摘要
目的:探讨高频超声、可移动数字化X线对新生儿坏死性小肠结肠炎(NEC)的诊断价值及对NEC分期的一致性,以期为临床早期诊断、针对性制定干预措施提供参考依据。方法:回顾性分析2023年3月至2024年3月在我院就诊的84例疑似NEC患儿(伴有腹胀、呕吐、血便等)的临床资料,进行高频超声、可移动数字化X线检查,以临床综合诊断(结合临床症状、实验室指标、手术病理)结果为“金标准”,比较高频超声、可移动数字化X线检查单独、联合对NEC的诊断结果、诊断效能,并采用Kappa值分析2种方法对不同分期NEC的诊断结果与临床综合诊断结果的一致性。结果:经临床综合诊断结果显示,84例疑似NEC患儿中阳性56例,阴性28例;56例NEC患儿中Ⅰ期20例,Ⅱ期25例,Ⅲ期11例。经可移动数字化X线检查结果显示,阳性43例,阴性41例;经高频超声检查结果显示,阳性45例,阴性39例;经高频超声联合可移动数字化X线诊断结果显示,阳性55例,阴性29例。高频超声联合可移动数字化X线检查对NEC诊断灵敏度、准确率、阴性预测值高于单独高频超声检查及可移动数字化X线检查;漏诊率低于高频超声及可移动数字化X线检查,差异均有统计学意义(P<0.05)。经可移动数字化X线诊断结果显示,Ⅰ期17例,Ⅱ期16例,Ⅲ期10例,与临床综合诊断结果一致性Kappa值为0.618(P<0.01);经高频超声诊断结果显示,Ⅰ期17例,Ⅱ期18例,Ⅲ期10例,与临床综合诊断结果一致性Kappa值为0.701(P<0.01);经高频超声联合可移动数字化X线诊断结果显示,Ⅰ期20例,Ⅱ期23例,Ⅲ期12例,与临床综合诊断结果一致性Kappa值为0.886(P<0.01)。结论:高频超声联合可移动数字化X线可提高对NEC的诊断准确性,临床可通过其早期评估NEC分期,为临床早期评估诊断、针对性制定干预治疗方案提供参考依据。
Objective:To explore the diagnostic value of high-frequency ultrasound and mobile digital X-ray in neonatal necrotizing enterocolitis(NEC)and the consistency in staging of NEC,in order to provide reference for early clinical diagnosis and targeted intervention measures.Methods:The clinical data of 84 suspected NEC neonates(with abdominal distension,vomiting,bloody stool,etc.)who were treated in our hospital from Mar 2023 to Mar 2024 were retrospectively analyzed.After admission,they were all examined by high-frequency ultrasound and mobile digital X-ray,and the clinical comprehensive diagnosis(combining clinical symptoms,laboratory indicators,surgical pathology)results were used as the“gold standard”to compare the diagnostic results and efficacy of high-frequency ultrasound and mobile digital X-ray examinations alone and in combination for NEC.The consistency between the diagnostic results of the two methods for different stages of NEC and the clinical comprehensive diagnosis results was analyzed using Kappa value.Results:The comprehensive clinical diagnosis results showed that among 84 suspected NEC neonates,56 were positive and 28 were negative.Among the 56 cases of NEC,20 cases were in stageⅠ,25 cases in stageⅡ,and 11 cases in stageⅢ.The results of mobile digital X-ray examination showed that 43 were positive and 41 were negative.The results of high-frequency ultrasound examination showed that 45 were positive and 39 were negative.The results of high-frequency ultrasound combined with mobile digital X-ray diagnosis showed that 55 were positive and 29 were negative.The sensitivity and accuracy of high-frequency ultrasound combined with mobile digital X-ray examination for NEC diagnosis were higher than those of high-frequency ultrasound examination or mobile digital X-ray examination alone(P<0.05).Moreover,the missed diagnosis rate of the combined detection was lower(P<0.05).The results of mobile digital X-ray diagnosis showed that there were 17 cases in stageⅠ,16 cases in stageⅡ,and 10 cases in stageⅢ.The consistency Kappa value with the comprehensive clinical diagnosis results was 0.618(P<0.01).The results of high-frequency ultrasound diagnosis showed that there were 17 cases in stageⅠ,18 cases in stageⅡ,and 10 cases in stageⅢ.The consistency Kappa value was 0.701(P<0.01).The results of high-frequency ultrasound combined with mobile digital X-ray diagnosis showed that there were 20 cases in stageⅠ,23 cases in stageⅡ,and 12 cases in stageⅢ.The consistency Kappa value was 0.886(P<0.01).Conclusion:High-frequency ultrasound combined with mobile digital X-ray can improve the diagnostic accuracy of NEC,and can be used clinically to assess the stage of NEC early,providing a reference for early clinical evaluation and diagnosis,as well as targeted intervention treatment plans.
作者
李晶
王杏丽
张懿
LI Jing;WANG Xingli;ZHANG Yi(Department of Ultrasound,Maternal and Child Health Hospital,Luoyang 471000,China)
出处
《沈阳医学院学报》
2025年第5期487-491,共5页
Journal of Shenyang Medical College
