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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。
Objective To investigate the value of abdominal ultrasound in the diagnosis of neonatal necrotizing enterocolitis (NEC). Methods From April 2011 to April 2013, our hospital neonates admitted to clinical suspect NEC preterm infants, children diagnosed with suspected NEC routine lateral abdomen X-ray and abdominal B-ultrasound, and after 12 h Reexamination of X-ray and abdomen B-super, in order to appear intestinal wall thickening, intestinal wall gas, portal vein gas in any one of the positive results, did not appear sentenced negative results. Diagnostic test was used to evaluate the diagnostic value of abdominal ultrasonography in NEC with sensitivity, specificity, accuracy and ROC curve. Results A total of 93 suspected NEC preterm infants were enrolled. There were 49 males and 44 females, gestational age (31.4 ± 2.1) weeks and weight (1825 ± 236) g. The sensitivity and specificity of abdominal ultrasonography were 90.5% and 54.9% respectively, the accuracy was 66.6% and the area under the ROC curve (AUC) was 0.727 (P < 95% CI 0.622 ~ 0.831). The sensitivity and specificity of abdominal ultrasonography were 88.7% and 45.0% respectively, accuracy was 74.2%, AUC = 0.668 (95% CI 0.554 ~ 0.783 ). Conclusion The clinical manifestations of abdominal B-ultrasound may be superior to the Bell method in the diagnosis of NEC, which has important clinical value.