| Objective:To explore the application value of LUS in children with CAP and compare it with chest X-ray and CT.Methods:From September 1,2017 to March 31,2019 in the Department of Pediatrics,First Hospital of Jilin University,we selected 157 children who were admitted to hospital and whose final diagnosis were community-acquired pneumonia(CAP)as the experimental group.All the 157 children underwent lung ultrasound examination and met the inclusion and exclusion criteria.During the same period,70 children who had an ultrasound examination within 3 days after admission and met the exclusion criteria were selected as the control group.The 70 children were not diagnosed with CAP finally(19 patients with acute upper respiratory tract infection and 51 patients with acute bronchitis).Among the 157 subjects,78 cases underwent chest X-ray examination and 125 cases underwent lung CT examination,46 cases underwent chest X-ray and CT examination simultaneously.In addition,157 subjects were divided into three groups according to the different pathogens,32 cases were divided into the viral pneumonia group.38 cases were divided into the bacterial pneumonia group and 40 cases were divided into the MPP group,47 cases with mixed infection and unclear pathogen type were not included in this study.The children with viral pneumonia,bacterial pneumonia and MPP whose lung consolidation were detected by ultrasound were divided into 22 patients in the viral pneumonia with lung consolidation group,35 patients in the bacterial pneumonia with lung consolidation group,34 patients in the MPP with lung consolidation group.Data of each group were collected and analyzed statistically.Results:1.The abnormal ultrasonic signs of 157 children with CAP included pleural line abnormalities(85.4%),lung consolidation(73.2%),air bronchograms(67.5%),pleural effusion(57.3%),and AIS(17.2%),with statistically significant differences compared with the control group(P<0.05).2.In the comparison between LUS and chest X-ray,the positive rates of lung consolidation and pleural effusion diagnosed by LUS were 73.1% and 57.7%,respectively,which were higher than the chest X-ray diagnosis results: 58.97% and 12.8%,the differences were statistically significant(P <0.05).3.In the contrast of LUS and lung CT,the results were as follows: lung consolidation(Kappa = 0.881,P < 0.05),pleural effusion(Kappa = 0.867,P < 0.05),and pleural thickening(Kappa = 0.842,P < 0.05),AIS(Kappa = 0.935,P <0.05),They all had a good diagnostic consistency with CT.4.When analyzing the relationship between AIS and pneumonia with different pathogens,it was found that59.4% of patients in the viral pneumonia group had AIS,significantly higher than those in the bacterial pneumonia group(7.9%)and MPP group(5%),with statistically significant differences(P<0.001).There was no statistically significant difference between the bacterial pneumonia group and the MPP group.In analyzing the relationship between the size of lung consolidation and pneumonia with different pathogens,we found that the mean size of lung consolidation of bacterial pneumonia,MPP,viral pneumonia were(36.4±17.2)mm,(34.5±16.4)mm,(22.8±14.6)mm,respectively.The size of lung consolidation in bacterial pneumonia are bigger than that in viral pneumonia,The differences were statistically significant(P< 0.05),the size of lung consolidation in MPP are bigger than that in viral pneumonia,the differences were statistically significant(P< 0.05).when we compare bacterial pneumonia with MPP pneumonia patients,there was no statistically significant difference between them(P > 0.05).ROC curve was drawn to calculate the cut-off value of the size of lung consolidation between pneumonia with different pathogens,it was found that the AUC was 0.756(95%CI: 0.623 ~ 0.889),(P < 0.05),when we compared bacterial pneumonia with viral pneumonia.The optimal cut-off value was 16.45 mm.The sensitivity and specificity were 91.4% and 54.5%,respectively.When we compared the MPP with the viral pneumonia,the AUC was 0.733(95%CI: 0.592 ~0.873),(P<0.05).The optimal cut-off value was 26 mm,and its sensitivity and specificity were 70.6% and 72.7%,respectively.When we compared the MPP with the bacterial pneumonia,the AUC was 0.532(95%CI: 0.393 ~0.670),(P>0.05).Conclusion:1.LUS is better than chest X-ray in the diagnosis of lung consolidation and pleural effusion.2.The diagnosis of lung consolidation,pleural effusion,pleural thickening and AIS by LUS have a good diagnostic consistency with CT.LUS is a reliable diagnostic method.3.AIS and the size of lung consolidation can provide reference to distinguish bacterial pneumonia with viral pneumonia,and to distinguish MPP with viral pneumonia. |
