Correlative Research On The Diagnostic Value Of Lung Ultrasound In Adult Interstitial Lung Disease And Childhood Pneumonia

Interstitial lung disease(ILD)was before called interstitial pneumonia,which is caused by various causes of pulmonary interstitial inflammatory and fibrotic diseases.The histopathological features are lymphocytes and monocytes.Infiltration is the group leader.ILD is a heterogeneous disease,including more than 200 diseases.It is one of the most common clinically difficult diseases.It is often a serious threat to human health because of difficult diagnosis,difficult treatment,and poor prognosis.Children are prone to pneumonia because the body’s immune system is not yet fully developed,which is also the most important cause of death in preschool children.At present,high-resolution CT scan(HRCT)is the first choice for the diagnosis of pediatric pneumonia and ILD.However,as we all know,CT examination has many shortcomings,such as radioactivity,which is extremely harmful to children and pregnant women;it cannot be repeated multiple times and cannot be performed at the bedside;it is expensive and expensive;it is not suitable for emergency and intensive care units.Patients who are inconvenient to move and the progress of the disease need to be continuously monitored.Therefore,there is a need for a simple,easy-to-use,fast,inexpensive,and radiation-free imaging inspection method.In recent years,due to the rapid development of ultrasound technology,lung ultrasound(LUS)has been applied to the diagnosis of respiratory diseases.Studies have explored the diagnostic value of LUS in ILD and childhood pneumonia.However,data on the role of LUS in the diagnosis of ILD and childhood pneumonia are still limited,especially the results of studies compared with chest radiology are not completely consistent.Therefore,this study carried out evidence-based medicine research on the above issues.Through an observational study based on the STROBE guidelines,retrospective analysis of adult patients with suspected ILD who were hospitalized or outpatients in the Department of Respiratory and Critical Care Medicine of Binzhou Medical University Hospital from September 2018 to December 2019,and the main endpoints were B-line,pleural line,lung consolidation and other signs in order to deeply explore the diagnostic value of LUS in patients with ILD.We enrolled 22 studies to conduct a systematic analysis to compare the diagnostic value of LUS and chest X-ray in patients with childhood pneumonia in order to provide clinicians with valuable information.Part one Utility of lung ultrasound to identify adult interstitial lung disease:An observational study based on the STROBE guidelinesObjective:Interstitial lung disease(ILD)seriously threatens the health of patients.High-resolution CT(HRCT)is currently the first choice for the diagnosis of ILD.However,CT is radioactive and cannot be repeated multiple times and performed bedside examinations,and is expensive,especially for patients with inconvenient mobility such as emergency rooms and intensive care units,and patients who require continuous monitoring of their disease progression.An inexpensive and radiation-free imaging technology is required.Lung ultrasound(LUS)has recently been used to identify ILD.However,data on the role of LUS in the diagnosis of ILD are still limited.The purpose of this study is to investigate the diagnostic value of LUS compared with HRCT in patients with ILD.Methods:1.This study retrospectively analyzed 66 adult patients with suspected ILD who were hospitalized or outpatients in the Department of Respiratory and Critical Care Medicine of Binzhou Medical University Hospital from September 2018 to December 2019.All patients underwent bilateral LUS examinations and HRCT scans with informed consent.The interval between HRCT examinations should not exceed one week.The ultrasound examiner records the sonogram of the pleura and lung parenchyma in real time.The main lung ultrasound observation endpoints included the number of B lines,the thickness of the pleural line,whether the pleural line is regular,whether there is a consolidation area under the pleura,and whether there is pleural effusion.2.ILD diagnostic criteria:LUS,B-line semi-quantitative score>0 point;HRCT,Warrick score>0 point.The outcomes of LUS in diagnosing ILD including sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR),positive predictive value(PPV),and negative predictive value(NPV),and receiver operating characteristic curve(ROC)was compared with that of HRCT.The reference standard used for the diagnosis of ILD was based on history,clinical findings and examination,and laboratory and instrumental tests,including pulmonary function tests,lung histopathology,and HRCT(without LUS findings).Results:1.Among 66 suspected ILD patients,the final clinical diagnosis of ILD was 55 cases.The Warrick scores were(11.02±1.77)scores,and the B line scores were(16.26±5.44)scores for 55 patients.2.HRCT was positive in 55 patients,whereas LUS detected ILD in 51 patients.Four patients with negative LUS findings were positive on HRCT.3.The results showed that the sensitivity of LUS was 93%(95%CI:0.82-0.98),the specificity was 73%(95%CI:0.39-0.94),the PLR was 3.40(95%CI:1.29-8.95),the NLR was0.10(95%CI:0.04-0.27),the PPV was 0.94(95%CI:0.87-0.98),the NPV was 0.67(95%CI:0.42-0.85).The sensitivity of HRCT was 100%(95%CI:0.94-1.00),and the specificity is 82%(95%CI:0.48-0.98),PLR 5.49(95%CI:1.58-19.27),NLR 0.01(95%CI:0.00-0.18),PPV 0.97(95%CI:0.89-0.99),NPV 1.00(95%CI:0.96-1.00).There was no statistically significant difference in sensitivity and specificity between the two methods(χ~2=2.25,0.00,P=0.13,1.00).The misdiagnosis rateαof LUS was 0.27,the missed diagnosis rateβwas 0.07,the Youden index J was 0.65,and the consensus rate was 89%.The misdiagnosis rateαof HRCT was 0.18,the missed diagnosis rateβwas 0.00,the Youden index J was 0.82,and the consensus rate was 97%.4.The AUC(area under the ROC curve)of LUS was 0.954(95%CI:0.87-0.99),and the AUC of HRCT was 0.999(95%CI:0.94-1.00).Comparison of the two ROC curves revealed significant difference in the diagnostic value of the two methods for the diagnosis of ILD(Z=1.97,P=0.048).Conclusions:1.Our results indicated that LUS also has good sensitivity and specificity in the diagnosis of ILD,and can be used as a useful supplement for HRCT in the diagnosis of ILD. 2.Considering the advantages of LUS that are radiation-free,portable,non-invasive,and capable of repetitive testing at the bedside,LUS should be recommended as a valuable screening tool for patients with suspected ILD.Part two Lung ultrasound versus chest radiography in the diagnosis of children pneumonia: systematic evidenceObjective: At present,numerous studies have investigated the diagnostic yield of lung ultrasound(LUS)in children pneumonia.However,these studies not only had wide variation in sample size,but also conveyed inconclusive results.The aim of this meta-analysis was to evaluate the diagnostic value of LUS in comparison to chest radiography(CXR)in children with pneumonia.Methods: 1.The present study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Computer-based retrieval was performed on Pub Med and EMBASE from inception through October 2019 for eligible studies.All data were extracted from all trials by two independent investigators.Quality was evaluated according to the quality assessment of diagnostic accuracy studies-2,and Meta-Disc was adopted to perform meta-analysis.Heterogeneity was assessed using Q and I2 statistics.2.The pooled sensitivity,specificity,and diagnostic odds ratio(DOR)with 95% confidence intervals(CIs)as the primary outcomes were calculated for each index test.All meta-analyses were performed using Meta-Di Sc 1.4.Publication bias was inspected using Deek’s funnel plot,which was analyzed using Stata 12.0.A Z-test was performed to determine whether there was a statistical difference in the overall sensitivity and specificity between LUS and CXR.A two-sided P value of < 0.05 was considered to statistical significance.Results: 1.A total of 1605 relevant articles were identified from the initial search.After reviewing the titles and abstracts,1555 articles were excluded for duplicate studies and for various reasons.Finally,the remaining 22 eligible studies with a total of 2470 patients were identified for the present meta-analysis.2.The overall diagnostic sensitivity was 0.95(95% CI: 0.94 to 0.96)and 0.91(95% CI: 0.68 to 0.82),and the overall diagnostic specificity was 0.90(95% CI: 0.87 to 0.92)and 1.00(95% CI: 0.99 to 1.00)for children pneumonia diagnosed by LUS and CXR,respectively.Heterogeneity was significant in terms of pooled sensitivity for the two arms.Next,sensitivity analyses were performed to further explore the potential source of heterogeneity across studies.Further exclusion of any single study did not resolve the heterogeneity,and the pooled sensitivity ranged from 0.95(95% CI: 0.94 to 0.96)to 0.95(95% CI: 0.94 to 0.96),0.91(95% CI: 0.89 to 0.92)to 0.91(95% CI: 0.90 to 0.93)for LUS and CXR,respectively.Next,threshold effect analysis showed that the Spearman’s correlation coefficients were-0.390(P = 0.073)and-0.421(P = 0.051)for LUS and CXR,which suggested that no diagnostic threshold effect existed for pneumonia diagnoses.3.The pooled PLR,NLR,and DOR were 8.67(95% CI: 3.98 to 18.89),0.07(95%CI: 0.05 to 0.10),and 137.49(95% CI: 60.21 to 313.98)for LUS,respectively.Correspondingly,the pooled PLR,NLR,and DOR were 19.96(95% CI: 10.42 to 38.24),0.09(95%CI: 0.06 to 0.14),and 369.66(95% CI: 137.14 to 996.47)for CXR,respectively.Additionally,the two SROC curves showed that the AUC and Q index with a standard error(SE)of 0.9817(0.9405 ± 0.0122)and 0.9866(0.9505 ± 0.0125)for LUS and CXR,respectively.4.The Z-test for the overall sensitivity and specificity suggested that there was no statistical difference between LUS and CXR(all P > 0.05).Deeks’ funnel plot asymmetry test was used to evaluate the final set of studies for potential publication bias.The slope coefficient was associated with a P value of 0.70,which suggested symmetry in the data and no publication bias.Conclusions: Our results indicated that LUS is a reliable,valuable,and alternative method to CXR and could be considered as a first-line imaging modality for the diagnosis of pediatric pneumonia.