儿童肺炎支原体肺炎的临床及影像学特征分析

Analysis of clinical and imaging features of mycoplasma pneumoniae pneumonia in children

目的 回顾性分析儿童肺炎支原体肺炎的临床表现和影像学特征,为临床诊治提供依据。方法 回顾性分析2023年11月至2024年1月在清华大学第一附属医院和首都儿科研究所附属儿童医院门诊就诊及住院的肺炎支原体肺炎患儿200例的临床资料、胸部CT影像学资料和病原学检查结果。胸部CT影像观察指标包括病灶在肺内的分布范围、支气管壁增厚、肺内病灶的影像表现形式、有无塑形性支气管炎、有无胸腔积液等。结果 共纳入200例肺炎支原体肺炎患儿,年龄范围1月龄至15岁,平均年龄(8.29±2.81)岁,其中男107例(53.5%),女93例(46.5%)。临床症状主要为发热165例(66.0%),发热病程1~30d,中位数7d;其次是咳嗽162例(64.8%),咳嗽病程2~60d,中位数7d;其他症状按频率依次为咳痰、喘息、流涕、咽痛、呕吐、头痛、胸痛、呼吸困难、荨麻疹等。肺部病灶累及最多为左肺下叶,其次是右肺下叶;影像学表现依次是支气管壁增厚、树芽征和肺实变。儿童肺炎支原体肺炎合并感染腺病毒最多见。发生塑形性支气管炎与非塑形性支气管炎的患儿在合并呼吸道合胞病毒感染、树芽征、腺泡结节、肺实变、肺不张、胸腔积液等方面差异有统计学意义。结论 儿童肺炎支原体肺炎以发热、咳嗽为主要临床表现特征;支气管壁增厚、树芽征、树雾征、肺大片实变等为最常见的特征性影像表现。当肺炎支原体肺炎患儿肺部影像表现为腺泡结节、肺实变、肺不张、胸腔积液时应考虑塑形性支气管炎的存在。

Objective The clinical manifestations and imaging features of mycoplasma pneumoniae pneumonia in children were retrospectively analyzed to provide basis for clinical diagnosis and treatment.Method The general clinical data,chest CT imaging data and etiological examination results of 200 outpatients and inpatients with mycoplasma pneumoniae pneumonia in the First Hospital of Tsinghua University and the Children's Hospital Affiliated to Capital Institute of Pediatrics from November 2023 to January 2024 were retrospectively analyzed.Chest CT imaging indicators included the distribution of lesions in the lung,thickening of the bronchial wall,imaging manifestations of lesions in the lung,presence or absence of plastic bronchitis,presence or absence of pleural effusion,etc.Result A total of 200 children with mycoplasma pneumoniae pneumonia were included,ranging from 1 month to 15 years old,with an average age of(8.29±2.81)years,including 107 boys(53.5%)and 93 girls(46.5%).The main clinical symptom was fever in 165 cases(66.0%).The duration of fever ranged from 1 to 30 days,with a median of 7 days.Followed by 162 cases of cough(64.8%),the duration of cough ranged from 2 to 60 days,with a median of 10 days days.Other symptoms in order of frequency were expectoration,wheezing,runny nose,sore throat,vomiting,headache,chest pain,dyspnea,urticaria,etc.The most involved lung lesions were left inferior lobe,followed by right inferior lobe.The most common imaging findings were bronchial wall thickening,tree-in-bud sign,and consolidation.Mycoplasma pneumoniae pneumonia in children with adenovirus infection is the most common.The children with plastic bronchitis and non-plastic bronchitis had statistically significant differences in respiratory syncytial virus infection,tree-in-bud sign,acinar nodules,consolidation,atelectasis and pleural exudation.Conclusion The main clinical manifestations of mycoplasma pneumoniae pneumonia in children are fever and cough.Thickening of bronchial wall,tree-in-bud sign,tree-in-fog sign,and mass consolidation are the most common characteristic imaging manifestations.The presence of plastic bronchitis should be considered when the pulmonary imaging of children with mycoplasma pneumoniae pneumonia shows acinar nodules,consolidation,atelectasis and pleural exudation.