X线评分量表联合腹部超声可较好识别新生儿坏死性小肠结肠炎:89例前瞻性研究

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。 

Diagnostic value of duck abdominal assessment scale combined with abdominal ultrasound in neonatal necrotizing enterocolitis

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.