儿童肺炎支原体肺炎与肺炎支原体合并链球菌感染肺炎的胸部CT鉴别诊断研究

Chest CT in differential diagnosis of children with Mycoplasma pneumoniae pneumonia and children with Mycoplasma pneumoniae pneumonia complicated with Streptococcus infection

目的探讨儿童肺炎支原体肺炎与肺炎支原体合并链球菌感染肺炎的胸部CT表现及其鉴别,为该病的临床诊治提供参考。方法选取2013年11月-2015年11月医院收治的肺炎患儿74例,根据血清MP-IgM检测以及链球菌血培养的结果,将32例单纯肺炎支原体肺炎的患儿分为A组,将42例肺炎支原体合并链球菌感染肺炎的患儿分为B组,对比两组患儿胸部CT检查中气道和肺间质病变征象的出现率;对比两组患儿的胸腔积液量以及肿大淋巴结的体积;对比两组患儿的肺内病变形态。结果 A组患儿胸部CT出现磨玻璃影、网状影、支气管壁增厚、支气管血管束增厚的比例均显著高于B组(P<0.05);B组患儿出现胸腔积液的有24例占57.14%,显著高于A组(P<0.05);B组患儿胸腔积液的厚度为(14.63±12.57)mm,显著大于A组(P<0.05);B组肿大淋巴结的最大横径为(11.29±3.26)mm,显著大于A组(P<0.05);A组肺内病变形态为扇形薄片影的有24例占75.00%,显著多于B组(P<0.05);B组肺内病变形态为无规律肺内实变影的有37例占88.10%,显著多于A组(P<0.05)。结论单纯肺炎支原体肺炎胸部CT像以肺间质改变为主;合并肺炎链球菌感染时,CT像表现出肺泡炎症反应的肺内片状阴影,且胸腔积液和淋巴结肿大更为明显。

OBJECTIVE To explore the chest CT features of the children with Mycoplasma pneumoniae pneumonia and children with M.pneumoniae pneumonia complicated with Streptococcusinfection and analyze the value in differential diagnosis so as to provide guidance for clinical diagnosis and treatment of the disease.METHODS A total of 74 children with pneumonia who were treated in the hospital from Nov 2013 to Nov 2015 were enrolled in the study.According to the results of detection of serum MP-IgM and blood culture of Streptococcus,32 children with single M.pneumoniae pneumonia were assigned as the group A,and 42 children with M.pneumoniae pneumonia complicated with Streptococcus infection were set as the group B.The rates of emergence of signs of airway and pulmonary interstitial lesions in the chest CT examination were compared between the two groups of children,the pleural effusion volume and the volume of enlarged lymph nodes were compared between the two groups of children,and the morphological features of lung lesions were observed and compared between the two groups of children.RESULTS The chest CT examination showed that the proportions of the children with ground glass opacities,reticulation,thickening of bronchial wall,and thickening of bronchovascular bundles were significantly higher in the group A than in the group B（P〈0.05）.The proportion of the children with pleural effusion was 57.14%（24cases）in the group B,significantly higher than that in the group A（P〈0.05）.The thickness of pleural effusion of the group B was（14.63±12.57）mm,significantly greater than that of the group A（P〈0.05）;the maximum transverse diameter of enlarged lymph nodes of the group was（11.29±3.26）mm,significantly greater than that of the group A（P〈0.05）.As compared with the morphological feature of the lung lesions,the proportion of the children with fan-shaped sheet shadow was 75.00%（24cases）in the group A,significantly higher than that in the group B（P〈0.05）;the proportion of the children with irregular pulmonary real opacities was 88.10%（37cases）in the group B,significantly higher than that in the group A（P〈0.05）.CONCLUSION The change of signs of pulmonary interstitial lesions is dominant among the chest CT imaging features of the children with single M.pneumoniae pneumonia;when it is complicated with Streptococcus infection,the CT imaging shows the lung patchy shadows due to alveolar inflammation,with the pleural effusion and enlargement of lymph nodes more obvious.