Diagnostic Value Of Pulmonary Ultrasonography Combined With Inflammatory Markers In Adult Community-Acquired Pneumonia

Objective To observe the imaging characteristics of Lung Ultrasound(LUS)in adult community acquired pneumonia(CAP).Chest CT was taken as the "gold standard" of CAP diagnosis to discuss the diagnostic value of LUS combined with inflammatory markers in adult community-acquired pneumonia,so as to provide reference and new ideas for improving the diagnostic level of adult community-acquired pneumonia.Methods From April 2018 to February 2019,a prospective control study was conducted on 72 patients who were admitted to the outpatient department of respiratory medicine and the department of geriatric diseases of Hebei People's Hospital,and who were suspected to have been diagnosed as CAP through the history of present illness and rigorous physical examination On the day of admission,the chest CT was improved for definite diagnosis,chest X-ray and LUS imaging data were collected within 48 hours after admission,and venous blood was retained for WBC+PCT examination.To observe the imaging changes of lung consolidation,abnormal pleural line,B-line,abnormal lung sliding sign,pleural effusion sign,dynamic and static air bronchogram,and alveolar interstitial syndrome in CAP.Chest CT was used as the gold standard for diagnosis,and White blood cell(WBC)and Procalcitonin(PCT)were used as the representative factors of inflammatory markers to compare the advantages and disadvantages of LUS combined WBC,PCT and chest X-ray in the diagnosis of CAP.The diagnostic value of CAP in adults was evaluated according to the sensitivity,specificity,positive predictive value and negative predictive value of LUS sign,WBC count,PCT and the combined detection of CAP in patients,and the diagnostic consistency was compared with that of chest CT.Results 72 patients with suspected CAP diagnosis have been included in this study.Among them,50 patients(69.4%)were finally diagnosed as CAP by chest CT scan,which was used as the gold diagnostic standard and consistency test standard.41 patients(56.9%)were diagnosed by LUS,with sensitivity of 82.00%,specificity of 90.01%,and consistency test of Kappa value of 0.669.And accompany by a variety of different ultrasonic signs,of which b-line sign sensitivity of 68.00%and specificity of 59.09%.The sensitivity and specificity of slip sign were 42.00%and 72.73%,respectively.The sensitivity and specificity of lung consolidation and debris signs were 76.00%and 81.82%,respectively.The sensitivity and specificity of air bronchogram were 58.00%and 86.36%,respectively.The sensitivity and specificity of abnormal pleural line were 56.00%and 54.55%,respectively.The sensitivity and specificity of pleural effusion were 20.00%and 86.36%respectively.The sensitivity of alveolar interstitial syndrome was 12.00%.The specificity was 86.36%.38 patients(52.8%)were diagnosed by chest X-ray,with sensitivity of 76.00%,specificity of 81.82%,and diagnostic consistency test of Kappa value of 0.525.WBC of 37 patients(51.4%)was higher than normal,with a sensitivity of 74.00%and a specificity of 68.18%.The sensitivity and specificity of PCT were 44.00%and 90.91%,respectively.LUS was combined with WBC and PCT to diagnose 48 patients,with sensitivity of 96.00%,specificity of 95.54%,and diagnostic consistency test Kappa value of 0.903,indicating a good diagnostic consistency with chest CT.Conclusion In summary,timely detection of serum PCT,WBC and simplified pulmonary infection score is helpful for early diagnosis and disease evaluation of patients suspected of having CAP,but combined imaging examination results are still needed for the final diagnosis of CAP.As an effective imaging method for diagnosis of community-acquired pneumonia,lung doppler ultrasound has many advantages,such as no ionizing radiation,can be carried out near the bed,repeatable and cheap,and its diagnostic value is no less than that of chest X-ray.In this study,compared with LUS,CXR and other imaging examinations alone,LUS combined with WBS,PCT and other inflammatory markers has relatively higher sensitivity and specificity for the diagnosis of CAP,and is consistent with the diagnosis results of chest CT.It has much more higher clinical promotion value.Figure 7;Table 2;Reference 85.