肺部超声检查对肺炎患者治疗方案调整预测价值

doi:10.3969/j.issn.1004-583X.2022.02.007

摘要/Abstract

摘要：

目的探讨肺部超声对肺炎患者抗感染治疗方案调整的临床价值。方法连续录入解放军第967医院呼吸内科2019年12月1日至2021年2月28日收治的肺炎患者96例,分别记录其入院时及治疗第3天肺超声评分(lung ultrasound score, LUS)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、嗜中性粒细胞百分比(NEU%)、临床症状以及抗生素治疗方案。根据治疗第3天抗生素调整与否分为调整组与未调整组,比较两组入院时以及治疗第3天LUS变化,分析抗生素调整的影响因素。根据第3天LUS变化差值(ΔLUS)将患者分为ΔLUS≥0和ΔLUS<0两组,观察两组预后情况。结果 (1)抗生素调整组治疗后LUS较前增加,未调整组评分较前下降。虽然两组在治疗前LUS差异无统计学意义(P=0.089),但在治疗第3天时差异具有统计学意义(P<0.05)。(2)多因素Logistic回归分析显示,ΔLUS(P=0.000;OR=1.563,95%CI:1.229-1.987)以及hs-CRP差值(Δhs-CRP)(P=0.001;OR=1.045,95%CI:1.018-1.074)与抗生素调整相关。(3)采用受试者工作特征(ROC)曲线分析ΔLUS对抗生素调整的预测价值,结果显示其敏感度为81.3%,特异度为82.8%,ROC曲线下面积(AUC)为0.806。当ΔLUS与Δhs-CRP联合后AUC为0.901,大于ΔLUS、Δhs-CRP,预测价值更高。结论肺部超声可作为治疗方案调整的辅助参考之一,联合hs-CRP辅助调整肺炎患者抗生素治疗方案效能更高。

关键词: 肺炎, 肺部超声评分, 治疗

Abstract:

Objective To explore the clinical value of pulmonary ultrasonography on adjusted anti-infection therapeutic regimen for patients with pneumonia.Methods Ninety six patients with pneumonia admitted to the Department of Respiratory Medicine of the 967 Hospital of the People's Liberation Army from December 1, 2019 to February 28, 2021 were recorded consecutively; and lung ultrasound scores (LUS), high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), neutrophil percentage (NEU%), clinical symptoms and antibiotic treatment regimen were recorded respectively on admission and the 3^rd Day of treatment. Patients were divided into adjusted group and unadjusted group based on adjusted antibiotics on the 3^rd Day of treatment. The change in LUS on admission and the 3^rd Day of treatment were compared in groups, and the factors of adjustments on antibiotics were analyzed. Patients were divided into two groups including the ΔLUS≥0 group and ΔLUS<0 group based on the difference in change of LUS (ΔLUS) on the 3 ^rd Day, and the prognosis of patients in two groups was observed. Results (1) LUS of patients in the adjusted antibiotics group increased after treatment, while the unadjusted group decreased. The difference in LUS between groups before treatment was statistically significant (P=0.089), the difference on the 3^rd Day of treatment was statistically significant (P<0.05). (2) Logistic regression analysis showed that ΔLUS (P=0.000; OR=1.563, 95%CI: 1.229-1.987) and difference in hs-CRP (Δhs-CRP)(P=0.001; OR=1.045, 95%CI: 1.018-1.074) were associated with antibiotic adjustment. (3) The predictive value of ΔLUS on antibiotic adjustment was analyzed by receiver operating characteristic (ROC) curve. The results showed the sensitivity, specificity, and the area under ROC curve (AUC) were 81.3%, 82.8%, and 0.806, respectively. AUC was 0.901 after combination of ΔLUS and Δhs-CRP, being greater than ΔLUS and Δhs-CRP, and the predictive value was higher. Conclusion Pulmonary ultrasonography is eligible to be used as one of auxiliary references for adjusted therapeutic regimen, and it is more effective to adjust the therapeutic regimen of pneumonia patients by combining hs-CRP.

Key words: pneumonia, lung ultrasound score, treatment

中图分类号:

R563.1

余鑫, 刘中洋. 肺部超声检查对肺炎患者治疗方案调整预测价值[J]. 临床荟萃, 2022, 37(2): 133-136.

Yu Xin, Liu Zhongyang. Predictive value of lung ultrasonography on adjusted therapeutic regimen for patients with pneumonia[J]. Clinical Focus, 2022, 37(2): 133-136.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.02.007

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I2/133

图/表 5

参考文献 20

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特征	抗生素调整组 (n=32)	抗生素未调整组 (n=64)	χ²/t值	P值
年龄(岁)	44.69±25.97	49.13±23.82	-0.723	0.469
性别(男/女,例)	20/12	48/16	1.613	0.204
hs-CRP(mg/L)	46.91±50.99	56.88±82.03	-0.264	0.792
WBC(×10⁹/L)	8.50±5.65	7.37±3.29	-0.054	0.957
NEU%(%)	63.22±15.29	67.41±12.70	-1.329	0.184
症状(例)
咳嗽	25	58	1.880	0.170
咳痰	27	53	0.038	0.846
发热	19	35	0.190	0.663
乏力	10	19	0.025	0.875
胸闷气短	12	24	0.000	1.000
PSI分级(例)
低危组中高危组	24 8	49 15	0.029	0.866

特征	抗生素调整组 (n=32)	抗生素未调整组 (n=64)	χ²/t值	P值
年龄(岁)	44.69±25.97	49.13±23.82	-0.723	0.469
性别(男/女,例)	20/12	48/16	1.613	0.204
hs-CRP(mg/L)	46.91±50.99	56.88±82.03	-0.264	0.792
WBC(×10⁹/L)	8.50±5.65	7.37±3.29	-0.054	0.957
NEU%(%)	63.22±15.29	67.41±12.70	-1.329	0.184
症状(例)
咳嗽	25	58	1.880	0.170
咳痰	27	53	0.038	0.846
发热	19	35	0.190	0.663
乏力	10	19	0.025	0.875
胸闷气短	12	24	0.000	1.000
PSI分级(例)
低危组中高危组	24 8	49 15	0.029	0.866

组别	例数	LUS评分
组别	例数	治疗前	治疗第3天
抗生素调整组	32	6.28±2.87	7.41±3.24
抗生素未调整组	64	5.33±2.76	3.37±3.53
t值		-1.703	-4.966
P值		0.089	0.000

组别	例数	LUS评分
组别	例数	治疗前	治疗第3天
抗生素调整组	32	6.28±2.87	7.41±3.24
抗生素未调整组	64	5.33±2.76	3.37±3.53
t值		-1.703	-4.966
P值		0.089	0.000

变量	β 值	S值	Wald χ²值	P值	OR值	95%CI
变量	β 值	S值	Wald χ²值	P值	OR值	下限	上限
Δhs-CRP(mg/L)	0.044	0.014	10.555	0.001	1.045	1.018	1.074
ΔNEU%	0.019	0.023	0.639	0.424	1.019	0.973	1.067
ΔWBC(×10⁹/L)	-0.072	0.093	0.593	0.441	0.931	0.775	1.117
ΔLUS	0.447	0.122	13.302	0.000	1.563	1.229	1.987
常量	-0.257	0.330	0.607	0.436	0.773