| 摘要: |
| 目的 探讨肺超声评分（LUS）评估油酸致山羊急性肺损伤（ALI）的诊断价值，为临床早期快速评价ALI提供诊断思路。方法 将16只山羊随机分为轻伤组和重伤组，每组各8只，通过耳缘静脉分别注射不同剂量油酸（轻伤组：0.05 ml/kg；重伤组：0.10 ml/kg）建立相应ALI模型。将山羊双侧胸壁以第5肋为界分为左上、左下、右上及右下4个肺区，分别于致伤前和致伤后1 h、3 h、6 h动态观察两组山羊全肺及各肺区超声表现并进行LUS，绘制受试者工作特征（ROC）曲线分析伤后1 h、3 h、6 h全肺及各肺区LUS评估山羊ALI严重程度的诊断价值。应用血气分析和炎症因子检测分别获得各时间点动脉血气指标[氧分压（PaO2）、氧饱和度（SaO2）和氧合指数（PaO2/FiO2）]和肿瘤坏死因子-α（TNF-α），比较两组上述指标的差异。然后处死山羊，取出全肺观察肺大体损伤情况，取肺组织行病理组织学检查并进行病理损伤评分，计算肺湿干比，分析各肺区LUS与肺湿干比、病理损伤评分的相关性。结果 轻伤组1只山羊于致伤后5 h死亡，余山羊均成功建立油酸诱导山羊ALI模型。各ALI模型致伤后全肺LUS随着时间增加呈逐渐上升趋势，重伤组伤后1 h、3 h、6 h全肺LUS均显著高于轻伤组（均P＜0.05）。分区LUS结果显示，右下肺LUS在伤后各时间点两组之间均存在统计学差异（均P＜0.05），而其他三个肺区LUS在伤后各时间点两组之间均无统计学差异，重伤组左下肺LUS在伤后6 h显著高于左上肺，右下肺LUS在伤后3 h、6h显著高于右上肺（均P＜0.05），轻伤组各区LUS之间无统计学差异。ROC曲线分析显示，伤后各时间点全肺LUS预测ALI严重程度的AUC均＞0.8，致伤后1 h右下肺LUS的预测效能最高（AUC=0.938），但各时间点各肺区AUC之间无统计学差异。轻、重伤组致伤后3 h、6 h PaO2、SaO2、PaO2/FiO2比较差异均有统计学意义（均P＜0.05）。轻、重伤组致伤后随着时间增加TNF-α呈逐渐上升趋势，但与致伤前比较差异均无统计学意义。重伤组肺湿干比显著高于轻伤组（重伤组湿干比：7.36±0.97；轻伤组湿干比：5.86±0.50）（P＜0.01），重伤组全肺病理损伤评分显著高于轻伤组（P＜0.05），分区结果显示，重伤组内左下肺、右下肺的病理损伤评分显著高于左上肺、右上肺，而轻伤组内右下肺病理损伤评分显著高于右上肺（均P＜0.05）。相关性分析显示，伤后6h全肺、左下肺、右上肺及右下肺LUS在伤后6h均与肺湿干比呈正相关（均P＜0.05），各肺区中右下肺r值最高（r=0.634）。肺超声与肺病理损伤评分相关性分析结果显示，伤后6h全肺、左下肺及右下肺LUS均与肺病理损伤评分呈正相关（均P＜0.05），各肺区中右下肺r值最高（r=0.624）。结论 应用LUS可及时评估山羊ALI早期肺损伤程度和变化，具有一定的诊断价值；不同肺区LUS存在差异，其中右下肺与肺损伤程度的相关性更高。 |
| 关键词: 肺超声评分 山羊 油酸 急性肺损伤 诊断效能 |
| DOI： |
| 投稿时间：2023-10-23修订日期：2023-11-27 |
| 基金项目:国家重点研发计划(2023YFC3011801);省部级课题(ALJ18J001);重庆市技术创新与应用示范社会民生类一般项目（cstc2018jscx-msybX0018） |
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| Experimental Study of Lung Ultrasound Score for the Evaluation of Acute Lung Injury Induced by Oleic Acid in Goats |
| ZHANG Yingying,HAN Dong,CHEN Xiao,YANG Huan,LI Guanhua,ZENG Lin,WANG Yuanhua,FANG Jingqin,WANG Jianmin,LI Tao |
| (Department Of Ultrasound Diagnosis,Daping Houspital,Army Military Medical University) |
| Abstract: |
| Objective: This study aimed to investigate the diagnostic efficacy of lung ultrasound score (LUS) in evaluating oleic acid-induced acute lung injury (ALI) in goats, providing insights for the early and rapid assessment of ALI. Methods: Sixteen goats were randomly assigned to mild and severe injury groups, each comprising eight goats. The ALI models were induced by injecting varying doses of oleic acid (0.05 ml/kg for the mild group and 0.10 ml/kg for the severe group) via the ear vein. The goats' bilateral chest walls were divided into four lung regions: upper left, lower left, upper right, and lower right. LUS was conducted on the entire lung and each lung region before and at 1 h, 3 h, and 6 h post-injury. Receiver operating characteristic (ROC) curves were generated to assess the diagnostic value of LUS in determining ALI severity at these time points. Arterial blood gas indicators (partial pressure of oxygen (PaO2), oxygen saturation (SaO2), and oxygenation index (PaO2/FiO2)) and tumor necrosis factor-α (TNF-α) were measured through blood gas analysis and inflammatory factor detection at each time point. The differences in these indicators between the mild and severe injury groups were compared. Subsequently, the goats were euthanized, and the entire lung was extracted for gross examination of lung injury. Lung tissue samples were subjected to pathological histological examination and pathological injury score determination. The lung wet-dry ratio was calculated to analyze the correlation between LUS in each lung region and the lung wet-dry ratio and pathological injury score. Results: One goat in the mild injury group succumbed 5 h after injury, while the remaining goats successfully established the oleic acid-induced goat ALI model. The LUS of the entire lung after injury exhibited a progressive increase over time, with the severe injury group demonstrating significantly higher LUS values than the mild injury group at 1 h, 3 h, and 6 h post-injury (all P＜0.05). Partitioned LUS results revealed a statistically significant difference between the two groups in the right lower lung LUS at each time point post-injury (all P＜0.05). However, no statistical difference was observed in the LUS of the other three lung regions at each time point post-injury. The LUS of the left lower lung in the severe injury group was notably higher than that in the left upper lung after 6 h of injury. Additionally, the LUS of the right lower lung in the severe injury group was significantly higher than that in the right upper lung after 3 h and 6 h of injury (all P＜0.05), with no statistical difference in the LUS of each area in the mild injury group. ROC curve analysis indicated that the area under the curve (AUC) of LUS predicting the severity of ALI in the entire lung at each time point post-injury was ＞0.8. The highest predictive efficacy was observed for the right lower lung LUS at 1 h post-injury (AUC=0.938), although no statistical difference was found between the AUC values of each lung region at each time point. The differences in PaO2, SaO2, and PaO2/FiO2 between the mild and severe injury groups at 3 h and 6 h post-injury were statistically significant (all P ＜0.05). TNF-α increased gradually over time post-injury in both the mild and severe injury groups, but no statistical difference was observed compared to pre-injury levels. The lung wet-dry ratio in the severe injury group was significantly higher than that in the mild injury group (wet-dry ratio of the severe injury group: 7.36 ± 0.97; wet-dry ratio of the mild injury group: 5.86 ± 0.50) (P＜0.01). Furthermore, the pathological injury score of the entire lung in the severe injury group was significantly higher than that in the mild injury group (P＜0.05). Partitioned results revealed that the pathological injury score of the left lower lung and right lower lung in the severe injury group was significantly higher than that of the left upper lung and right upper lung, while the pathological injury score of the right lower lung in the mild injury group was significantly higher than that of the right upper lung (all P＜0.05). Correlation analysis demonstrated that LUS of the entire lung, left lower lung, right upper lung, and right lower lung at 6 h post-injury were positively correlated with the lung wet-dry ratio (all P＜0.05), with the right lower lung exhibiting the highest correlation coefficient among all lung regions (r=0.634). Correlation analysis demonstrated that LUS of the entire lung, left lower lung, and right lower lung at 6 h post-injury were positively correlated with the pathological injury score of the lung (all P＜0.05), with the right lower lung exhibiting the highest correlation coefficient among all lung regions (r=0.624). Conclusion: Lung ultrasound score (LUS) proves effective in promptly assessing the degree and progression of early lung injury in goats with ALI, offering valuable diagnostic insights. Variations in LUS exist among different lung regions, with a higher correlation observed between the right lower lung and the degree of lung injury. |
| Key words: Lung ultrasound score Goats Oleic acid Acute lung Injury Diagnostic efficiency |
