婴幼儿弥漫性肺疾病的高分辨率CT表现

High resolution computed tomographic findings in infants with diffuse lung disease

目的 探讨婴幼儿弥漫性肺疾病（DLD）的高分辨率CT（HRCT）表现.方法 回顾性分析2010至2013年首都儿科研究所附属儿童医院收治的75例＜2岁弥漫性肺疾病患儿的肺部HRCT影像资料.75例患儿中男56例,女19例,男∶女=2.9∶1;年龄2 d～24个月,平均10.9个月.根据临床或病理检查结果将病例分为：（1）“全身型疾病相关组”（30例）、（2）“肺泡结构破坏相关组”（23例）、（3）“婴幼儿特有疾病组”（22例）.观察并比较各组患儿HRCT出现气道病变、间质病变以及气腔病变征象的情况.结果 3组患儿HRCT均可见支气管扩张[（1）、（2）、（3）组顺序例数（后同）为3例、16例和1例]、支气管壁增厚（4例、11例和10例）、马赛克征（2例、14例和12例）、网状阴影（23例、8例和16例）、小叶中心阴影（20例、7例和6例）和肺实变（1例、9例和10例）,3组间各征象出现例数差异有统计学意义（x2=24.52、6.08、18.00、12.56、9.11和11.50,P均＜0.05）,而支气管变形（1例、4例和1例）、间质气漏（20例、10例和12例）和磨玻璃阴影（18例、18例和15例）等征象的出现例数差异无统计学意义.结论 不同类型婴幼儿DLD患儿肺部HRCT表现具有一定特征.与其他两组疾病相比,“全身型疾病相关组”以肺叶内小叶中心阴影增多最常见,较少出现支气管壁增厚、肺内实变和马赛克征;“肺泡结构破坏相关组”以支气管扩张最常见,少见网状阴影;“婴幼儿特有疾病组”的HRCT无突出特点,但结合围产期病史和临床表现,有助于临床医生对疾病病因作出更准确判断.

Objective To investigate the high-resolution computed tomographic （HRCT） features of infants with diffuse lung disease （DLD） for improving the diagnostic accuracy clinically.Method Totally 75 infants under 2 years of age with DLD （2010-2013） were involved in this study.Among them,56 were males and 19 females,aged from 2 days to 24 months （mean age was 10.9 months）.According to the clinical or pathological data,the cases were enrolled into three groups,including systemic diseasesassociated infantile DLD （30 cases）,alveolar structure disorders-associated infantile DLD （23 cases）,and infantile DLD specific to infancy （22 cases）.Retrospectively,HRCT images,from the three groups respectively,were analyzed and compared.HRCT presentations including airway disorders,interstitial disorders and air space disorders were reviewed.Inter-reviewers consistency check was performed,the consistency between reviewers was good （K =0.64 ;P =0.03,＜ 0.05）,as well as x2 test.Result Among the three groups,some of the HRCT sings （bronchiectasis,thickened bronchiolar wall,mosaic sign,reticular,intralobular nodules and consolidations） had significant differences （x2 =24.52,6.08,18.00,12.56,9.11 and 11.50,P ＜ 0.05）.Conclusion The HRCT features of infantile pulmonary DLD/interstitial LD with different causes were as follows,compared to the other two groups,intralobular nodules was the main feature of the systemic diseases-associated infantile DLD,thickened bronchiolar wall,mosaic sign and consolidations were rare as well.Meanwhile,bronchiectasis was more common in alveolar structural disorders-associated infantile DLD,and reticular opacity was rarely seen.Associated clinical data,the HRCT presentations would help clinicians to make accurate diagnosis.