肺部超声在成人肺炎、急性心衰、慢性阻塞性肺疾病／哮喘急性加重的紧急诊断中的应用：系统评价及Meta分析
2018/10/24
摘要
背景：肺部超声能够加速合并气道症状的成人的危及生命的疾病的诊断。
目的：系统评价肺部超声在成人肺炎、急性心衰、慢性阻塞性肺疾病／哮喘急性加重诊断的应用。
方法：利用PubMed，Embase，Scopus，Web of Science和LILACS进行了前瞻性诊断准确性研究。Rutter-Gatsonis分层汇总ROC曲线方法用于评估肺部超声的总体准确性，Reitsma双变量模型来评估不同超声信号的准确性。
结果：纳入的25项研究中：14项评估肺炎，14项评估急性心衰以及4项评估慢性阻塞性肺疾病／哮喘急性加重。所对应的ROC曲线分别为肺炎0.984、急性心力衰竭0.914、慢阻肺／哮喘急性加重0.906。在考虑肺炎的患者中，强回声的敏感度及特异度分别为0.82(95%可信区间0.74-0.88)及0.93(95%可信区间0.85-0.98)。在急性心衰呼吸困难的患者中，弥漫性病变的敏感度及特异度分别为0.9(95%可信区间0.87-0.93)及0.93(95%可信区间0.91-0.95)，而在COPD/哮喘急性加重的呼吸衰竭的患者中，排除PLAPS的A线敏感度及特异度分别为0.93(95%可信区间0.72-0.98)及0.92(95%可信区间0.79-0.97)。
结论：肺部超声是肺炎，急性心力衰竭和COPD /哮喘急性加重的紧急诊断的准确工具。
Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis.
Staub LJ, Mazzali Biscaro RR
Abstract
BACKGROUND: Lung ultrasound can accelerate the diagnosis of life-threatening diseases in adults with respiratory symptoms.
OBJECTIVE: Systematically review the accuracy of lung ultrasonography (LUS) for emergency diagnosis of pneumonia, acute heart failure, and exacerbation of chronic obstructive pulmonary disease (COPD)/asthma in adults.
METHODS: PubMed, Embase, Scopus, Web of Science, and LILACS (Literatura Latino Americana e do Caribe em Ciências da Saúde; until 2016) were searched for prospective diagnostic accuracy studies. Rutter-Gatsonis hierarchical summary receiver operating characteristic method was used to measure the overall accuracy of LUS and Reitsma bivariate model to measure the accuracy of the different sonographic signs. This review was previously registered in PROSPERO (Centre for Reviews and Dissemination, University of York, York, UK; CRD42016048085).
RESULTS: Twenty-five studies were included: 14 assessing pneumonia, 14 assessing acute heart failure, and four assessing exacerbations of COPD/asthma. The area under the summary receiver operating characteristic curve of LUS was 0.948 for pneumonia, 0.914 for acute heart failure, and 0.906 for exacerbations of COPD/asthma. In patients suspected to have pneumonia, consolidation had sensitivity of 0.82 (95% confidence interval [CI] 0.74-0.88) and specificity of 0.94 (95% CI 0.85-0.98) for this disease. In acutely dyspneic patients, modified diffuse interstitial syndrome had sensitivity of 0.90 (95% CI 0.87-0.93) and specificity of 0.93 (95% CI 0.91-0.95) for acute heart failure, whereas B-profile had sensitivity of 0.93 (95% CI 0.72-0.98) and specificity of 0.92 (95% CI 0.79-0.97) for this disease in patients with respiratory failure. In patients with acute dyspnea or respiratory failure, the A-profile without PLAPS (posterior-lateral alveolar pleural syndrome) had sensitivity of 0.78 (95% CI 0.67-0.86) and specificity of 0.94 (95% CI 0.89-0.97) for exacerbations of COPD/asthma.
CONCLUSION: Lung ultrasound is an accurate tool for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of COPD/asthma.
背景：肺部超声能够加速合并气道症状的成人的危及生命的疾病的诊断。
目的：系统评价肺部超声在成人肺炎、急性心衰、慢性阻塞性肺疾病／哮喘急性加重诊断的应用。
方法：利用PubMed，Embase，Scopus，Web of Science和LILACS进行了前瞻性诊断准确性研究。Rutter-Gatsonis分层汇总ROC曲线方法用于评估肺部超声的总体准确性，Reitsma双变量模型来评估不同超声信号的准确性。
结果：纳入的25项研究中：14项评估肺炎，14项评估急性心衰以及4项评估慢性阻塞性肺疾病／哮喘急性加重。所对应的ROC曲线分别为肺炎0.984、急性心力衰竭0.914、慢阻肺／哮喘急性加重0.906。在考虑肺炎的患者中，强回声的敏感度及特异度分别为0.82(95%可信区间0.74-0.88)及0.93(95%可信区间0.85-0.98)。在急性心衰呼吸困难的患者中，弥漫性病变的敏感度及特异度分别为0.9(95%可信区间0.87-0.93)及0.93(95%可信区间0.91-0.95)，而在COPD/哮喘急性加重的呼吸衰竭的患者中，排除PLAPS的A线敏感度及特异度分别为0.93(95%可信区间0.72-0.98)及0.92(95%可信区间0.79-0.97)。
结论：肺部超声是肺炎，急性心力衰竭和COPD /哮喘急性加重的紧急诊断的准确工具。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（J Emerg Med.2018 Oct 9. S0736-4679(18)30925-9.）
（J Emerg Med.2018 Oct 9. S0736-4679(18)30925-9.）
Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis.
Staub LJ, Mazzali Biscaro RR
Abstract
BACKGROUND: Lung ultrasound can accelerate the diagnosis of life-threatening diseases in adults with respiratory symptoms.
OBJECTIVE: Systematically review the accuracy of lung ultrasonography (LUS) for emergency diagnosis of pneumonia, acute heart failure, and exacerbation of chronic obstructive pulmonary disease (COPD)/asthma in adults.
METHODS: PubMed, Embase, Scopus, Web of Science, and LILACS (Literatura Latino Americana e do Caribe em Ciências da Saúde; until 2016) were searched for prospective diagnostic accuracy studies. Rutter-Gatsonis hierarchical summary receiver operating characteristic method was used to measure the overall accuracy of LUS and Reitsma bivariate model to measure the accuracy of the different sonographic signs. This review was previously registered in PROSPERO (Centre for Reviews and Dissemination, University of York, York, UK; CRD42016048085).
RESULTS: Twenty-five studies were included: 14 assessing pneumonia, 14 assessing acute heart failure, and four assessing exacerbations of COPD/asthma. The area under the summary receiver operating characteristic curve of LUS was 0.948 for pneumonia, 0.914 for acute heart failure, and 0.906 for exacerbations of COPD/asthma. In patients suspected to have pneumonia, consolidation had sensitivity of 0.82 (95% confidence interval [CI] 0.74-0.88) and specificity of 0.94 (95% CI 0.85-0.98) for this disease. In acutely dyspneic patients, modified diffuse interstitial syndrome had sensitivity of 0.90 (95% CI 0.87-0.93) and specificity of 0.93 (95% CI 0.91-0.95) for acute heart failure, whereas B-profile had sensitivity of 0.93 (95% CI 0.72-0.98) and specificity of 0.92 (95% CI 0.79-0.97) for this disease in patients with respiratory failure. In patients with acute dyspnea or respiratory failure, the A-profile without PLAPS (posterior-lateral alveolar pleural syndrome) had sensitivity of 0.78 (95% CI 0.67-0.86) and specificity of 0.94 (95% CI 0.89-0.97) for exacerbations of COPD/asthma.
CONCLUSION: Lung ultrasound is an accurate tool for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of COPD/asthma.
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分析毛发以监测哮喘或COPD患者使用吸入药物的依从性
