成人支原体肺炎HRCT表现与抗体滴度值的相关性研究
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摘要
目的找到成人支原体肺炎患者初次就诊时的HRCT表现与抗体滴度值的某种相关性,提高成人支原体肺炎早期诊断的准确性。方法选取临床及血清学证实的103例成人支原体肺炎患者,回顾性分析患者初诊时的抗体滴度值及HRCT表现。结果 78例初诊抗体滴度值分别为1:80、1:160及1:320的成人支原体肺炎患者HRCT表现均为混合型明显高于单纯型(P<0.05)。磨玻璃密度影、小斑片状影及支气管壁厚明显多于余下其他类型(P<0.05)。其中抗体滴度值为1:80组没有出现大片状实变影,小斑片状影又多于磨玻璃密度影及支气管壁厚(P<0.05)。1∶320组与1∶160组相比,各征象出现几率差异缩小。25例初诊抗体滴度值为1∶640的患者HRCT表现混合型与单纯型无统计学差异(P>0.05)。树芽征、支气管壁厚、磨玻璃密度影、小斑片状影及大片实变影无统计学差异(P>0.05)。病灶分布情况,抗体滴度值1∶80及1∶320组单肺明显多于双肺(P<0.05)。抗体滴度值1:160及1:640组右肺下叶明显高于右肺上叶或右肺中叶(P<0.05)。但双肺下叶比较无统计学差异(P>0.05)。结论支原体肺炎影像学表现本身缺乏特异性,但通过对支原体肺炎患者初次抗体滴度值与HRCT表现结合的方式进行分析可以提高对本疾病的敏锐度,一旦怀疑,积极治疗,减少漏诊与误诊。
Objective To find out a certain correlation between HRCT performance and antibody titer value in the first visit of adult mycoplasma pneumonia patients, so as to improve the accuracy of early diagnosis of adult mycoplasma pneumonia. Methods 103 cases of adult mycoplasmal pneumonia confirmed by clinical and serological examination were retrospectively analyzed, and the antibody titers and HRCT findings of patients at the initial diagnosis were retrospectively analyzed. Results The HRCT appearances of 78 cases of adult mycoplasma pneumonia, whose initial antibody titers were 1 ∶80, 1 ∶160 and 1 ∶320, showed that mixed type significantly higher than simple type(P<0.05). Ground glass density, patchy shadow and bronchial wall thickness were significantly more than the rest(P<0.05). The antibody titer value of the group 1 ∶80 did not show massive consolidation, and the patchy shadow was more than ground glass density and bronchial wall thickness(P<0.05). When the group 1 ∶320 was compared with the group 1 ∶160, the probability difference decreased. There was no significant difference in the HRCT performance among the 25 patients with 1 ∶640 in the initial antibody titers(P>0.05). There was no significant difference in tree bud sign, bronchial wall thickness, ground glass density, small patch shape and large consolidation lesions(P>0.05). In the groups with the initial antibody titers 1 ∶80 and 1 ∶320, the distribution of lesions in single lung was more than that of double lung(P<0.05). In the groups with the initial antibody titers 1 ∶160 and 1 ∶640, the distribution of lesions in the right inferior lobe was more than those in the right upper lobe or the right middle one(P<0.05). However, there was no significant difference between the lower lobes of both lungs(P>0.05). Conclusion The imaging findings of mycoplasma pneumonia are lacking in specificity. But through the analysis of the combination of the initial antibody titer value of mycoplasma pneumonia and the HRCT expression, it can improve the acuity of the disease. Once suspected, active treatment can reduce missed diagnosis and misdiagnosis.
Objective To find out a certain correlation between HRCT performance and antibody titer value in the first visit of adult mycoplasma pneumonia patients, so as to improve the accuracy of early diagnosis of adult mycoplasma pneumonia. Methods 103 cases of adult mycoplasmal pneumonia confirmed by clinical and serological examination were retrospectively analyzed, and the antibody titers and HRCT findings of patients at the initial diagnosis were retrospectively analyzed. Results The HRCT appearances of 78 cases of adult mycoplasma pneumonia, whose initial antibody titers were 1 ∶80, 1 ∶160 and 1 ∶320, showed that mixed type significantly higher than simple type(P<0.05). Ground glass density, patchy shadow and bronchial wall thickness were significantly more than the rest(P<0.05). The antibody titer value of the group 1 ∶80 did not show massive consolidation, and the patchy shadow was more than ground glass density and bronchial wall thickness(P<0.05). When the group 1 ∶320 was compared with the group 1 ∶160, the probability difference decreased. There was no significant difference in the HRCT performance among the 25 patients with 1 ∶640 in the initial antibody titers(P>0.05). There was no significant difference in tree bud sign, bronchial wall thickness, ground glass density, small patch shape and large consolidation lesions(P>0.05). In the groups with the initial antibody titers 1 ∶80 and 1 ∶320, the distribution of lesions in single lung was more than that of double lung(P<0.05). In the groups with the initial antibody titers 1 ∶160 and 1 ∶640, the distribution of lesions in the right inferior lobe was more than those in the right upper lobe or the right middle one(P<0.05). However, there was no significant difference between the lower lobes of both lungs(P>0.05). Conclusion The imaging findings of mycoplasma pneumonia are lacking in specificity. But through the analysis of the combination of the initial antibody titer value of mycoplasma pneumonia and the HRCT expression, it can improve the acuity of the disease. Once suspected, active treatment can reduce missed diagnosis and misdiagnosis.
引文
[1]YU Y,FEI A.Atypical pathogen infection in community-acquired pneumonia[J].Biosci Trends,2016,10(1):7-13.
[2]THACKER W L,TALKINGTON D F.Analysis of complement fixation and commercial enzyme immunoassays for detection of antibodies to Mycoplasma pneumoniae in human serum[J].Clin Diagn Lab Immunol,2000,7(5):778-780.
[3]张海邻,陈志敏,刘瀚旻,等.肺炎支原体感染的致病机制[J].中华儿科杂志,2016,54(2):94-97.
[4]付晓燕,辛德莉,秦选光.儿童肺炎支原体感染流行病学、临床特点、发病机制及治疗研究进展[J].山东医药,2015,55(4):96-99.
[5]王红连,徐进.儿童难治性肺炎支原体肺炎危险因素及支原体耐药的相关性分析[J].临床肺科杂志,2016,21(4):678-682.
[6]刘可娜,秦翠梅,尚艳梅.医院近五年肺炎支原体耐药性研究[J].中华医院感染学杂志,2018,28(3):333-335,339.
[7]刘学娟,张晓鹏,刘振疆.113例老年支原体肺炎的临床表现及影像学特点[J].临床肺科杂志,2017,22(2):266-269.
[8]谭晔,潘纪戍,杨正汉.成人肺炎支原体肺炎的CT表现[J].中华放射学杂志,2002,36(12):1112-1114.
[9]何洪浩.老年人支原体肺炎的CT表现[J].广东医学,2013,34(8):1252-1254.
[10]贾秀芬,翁晓明,叶彩儿,等.高龄患者支原体肺炎CT诊断的临床分析[J].中华医院感染学杂志,2013,23(24):5986-5987,5990.
[11]张晓晔,张伟,朱敏,等.成人支原体肺炎的CT影像表现[J].中国医学影像技术,2007,23(7):1026-1029.
[12]NEI T,YAMANO Y,SAKAI F,et al.Mycoplasma pneumoniae pneumonia:differential diagnosis by computerized tomography[J].Intern Med,2007,46(14):1083-1087.
[13]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[S].中华结核和呼吸杂志,2016,39(4):253-279.
[2]THACKER W L,TALKINGTON D F.Analysis of complement fixation and commercial enzyme immunoassays for detection of antibodies to Mycoplasma pneumoniae in human serum[J].Clin Diagn Lab Immunol,2000,7(5):778-780.
[3]张海邻,陈志敏,刘瀚旻,等.肺炎支原体感染的致病机制[J].中华儿科杂志,2016,54(2):94-97.
[4]付晓燕,辛德莉,秦选光.儿童肺炎支原体感染流行病学、临床特点、发病机制及治疗研究进展[J].山东医药,2015,55(4):96-99.
[5]王红连,徐进.儿童难治性肺炎支原体肺炎危险因素及支原体耐药的相关性分析[J].临床肺科杂志,2016,21(4):678-682.
[6]刘可娜,秦翠梅,尚艳梅.医院近五年肺炎支原体耐药性研究[J].中华医院感染学杂志,2018,28(3):333-335,339.
[7]刘学娟,张晓鹏,刘振疆.113例老年支原体肺炎的临床表现及影像学特点[J].临床肺科杂志,2017,22(2):266-269.
[8]谭晔,潘纪戍,杨正汉.成人肺炎支原体肺炎的CT表现[J].中华放射学杂志,2002,36(12):1112-1114.
[9]何洪浩.老年人支原体肺炎的CT表现[J].广东医学,2013,34(8):1252-1254.
[10]贾秀芬,翁晓明,叶彩儿,等.高龄患者支原体肺炎CT诊断的临床分析[J].中华医院感染学杂志,2013,23(24):5986-5987,5990.
[11]张晓晔,张伟,朱敏,等.成人支原体肺炎的CT影像表现[J].中国医学影像技术,2007,23(7):1026-1029.
[12]NEI T,YAMANO Y,SAKAI F,et al.Mycoplasma pneumoniae pneumonia:differential diagnosis by computerized tomography[J].Intern Med,2007,46(14):1083-1087.
[13]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[S].中华结核和呼吸杂志,2016,39(4):253-279.