肺部超声联合血清sCD163对小儿重症肺炎并发急性呼吸窘迫综合征的诊断价值

Diagnostic value of lung ultrasound combined with serum sCD163 for severe pneumonia complicated by acute respiratory distress syndrome in children

摘要:

目的 评估肺部超声（LUS）联合血清可溶性单核巨噬细胞血红蛋白清道夫受体（sCD163）对小儿重症肺炎（SP）并发急性呼吸窘迫综合征（ARDS）的诊断价值。方法 选取2019年6月—2022年6月在上海儿童医学中心三亚市妇女儿童医院就诊的SP患儿82例（SP组），SP并发ARDS患儿79例（ARDS组）。根据疾病严重程度将ARDS组分为轻、中、重度组。比较SP组、ARDS组LUS评分、血清sCD163水平；比较不同严重程度ARDS患儿LUS评分、血清sCD163水平；采用Spearman法分析LUS评分、血清sCD163水平与ARDS严重程度的相关性；绘制受试者工作特征（ROC）曲线评价LUS评分联合血清sCD163水平对ARDS的诊断效能。结果 ARDS组LUS评分、血清sCD163水平均高于SP组（P <0.05）。中、重度组LUS评分、血清sCD163水平均高于轻度组（P <0.05），重度组LUS评分、血清sCD163水平均高于中度组（P <0.05）。Spearman相关性分析显示，LUS评分、血清sCD163水平与ARDS严重程度呈正相关（r_s =0.809和.805，均P =0.000）。ROC曲线结果显示，LUS评分、血清sCD163水平诊断ARDS的最佳截断值分别为12分、72.79 ng/mL。LUS评分诊断ARDS的敏感性、特异性、准确性分别为64.56%（95% CI：0.595，0.697）、78.05%（95% CI：0.693，0.868）、71.43%（95% CI：0.632，0.796），曲线下面积（AUC）为0.768；血清sCD163水平诊断ARDS的敏感性、特异性、准确性分别为67.09%（95% CI：0.612，0.729）、78.05%（95% CI：0.685，0.876）、72.67%（95% CI：0.646，0.808），AUC为0.738；两者联合诊断ARDS的敏感性、特异性、准确性分别为84.81%（95% CI：0.755，0.941）、63.41%（95% CI：0.584，0.684）、73.91%（95% CI：0.651，0.827），AUC为0.778。结论 LUS联合血清sCD163对小儿SP并发ARDS具有较高的诊断效能，可为ARDS诊断及病情严重程度评估提供有效参考。

Abstract:

Objective To assess the diagnostic value of lung ultrasound (LUS) combined with the soluble form of hemoglobin scavenger receptor CD163 (sCD163) in children with severe pneumonia (SP) complicated by acute respiratory distress syndrome (ARDS).Methods A total of 82 children with SP who were treated in our hospital from June 2019 to June 2022 were selected and set as the SP group, and 79 children with SP complicated with ARDS were set as ARDS group. According to the severity of disease, those in the ARDS group were subdivided into mild group, moderate group and severe group. The LUS score and the serum level of sCD163 were compared between the SP group and the ARDS group and among children with different severity of ARDS. The Spearman's correlation analysis was performed to investigate the correlations of the LUS score and the serum level of sCD163 with the severity of ARDS. The receiver operating characteristic (ROC) curve was established to evaluate the diagnostic efficacy of the LUS score combined with the serum level of sCD163 for ARDS.Results Compared with the SP group, the LUS score and the serum level of sCD163 were significantly increased in the ARDS group (P < 0.05). Compared with the mild group, the LUS score and the serum level of sCD163 were significantly increased in the moderate and severe groups (P < 0.05). Compared with the moderate group, the LUS score and the serum level of sCD163 were significantly increased in the severe group (P < 0.05). Spearman's correlation analysis showed that the LUS score and the serum level of sCD163 were positively correlated with the severity of ARDS (r_s =0.809 and 0.805, both P = 0.000). The ROC curve analysis revealed that the optimal cut-off points of the LUS score and the serum level of sCD163 for diagnosing ARDS were 12 and 72.79 ng/mL. The sensitivity, specificity and accuracy of the LUS score in the diagnosis of ARDS were 64.56% (95% CI: 0.595, 0.696), 78.05% (95% CI: 0.693, 0.868) and 71.43% (95% CI: 0.632, 0.796), with the area under the curve (AUC) being 0.768. The sensitivity, specificity and accuracy of the serum level of sCD163 in the diagnosis of ARDS were 67.09% (95% CI: 0.612, 0.729), 78.05% (95% CI: 0.685, 0.878) and 72.67% (95% CI: 0.646, 0.808), with the AUC being 0.738. The sensitivity, specificity and accuracy of the combination of the LUS score and the serum level of sCD163 in the diagnosis of ARDS were 84.81% (95% CI: 0.755, 0.941), 63.41% (95% CI: 0.584, 0.684) and 73.91% (95% CI: 0.651, 0.827), with the AUC being 0.778.Conclusions LUS combined with serum sCD163 has a high diagnostic performance for children with SP complicated by ARDS, and therefore provides an effective reference for diagnosing ARDS and evaluating the disease severity.