天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (10): 1068-1071.doi: 10.11958/20170280

• 临床研究 • 上一篇    下一篇

胃液稳定微泡实验早期诊断早产儿肺透明膜病价值探讨

付扬喜 1，唐振 2，欧阳志翠 2，程光清 1△   

  1. 1 陕西省安康市中心医院新生儿科（邮编 725000）；2 中南大学湘雅三医院新生儿科
  • 收稿日期:2017-03-06 修回日期:2017-08-13 出版日期:2017-10-15 发布日期:2017-10-13
  • 通讯作者: 付扬喜 E-mail:839277118@qq.com
  • 作者简介:付扬喜（1975），男，博士，主治医师，主要从事新生儿神经方面研究

Investigation of the value of stable micro bubble test for early diagnosis of hyaline membrane disease in premature infants

FU Yang-xi1, TANG Zhen2, OUYANG Zhi-cui2, CHENG Guang-qing1△   

  1. 1 Newborn Department of Ankang City Central Hospital of Shaanxi Province, Ankang 725000, China； 2 Newborn Department of the Third Xiangya Hospital of Central South, University Changsha
  • Received:2017-03-06 Revised:2017-08-13 Published:2017-10-15 Online:2017-10-13

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摘要： 目的 探讨胃液稳定微泡实验（SMT）早期诊断早产儿肺透明膜病（HMD）的价值，为早期干预早产儿肺透 明膜病提供临床诊断方法。方法 选取 2013 年 1 月 1 日—2016 年 1 月 1 日在我院新生儿重症监护病房（NICU）住 院的 288 例早产儿作为研究对象，生后 30 min 内抽取初次胃液 1～2 mL 行 SMT 检查，低倍镜下数出每 mm2中直径< 15 μm 的稳定微泡数，以临床症状及生后 6 h 内胸 X 线片结果作为诊断早产儿肺透明膜病的金标准，将早产儿分为 病例组及对照组。比较 2 组一般资料情况，通过受试者工作特征（ROC）曲线确定诊断最佳临界稳定微泡数值。并分 别以微泡数<5 个/mm2，<10 个/mm2，<15 个/mm2及<20 个/mm2作为界值，计算诊断 HMD 的敏感度、特异度、阳性预测 值和阴性预测值。结果 288 例早产儿中确诊为肺透明膜病者 91 例（31.6%），非肺透明膜病者 197 例（68.4%）；病例 组较对照组胎龄小、出生体质量低、男婴所占比例较高（P＜0.05），2 组产前激素使用、胎膜早破、剖宫产的比例以及 5 min Apgar 评分差异均无统计学意义；微泡数为 15 个/mm2 是诊断早产儿肺透明膜病最佳临界值，曲线下面积 （AUC）为 0.80（0.73～0.84）。以微泡数<5 个/mm2诊断新生儿肺透明膜病符合者最多，为 38 例；以 10～15 个/mm2诊 断新生儿肺透明膜病符合者 16 例。胃液微泡数<15 个/mm2预测早产儿肺透明膜病的敏感度、特异度、阳性预测值、 阴性预测值及约登指数分别为 89.0%、91.4%、82.7%、94.7%及 80.4%，可作为预测 HMD 的指标。结论 SMT 法简 便、快速、经济，敏感度高，特异性好，能有效预测并早期诊断早产儿肺透明膜病，具备较高的临床应用价值。

关键词: 透明膜病, 婴儿, 早产, 疾病, 肺疾病, 早期诊断, ROC 曲线, 胃液稳定微泡实验

Abstract: Objective To explore the value of stable micro bubble test (SMT) for early diagnosis of hyaline membrane disease (HMD), and to provide early intervention for clinical diagnosis method of hyaline membrane disease in premature infants. Methods A total of 288 premature infants admitted to neonatal intensive care unit (NICU) of Ankang City Central Hospital from January 1st, 2013 to January 1st, 2016 were involved into the study. The primary gastric juice 1-2 mL was extracted for SMT test within 30 minutes after the birth. The number of the stable micro bubble with diameter < 15 μm was counted by low magnification. The clinical symptoms and X-ray results within 6 h after the birth were used as the gold standard of diagnosis of HMD. The premature infants were divided into the case group and control group. The general information was compared between two groups. The optimal critical stable micro bubble value was determined by the ROC curve. The number of micro bubbles <5/mm2, <10/mm2, <15/mm2 and <20/mm2 were used as the threshold, and the sensitivity, specificity, positive and negative predictive values were calculated for HMD diagnosis. Results Among the 288 cases of premature infants, 91 cases (31.6%) were diagnosed as HMD, 197 cases (68.4%) were diagnosed as non HMD. There were lower gestational age, lower birth weight and more proportion of male babies in the case group compared with those of control group (P＜0.05). There were no significant differences in prenatal usage of hormones, premature rupture of membranes, the proportion of cesarean section and 5-min Apgar scores between two groups. The number of micro bubbles of 15/mm2 was the optimal threshold for diagnosis of HMD, and AUC was 0.80 (0.73-0.84). When the number of micro bubbles of 5/mm2 was used for the diagnosis, 38 cases were in line with the diagnosed as HMD. When the number of micro bubbles of 10-15/mm2 was used for the diagnosis, 16 cases were in line with diagnosed as HMD. The number of micro bubbles of <15/ mm 2 was used as boundary value of HMD. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index for SMT prediction and early diagnosis of HMD were 89.0%, 91.4%, 82.7%, 94.7% and 80.4%, which can be used as predictive indicators of HMD. Conclusion SMT test is simple, rapid, economic, high sensitivity and good specificity, which can effectively predict and early diagnose HMD, and have high clinical value.

Key words: hyaline membrane disease, infant, premature, diseases, lung diseases, early diagnosis, ROC curve, stablemicrobubble test