肺炎支原体肺炎患儿HRCT征象与病情严重程度及预后的相关性

Correlation between HRCT signs and severity and prognosis in children with mycoplasma pneumoniae pneumonia

目的探讨肺炎支原体肺炎(MPP)患儿高分辨率CT(HRCT)征象与病情严重程度及预后的相关性。方法收集2015年1月至2018年1月聊城市第二人民医院收治的218例急性期MPP患者,依据临床肺部感染评分(CPIS)分为重症组(CPIS评分>6分)90例,轻症组(CPIS评分≤6分)128例;另选取同期来本院体检的50例健康儿童作为对照组。所有研究对象经HRCT扫描,HRCT征象分为大叶性肺炎、小叶性肺炎和支气管肺炎,并取血检测血清白细胞介素-6(IL-6)、IL-10和肿瘤坏死因子-α(TNF-α)水平。所有患儿经阿奇霉素治疗,评估术后疗效。分析MPP患者HRCT征象与病情严重程度及预后的相关性。结果重症组患儿IL-6、TNF-α水平分别为(94.31±12.60)、(33.71±4.50)pg/mL,均高于轻症组(64.30±9.81)、(22.13±4.11)pg/mL和对照组(11.20±3.51)、(12.52±2.40)pg/mL;而IL-10水平为(8.52±2.50)pg/mL,低于轻症组(14.31±3.81)pg/mL和对照组(23.41±5.30)pg/mL;且轻症组患儿IL-6、TNF-α水平高于对照组,IL-10水平低于对照组,差异均有统计学意义(P<0.05)。重症、轻症和对照组间HRCT征象(支气管肺炎、小叶性肺炎、大叶性肺炎)比较差异亦有统计学意义(P<0.05)。重症组患儿治疗后有效率为81.1%,低于轻症组患儿的95.3%,差异有统计学意义(P<0.05)。MPP的HRCT征象(支气管肺炎、小叶性肺炎、大叶性肺炎)与IL-6、TNF-α、CPIS评分呈显著正相关(r=0.62、0.64、0.64,P=0.00、0.01、0.00),与IL-10、预后(无效、进展、显效、痊愈)呈显著负相关(r=-0.47、-0.42,P=0.01、0.00)。结论MPP的HRCT征象能在一定程度上反映患儿血清炎症因子水平和病情严重程度,并能有效预测预后。

Objective To explore the relationship of high-resolutin computed tomogra-phy(HRCT)manifestation of mycoplasma pneumoniae pneumonia with severity of illness.Methods 218 patients with acute MPP admitted from January 2015 to January 2018 were divided into mild(CPIS score≤6 points,128 cases)and severe(CPIS score>6 points,90 cases)MPP according to the clinical pulmonary infection score(CPIS).50 healthy children with physical examination of the same period were chosen as control group.All subjects were scanned by HRCT,and they were divided into lobar pneumonia,lobular pneumonia and bronchopneumonia with HRCT signs.Blood levels of serum interleuk-6(IL-6),IL-10 and tumor necrosis factor-α(TNF-α)were measured.All patients were treated with azithromycin to evaluate postoperative outcomes.The correlation between HRCT signs and severity of disease and prognosis in patients with MPP was analyzed.Results Serum levels of IL-6,IL-10,TNF-αand HRCT signs(bronchial pneumonia,lobular pneumonia,lobar pneumonia)were significantly different between the severe,mild patients and control group,and any two groups(P<0.05).The total effective rate of severe children was lower than mild children(P<0.05).The HRCT signs of MPP(bronchial pneumonia,lobular pneumonia,lobar pneumonia)were significantly positively correlated with IL-6,TNF-α,and CPIS scores(r=0.62,0.64,0.64,P=0.00,0.01,0.00),and were negatively correlated with IL-10,prognosis(invalid,progression,markedly effective,recovery)(r=-0.47,-0.42,P=0.01,0.00).Conclusions The HRCT signs of MPP could reflect the level of serum inflammatory factors and the severity of the disease to some extent.HRCT has important application value for evaluating its prognosis.