腹部B超在新生儿坏死性小肠结肠炎诊断中的价值

目的探讨腹部B超在新生儿坏死性小肠结肠炎（NEC）诊断中的价值。方法选择2011年4月至2013年4月我院新生儿科收治的临床可疑NEC早产儿,患儿在诊断可疑NEC后常规行腹部正侧位X线片及腹部B超检查,并在12 h后复查X线片和腹部B超,以出现肠壁增厚、肠壁积气、门静脉积气之中的任何一项判定为阳性结果,均未出现判为阴性结果。采用诊断性检验方法,以灵敏度、特异度、准确度及ROC曲线评估腹部B超诊断NEC的价值。结果共纳入93例可疑NEC早产儿,男49例,女44例;胎龄（31.4±2.1）周;体重（1825±236）g。第1次检查腹部B超阳性61例,X线平片阳性52例,腹部B超的灵敏度和特异度分别为90.5%和54.9%,准确度66.6%,ROC曲线下面积（AUC）=0.727（95%CI 0.622～0.831）。12 h后复查腹部B超阳性69例,X线平片阳性53例,腹部B超的灵敏度和特异度分别为88.7%和45.0%,准确度74.2%,AUC=0.668（95%CI 0.554～0.783）。结论腹部B超结合临床表现可能优于Bell法在NEC的诊断,具有重要的临床应用价值。

The value of abdominal ultrasound in the diagnosis of neonatal necrotizing enterocolitis

Objective To study the diagnostic value of abdomen ultrasound for neonatal necrotizing enterocolitis（ NEC）. Methods From April 2011 to April 2013, we evaluated the sonographic and X-ray findings of abdomen in preterms who were clinically diagnosed of NEC. We performed abdominal ultrasound and X-rays in all patients,and followed up 12 hours later. Any of the signs of thickening of bowel wall,pneumatosis intestinalis and portal venous gas were considered positive.Diagnostic test method was used to evaluate the value of abdominal ultrasound. Results 93 preterms was recruited,including 49 males and 44 females. Their average gestational age was（31. 4 ± 2. 1） weeks,and their mean weight was（1825 ± 236）g. The first examination showed positive sonographic findings in 61 preterm and positive X-ray findings in 52. The sensitivity and specificity were 90. 48% and 54. 9%respectively. The ROC curve showed AUC of 0. 727（95% CI 0. 622- 0. 831）. After 12 hours,69 had positive sonographic findings and 53 X-ray findings. The sensitivity and specificity were 88. 68% and45% respectively. The ROC curve showed AUC of 0. 727（95% CI： 0. 554- 0. 783）. Conclusions Abdominal ultrasonography can be helpful for the early diagnosis and monitoring of patients with NEC.