儿童支原体肺炎不同影像学表现临床分析

Epidemiology, treatment and outcome of different imaging manifestations of Mycoplasma pneumoniae pneumonia in children

目的 探讨儿童肺炎支原体肺炎(MPP)胸部影像学的差异性表现,分析其流行病学特点并评价其治疗、预后等,为其分类及诊疗方案提供临床依据。方法 选取寿光市人民医院儿科收住的诊断为MPP的486例患儿为研究对象,根据胸部影像学表现分为支气管肺炎型MPP组(BP-MPP),大叶性肺炎型MPP组(LP-MPP)和间质性肺炎型MPP组(IP-MPP),收集患儿性别、年龄、居住地、发病季节、疾病治疗及预后情况。结果 (1)共收集到486例MPP患儿,BP-MPP组170例,LP-MPP组232例,IP-MPP组84例,年龄(5.15±2.83)岁,3组间患儿平均年龄差异具有显著性(P<0.05),性别、居住地差异不显著(P>0.05)。(2)夏秋季节MPP检出率显著低于秋冬季节(P<0.05),3组患儿发病季节分布差异显著(P<0.05)。(3)3组患儿在应用抗支原体治疗后咳嗽、喘鸣音、气喘改善时间无统计学差异(P>0.05),发热改善时间LP-MPP组、BP-MPP组晚于IP-MPP组(P<0.05)。LP-MPP组患儿静脉激素应用比例显著高于BP-MPP组与IP-MPP组(P<0.05),且支气管肺泡灌洗应用及吸氧比例最高(P<0.05)。结论 (1)儿童MPP胸部影像学表现可出现多样化,低龄患儿以IP-MPP及BP-MPP为主,学龄期儿童以LP-MPP为主,其与发病季节相关。(2)IP-MPP组、BP-MPP组及LP-MPP组患儿在治疗方面存在显著差异,临床可依据不同患儿影像学特征进行针对性的临床监测及治疗。

Objective To investigate the differences in the chest imaging of mycoplasma pneumoniae pneumonia(MPP) in children, analyze its epidemiological features, and evaluate its treatment and prognosis, in order to provide a clinical basis for its classification and treatment.Methods The 486 children diagnosed with MPP admitted to the pediatric department of Shouguang People’s Hospital were selected for the study and were divided into bronchial pneumonia pattern MPP(BP-MPP),lobar pneumonia pattern MPP(LP-MPP) and interstitial pneumonia pattern MPP(IP-MPP) groups based on chest imaging, collecting information on the child’s sex, age, place of residence, season of onset, treatment and prognosis of the disease.Results(1)A total of 486 children with MPP were collected, 170 in the BP-MPP group, 232 in the LP-MPP group and 84 in the IP-MPP group, aged(5.15±2.83) years.The difference in the mean age of the children between the three groups was significant(P<0.05),while the difference in gender and place of residence was not significant(P>0.05).(2)The detection rate of MPP from summer to autumn was significantly lower than that from autumn to winter(P<0.05),and the seasonal distribution of children in the three groups was significantly different(P<0.05).(3)There was no statistical difference in the improvement time of cough, wheezing and shortness of breath after the application of anti-mycoplasma treatment in the three groups(P>0.05),and the improvement time of fever in the LP-MPP and BP-MPP groups was later than that in the IP-MPP group(P<0.05).The proportion of children applying intravenous hormones was significantly higher in the LP-MPP group than in the BP-MPP and IP-MPP groups(P<0.05).The proportion of bronchoalveolar lavage application and oxygen inhalation was the highest(P<0.05).Conclusions(1)The chest imaging manifestations of MPP in children can be diverse, with IP-MPP and BP-MPP predominating in younger children and LP-MPP in school-age children, and the chest imaging features of children correlated with the season of onset.(2)There are significant differences in the treatment of children in the IP-MPP,BP-MPP and LP-MPP groups, and clinical monitoring and treatment can be tailored according to the imaging characteristics of different children.