Xie Wen, Ruan Junxian, Jiang Qiuxia, Zheng Jingyang, Lin Weiru, Lyu Guorong
Department of Ultrasound, Quanzhou Maternity and Children's Hospital, Quanzhou, China.
Department of Pneumology, Quanzhou Maternity and Children's Hospital, Quanzhou, China.
Front Pediatr. 2024 Aug 5;12:1411365. doi: 10.3389/fped.2024.1411365. eCollection 2024.
This study aimed to investigate the diagnostic utility of the modified lung ultrasound score (MLUS) in distinguishing between Mycoplasma pneumonia and viral pneumonia in children and evaluate their severity.
A prospective collection of 137 suspected cases of community-acquired pneumonia in children admitted to the Quanzhou Maternity and Children's Hospital in Quanzhou City, Fujian Province, from January 2023 to December 2023 constituted the study cohort. All patients underwent lung ultrasound examinations, and MLUS scores were assigned based on ultrasound findings, including pleural lines, A-lines, B-lines, and lung consolidations. Based on the pathogenic results, the patients were categorized into the Mycoplasma pneumonia (74 cases) and viral pneumonia (63 cases) groups. The severity was classified as mild (110 cases) or severe (27 cases). The diagnostic value of MLUS for Mycoplasma pneumonia and viral pneumonia in children was analyzed.
(1) MLUS scores were significantly different between the Mycoplasma pneumonia (15, 10-21) and viral pneumonia (8, 5-16) groups ( = 0.002). ROC curve analysis indicated that using a cut-off value of 11, MLUS exhibited a sensitivity of 70.3%, specificity of 58.7%, and an area under curve (AUC) of 0.653 for diagnosing Mycoplasma pneumonia. Furthermore, large-area lung consolidation on ultrasound images demonstrated good diagnostic performance for predicting Mycoplasma pneumonia, with an AUC of 0.763, a sensitivity of 71.6%, and a specificity of 81.0%. (2) MLUS scores were significantly different between the mild pneumonia (10.5, 5-17) and severe pneumonia (21, 16-29) groups ( < 0.001). ROC curve analysis using a cut-off value of 16 showed a sensitivity of 77.8%, specificity of 73.6%, and AUC of 0.818 for diagnosing severe pneumonia. Multivariate regression analysis revealed that both MLUS and white blood cell count were independent factors influencing the severity. The constructed nomogram model demonstrated robust stability with a sensitivity of 85.2%, a specificity of 74.5%, and an AUC of 0.858 for predicting severe childhood pneumonia.
MLUS, coupled with ultrasound signs of large-area lung consolidation, had reference significance for the differential diagnosis of Mycoplasma pneumonia and viral pneumonia in children and can be a preliminary assessment of the severity of viral pneumonia or mycoplasma pneumonia in children.
本研究旨在探讨改良肺超声评分（MLUS）在鉴别儿童支原体肺炎和病毒性肺炎中的诊断价值，并评估其严重程度。
前瞻性收集2023年1月至2023年12月福建省泉州市妇幼保健院收治的137例疑似儿童社区获得性肺炎病例作为研究队列。所有患者均接受肺超声检查，并根据超声检查结果（包括胸膜线、A线、B线和肺实变）进行MLUS评分。根据病原学结果，将患者分为支原体肺炎组（74例）和病毒性肺炎组（63例）。严重程度分为轻度（110例）或重度（27例）。分析MLUS对儿童支原体肺炎和病毒性肺炎的诊断价值。
（1）支原体肺炎组（15，10 - 21）和病毒性肺炎组（8，5 - 16）的MLUS评分差异有统计学意义（=0.002）。ROC曲线分析表明，以11为临界值，MLUS诊断支原体肺炎的灵敏度为70.3%，特异度为58.7%，曲线下面积（AUC）为0.653。此外，超声图像上的大面积肺实变对预测支原体肺炎具有良好的诊断性能，AUC为0.763，灵敏度为71.6%，特异度为81.0%。（2）轻度肺炎组（10.5，5 - 17）和重度肺炎组（21，16 - 29）MLUS评分差异有统计学意义（<0.001）。以16为临界值的ROC曲线分析显示，诊断重度肺炎的灵敏度为77.8%，特异度为73.6%，AUC为0.818。多因素回归分析显示，MLUS和白细胞计数均为影响严重程度的独立因素。构建的列线图模型具有较强的稳定性，预测儿童重度肺炎的灵敏度为85.2%，特异度为74.5%，AUC为0.858。
MLUS联合大面积肺实变的超声征象对儿童支原体肺炎和病毒性肺炎的鉴别诊断具有参考意义，可作为儿童病毒性肺炎或支原体肺炎严重程度的初步评估指标。
