胸部CT鉴别小儿MP肺炎与MP并SP肺炎的价值探析
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摘要
目的探析小儿支原体肺炎(MP感染与MP并链球菌属肺炎(SP)感染使用胸部CT鉴别应用价值。方法回顾性分析我院2015年6月-2018年6月收治83例MP患儿资料,均行链球菌血培养和血清MP-Ig检查,依据检查结果将40例单纯MP患儿纳入MP组,43例MP合并SP患儿纳入MP-SP组。两组患儿均接受胸部CT检查,分析两组患儿胸部CT表现,比较两组患儿淋巴结出现结影与胸腔积液,胸部CT征象,肺部发生病变情况。结果 MP组患儿胸腔积液发生率显著低于MP-SP组患儿(P<0.05),MP组患儿淋巴结结影平均横径和胸腔积液厚度小于MP-SP组患儿,差异具有统计学意义(P<0.05);MP组患儿胸部CT支气管血管束增厚、网状影、磨玻璃影和支气管壁增厚等征相发生率显著高于MP-SP组患儿(P<0.05);MP组患儿肺部发生病变情况如无规律肺内实变影发生率低于MP-SP组,而扇形薄片影发生率高于MP-SP组患儿,两组之间差异显著(P<0.05)。结论 MP患儿肺部病变主要由于间质性病变,而MP并SP患者肺部病变则是由肺泡炎症所致,其是鉴别两种肺炎依据之一。
Objective To investigate the application value of chest CT in identifying mycoplasma pneumonia(MP) infection and MP combined with streptococcus pneumonia(SP) infection in children. Methods A retrospective analysis was performed on the data of83 children with MP in the hospital from June 2015 to June 2018. all of them underwent streptococcal blood culture and serum MP-Ig examination. According to the examination results, 40 children with MP were included in the MP group. 43 children with MP combined with SP were included in the MP-SP group. Both groups underwent chest CT examination, and the findings were analyzed. The incidence of lymph node shadow and pleural effusion, chest CT signs and incidence of lung lesions were compared between the two groups. Results The incidence of pleural effusion in MP group was significantly lower than that in MP-SP group(P<0.05). The mean transverse diameter of lymph node shadow and pleural effusion thickness of MP group were smaller than those of MP-SP group(P<0.05). The incidence rates of chest CT bronchial vascular bundle thickening,reticular shadow, ground glass shadow and bronchial wall thickening in MP group were significantly higher than those in MP-SP group(P<0.05). The incidence of lung lesions like irregular consolidation in the lung in MP group was lower than that in MPSP group while the incidence of fan-shaped thin shadow was higher than that in MPSP group(P<0.05). Conclusion Lung lesions in children with MP are mainly caused by interstitial lesions, while lung lesions in children with MP and SP are caused by alveolar inflammation, which is one of the criteria for identifying the two kinds of pneumonia.
Objective To investigate the application value of chest CT in identifying mycoplasma pneumonia(MP) infection and MP combined with streptococcus pneumonia(SP) infection in children. Methods A retrospective analysis was performed on the data of83 children with MP in the hospital from June 2015 to June 2018. all of them underwent streptococcal blood culture and serum MP-Ig examination. According to the examination results, 40 children with MP were included in the MP group. 43 children with MP combined with SP were included in the MP-SP group. Both groups underwent chest CT examination, and the findings were analyzed. The incidence of lymph node shadow and pleural effusion, chest CT signs and incidence of lung lesions were compared between the two groups. Results The incidence of pleural effusion in MP group was significantly lower than that in MP-SP group(P<0.05). The mean transverse diameter of lymph node shadow and pleural effusion thickness of MP group were smaller than those of MP-SP group(P<0.05). The incidence rates of chest CT bronchial vascular bundle thickening,reticular shadow, ground glass shadow and bronchial wall thickening in MP group were significantly higher than those in MP-SP group(P<0.05). The incidence of lung lesions like irregular consolidation in the lung in MP group was lower than that in MPSP group while the incidence of fan-shaped thin shadow was higher than that in MPSP group(P<0.05). Conclusion Lung lesions in children with MP are mainly caused by interstitial lesions, while lung lesions in children with MP and SP are caused by alveolar inflammation, which is one of the criteria for identifying the two kinds of pneumonia.
引文
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[1 3]高岭,韩军,程成,等.小儿支原体肺炎合并胸腔积液体内D-二聚体、降钙素原、C-反应蛋白变化研究[J].中国儿童保健杂志,2 01 6,24(2):185-188.
[14]郭美玲,王月训,郭丽,等.小儿肺炎支原体肺炎与链球菌属感染肺炎的CT鉴别诊断[J].中华医院感染学杂志,2015,25(2):443-445.
[15]李晓岚.血清降钙素原在各种肺炎患儿鉴别诊断与治疗中的临床价值[J].临床肺科杂志,2015,20(1):90-91.
[2]Keller L E,Ashley R D,Mcdaniel L S.Nonencapsula tedS treptococcus pneumoniae:Emergence and Pathogenesi s[J].Mbio,2016,7(2):e01792.
[3]王盈红,曹小彩,宋文涛,等.细菌和病毒混合感染对儿童社区获得性肺炎的影响[J].临床儿科杂志,2016,34(5):342-347.
[4]陈霞,侯振洲,崔喜英,等.肺炎支原体肺炎患儿的胸部CT影像学特点及临床诊断[J].中国妇幼保健,2015,30(12):1865-1866.
[5]张义堂,王中晓,杨红,张伟东,吕亚洲,刘平.支原体肺炎与肺炎链球菌性肺炎儿童的CT表现差异分析[J].中国CT和MRI杂志,2018,16(1):63-65.
[6]中华医学会儿科学分会呼吸学组.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.
[7]陈春晖,房涛,王道建,等.46例小儿支原体肺炎胸部CT比较分析[J].中国CT和MRI杂志,2 01 5,1 3(4):33-35.
[8]Elemraid M A,Rush ton S P,Clark J E,et al.A case-control study to assess the urinary pneumococcal antigen test in childhood pneumonia[J].Clinical Pediatrics,2014,53(3):286-288.
[9]吕利英,吕哲昊,吕祎梅,等. 126例不同年龄段儿童支原体肺炎的胸部CT影像学特征[J].临床肺科杂志,2017,22(2):294-298.
[10]贾莅彦,张剑,何朝晖.CT在小儿支原体肺炎和链球菌属感染肺炎的诊断价值比较[J].检验医学与临床,2 017,14(18):2718-2719.
[11]杨云,王卫中,田静,等.小儿肺炎链球菌肺炎治疗后临床效果和影像学特点[J].河北医药,2 01 7,39(21):3261-3264.
[12]王淑英,牟月芝,李宏伟,等.儿童支原体肺炎与肺炎链球菌性肺炎的CT表现及鉴别诊断[J].中华医院感染学杂志,2015,25(13):3092-3093.
[1 3]高岭,韩军,程成,等.小儿支原体肺炎合并胸腔积液体内D-二聚体、降钙素原、C-反应蛋白变化研究[J].中国儿童保健杂志,2 01 6,24(2):185-188.
[14]郭美玲,王月训,郭丽,等.小儿肺炎支原体肺炎与链球菌属感染肺炎的CT鉴别诊断[J].中华医院感染学杂志,2015,25(2):443-445.
[15]李晓岚.血清降钙素原在各种肺炎患儿鉴别诊断与治疗中的临床价值[J].临床肺科杂志,2015,20(1):90-91.