儿童肺炎支原体肺炎的病理及影像学表现特点

Pathological and imaging manifestations of mycoplasma pneumoniae pneumonia in children

肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)是我国儿童社区获得性肺炎中最常见的类型,早期识别危重症病例、合理救治、减少后遗症是MPP诊治的关键。MPP发病机制在于肺炎支原体对呼吸道的直接损伤和宿主异常免疫应答,病理表现包括肺气道及肺间质炎、塑形性支气管炎、肺泡炎性渗出、坏死性肺炎、肺栓塞及胸腔积液等。影像学对MPP病情严重程度判断和预后评估有重要作用。MPP影像学表现主要有塑形性支气管炎、树芽征、小叶中心结节、树雾征、肺实变、肺坏死、肺栓塞、胸腔积液等。其中,肺坏死和肺栓塞是诊断重症MPP的重要指征。肺坏死临床症状以持续高热和C反应蛋白明显升高为特点。肺栓塞表现包括胸痛和/或咯血、D-二聚体升高和血性胸腔积液。本文结合相关研究进展,通过图文解析MPP影像学表现、相关的发病机制及病理表现,总结各影像学征象与MPP临床特点的关系,旨在提高儿科医生和放射科医生对儿童MPP的认识。

Mycoplasma pneumoniae pneumonia(MPP)is the most common type of community-acquired pneumonia in children in China.Early identification of severe cases,appropriate treatment,and reduction of sequelae are the crucial elements in the diagnosis and treatment of MPP.The pathogenesis of MPP is characterized by direct respiratory tract damage caused by mycoplasma pneumoniae and aberrant host immune response.Pathologic manifestations include pulmonary airway and interstitial inflammation,plastic bronchitis,alveolar inflammatory exudation,necrotizing pneumonia,pulmonary artery embolism,and pleural effusion.Radiographic imaging plays an important role in the severity determination and prognostic assessment of MPP.The main imaging features include plastic bronchiolitis,tree bud sign,centrilobular nodule,tree mist sign,pulmonary consolidation,pulmonary necrosis,pulmonary artery embolism,and pleural effusion.Notably,pulmonary necrosis and pulmonary artery embolism are important indications for the diagnosis of severe MPP.Clinical symptoms of pulmonary necrosis are characterized by persistent high fever and elevated CRP levels.Pulmonary embolism manifestations include chest pain and/or hemoptysis,elevated D-dimer,and bloody pleural effusion.With advancements in related research,this article presents a graphic-text analysis on the imaging features,pathogenesis and pathological manifestations of MPP.We also summarize the correlation between various imaging features and clinical characteristics of MPP,aiming to improve the understanding of MPP in children among pediatricians and radiologists.