小儿肺炎支原体肺炎与链球菌属感染肺炎的CT鉴别诊断

CT for identification and diagnosis of Mycoplasma pneumoniae pneumonia and Streptococcus spp infection in children

目的探讨小儿肺炎支原体肺炎(MP)与肺炎支原体合并链球菌属感染肺炎(SP)的胸部CT诊断鉴别,以提高临床诊治水平。方法选取2010年1月-2013年4月35例MP患儿为MP组,同时选取同时期合并SP的35例患儿作为MP+SP组,两组均予CT检查,观察在影像学上的表现差异。结果在CT征象上,MP组胸部CT磨玻璃影、网状影、支气管壁增厚、支气管血管束增厚的发生率分别为65.71%、82.86%、62.86%、80.00%;MP+SP组发生率分别为11.43%、11、43%、17.14%、20.00%;在肺内病变形态上,MP组扇形薄片影、无规律肺内实变影的发生率分别为71.43%、28.57%,MP+SP组发生率分别为25.71%、74.29%;MP组胸腔积液的发生率为17.14%,MP+SP组发生率为42.86%,两组比较差异有统计学意义(P<0.05);另外两组在胸腔积液厚度、淋巴结平均横径和95%CI上比较差异也有统计学意义(P<0.05)。结论小儿肺炎支原体肺炎与肺炎支原体合并链球菌感染肺炎可从胸部CT进行鉴别。

OBJECTIVE To explore the identification and diagnosis of Mycoplasma pneumoniae pneumonia and mixed M.pneumoniae and Streptococcus sppinfection in children so as to improve the clinical diagnosis and treatment.METHODS A total of 35 children with M.pneumoniae pneumonia who were treated from Jan 2010 to Apr2013were assigned as the MP group,meanwhile,35 children complicated with Streptococcus sppinfection were set as the MP plus SP group,both groups were given the CT examination,and the imaging findings were observed.RESULTS For the CT signs,the incidence of chest ground glass was 65.71%in the MP group,11.43%in the MP plus SP group;the incidence of reticular opacities was 82.86%in the MP group,11.43%in the MP plus SP group;the incidence of bronchial wall thickening was 62.86%in the MP group,17.14%in the MP plus SP group;the incidence of thickening of bronchial vascular bundle was 80.00%in the MP group,20.00%in the MP plus SP group.As for the morphological features of lung lesions,the incidence of thin fan film was 71.43%in the MP group,25.71%in the MP plus SP group;the incidence of erratic pulmonary opacities was 28.57%in the MP group,74.29% in the MP plus SP group.The incidence of pleural effusion was 17.14% in the MP group,42.86%in the MP plus SP group,there was significant difference（P〈0.05）;there was also significant difference in the thickness of pleural effusion,the average diameter of lymph nodes,or 95%CI（P 0.05）.CONCLUSIONThe chest CT can differentiate the M.pneumoniae pneumonia from the M.pneumoniae pneumonia complicated with Streptococcus sppinfection.