Diagnostic value of duck abdominal assessment scale combined with abdominal ultrasound in neonatal necrotizing enterocolitis
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摘要:
目的评估腹部X线评分量表（DAAS）联合腹部超声检查对新生儿坏死性小肠结肠炎（NEC）的诊断价值。 方法前瞻性纳入2017年1月~2019年12月在本院接受诊治的97例疑似NEC患儿作为研究对象，其中男性59例，年龄6.4±3.5 d；女性38例，年龄6.9±2.8 d。对所有患儿行腹部X线检查、超声检查。以手术病理结果为金标准，分别评估DAAS、超声检查及DAAS联合超声检查对NEC检出的一致率、敏感度、特异性、阳性预测值、阴性预测值；采用ROC曲线分析3种检查方式的诊断效能；对不同分期患儿的DAAS对比，对不同肠道病变患儿的DAAS比较。 结果经手术病理证实，89例确诊为NEC。对比手术病理结果，DAAS、腹部超声检查以及DAAS联合超声检查对于NEC的诊断一致率、敏感度、特异性均高于85%。3种检查方式对于NEC诊断效能的曲线下面积分别为0.96、0.94和0.98，DAAS联合超声检查的诊断效能最高。随着疾病严重程度的增加，DAAS明显增高，差异具有统计学意义（P < 0.05）。对比不同肠道病变患儿的DAAS，肠穿孔组患儿显著高于肠坏死组，两者差异具有统计学意义（P < 0.05）。 结论DAAS联合腹部超声检查能较好的识别NEC，具有重要的临床运用价值。 -
关键词:
- 腹部X线评分量表 /
- 腹部超声 /
- 新生儿坏死性小肠结肠炎
Abstract:ObjectiveTo evaluate the value of duck abdominal assessment scale (DAAS) combined with abdominal ultrasound in the diagnosis of neonatal necrotizing enterocolitis (NEC). MethodsA total of 97 children with suspected NEC who were diagnosed and treated in our hospital from January 2017 to December 2019 were prospectively included. Among them, 59 were males with an average of 6.4±3.5 d and 38 females with an average of 6.9±2.8 d. Abdominal X-ray examination and abdominal ultrasound were performed on all patients. Regarding the surgical pathological results as the gold standard, the agreement rate, sensitivity, specificity, positive predictive value and negative predictive value by DAAS, abdominal ultrasound and DAAS combined with abdominal ultrasound were used to assess the diagnostic ability. The ROC curve was used to analyze the diagnostic performance of the three methods. The DAAS of children with different pathological stages were compared, and the DAAS of children with different intestinal diseases were compared. ResultsEighty-nine cases were diagnosed as NEC by surgical pathology. Comparing the surgical pathological results, the agreement rate, sensitivity, and specificity of abdominal X-ray examination, abdominal ultrasound, and abdominal X-ray combined with abdominal ultrasound for the diagnosis of NEC were all higher than 85%. The area under the curve of the three methods for the diagnostic efficiency of NEC were 0.96, 0.94 and 0.98, respectively. The diagnostic efficiency of DAAS combined with abdominal ultrasound was the highest. As the severity of the disease increased, the DAAS of children was significantly increased (P < 0.05). DAAS of children in the intestinal perforation group were significantly higher than those in the intestinal necrosis group(P < 0.05). ConclusionThe combination of DAAS and abdominal ultrasound can identify NEC better, which has important clinical value. -
图 1 年龄5 d，Ⅱ期NEC患儿的X线图
Duke腹部X线评分量表（DAAS）评分5分，患儿肠管明显扩张积气，肠鸣音消失.
Figure 1. An X-ray picture of a 5-day-old child with stage Ⅱ NEC.
图 2 年龄6 d的Ⅲ期NEC患儿的X线图片
DAAS评分8分，患儿腹胀明显，肠管扩张，肠鸣音消失，大量腹水，并合并呼吸性酸中毒症状.
Figure 2. An X-ray picture of a 6-day-old child with stage Ⅲ NEC.
图 3 腹部X线评分、超声及腹部X线评分联合超声对NEC的诊断效能的ROC曲线
Figure 3. The ROC curve of the diagnostic efficacy of DAAS, abdominal ultrasound and DAAS combined with abdominal ultrasound for the diagnosis of NEC.
表 1 Duke腹部X线评分量表
Table 1. Duke abdominal X-ray score scale
X线评分 腹部影像学改变 0 正常充气 1 肠管轻度扩张 2 肠管中度扩张或正常充气状态合并有球状透明类似粪气影 3 局部肠袢中度扩张 4 局部肠间隙稍增宽或出现肠袢分离 5 肠间隙多发增宽 6 肠壁积气可能，伴有其他异常表现 7 肠袢固定或持续肠管扩张 8 肠壁积气（高度怀疑或者确诊） 9 合并门静脉积气 10 气腹 
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表 2 多模态影像技术对NEC的诊断效能
Table 2. Diagnostic efficacy of multi-modal imaging technology on NEC
检查方式 一致率（%） 敏感度（%） 特异性（%） 阳性预测值（%） 阴性预测值（%） Kappa值 腹部X线评分 88.70 92.10 50.00 95.30 36.40 0.36 超声 86.60 88.80 62.50 96.30 33.30 0.37 腹部X线+超声 95.90 96.60 87.50 98.90 70.00 0.76
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表 3 不同分期和不同肠道病变NEC患儿的腹部X线评分
Table 3. DAAS of NEC children with different stages and different intestinal lesions (分, Mean±SD)
组别 腹部X线评分 F/t P 按不同分期分组 38.184 < 0.001 Ⅰ期（n=45） 3.24±1.53 Ⅱ期（n=17） 5.51±2.02 Ⅲ期（n=27） 8.79±1.95 按不同肠道病变分组 2.218 0.041 肠穿孔组（n=11） 9.56±3.21 肠坏死组（n=7） 6.29±2.76
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