，具有较高的发病率和死亡率。肺部超声（LUS）已广泛应用于多种肺部疾病的诊断。然而，对于结缔组织病相关间质性肺疾病（CTD-ILD），尚无标准的超声扫描方法或评分方法；因此，有必要建立一套标准的评估方法。
方法
本研究前瞻性纳入了60例临床确诊为CTD且疑似ILD的连续患者。对所有患者进行了LUS和高分辨率计算机断层扫描（HRCT）检查。HRCT和LUS检查的时间间隔小于2周。采用改良评分法和布达评分法评估超声检查结果。采用HRCT沃里克评分法评估影像学结果。主要目的是评估改良超声评分法对CTD-ILD的诊断价值。
结果
改良法、布达法和HRCT法诊断CTD-ILD的约登指数结果分别为0.845、0.711和0.911，受试者操作特征（ROC）曲线下面积（AUC）分别为0.982[95%置信区间（CI）：0.945-1.000]、0.950（95%CI：0.851-0.990）和0.985（95%CI：0.949-1.000）。以临床诊断为金标准，改良法与HRCT法对CTD-ILD的一致性较高（Kappa值分别为0.872和0.913）。改良法和布达法的值随CTD-ILD严重程度的增加而持续显著增加。对于改良法，轻度、中度和重度组之间存在显著差异（P<0.05）。用于计算改良超声评分的ROC曲线预测轻度和重度肺纤维化病变的临界值分别为34分（敏感性，100%；特异性，92.9%；AUC=0.933；95%CI：0.807-1.000）和64.5分（敏感性，92.0%；特异性，85.3%；AUC=0.972；95%CI：0.929-1.000）。
结论
改良超声法对CTD-ILD的诊断价值高于布达法。
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