目的 探究肺炎支原体肺炎(MPP)患儿胸部X线片及CT双模态影像学分型与其临床特征及预后的关系。方法 回顾性分析2023-01-01至2024-12-31武警特色医学中心收治的MPP患儿,按X线表现分为支气管肺炎型和实变/肺不张型,按CT表现分为支气管肺炎型、实变/肺不张型和细支气管炎型。比较不同影像学分类患儿的临床特征、炎症指标及预后(难治性MPP、坏死性肺炎、闭塞性细支气管炎等)差异。结果 共纳入143例患儿,X线分型支气管肺炎型84例、实变/肺不张型59例。CT分型实变/肺不张型104例、支气管肺炎型22例、细支气管炎型17例。在X线影像分类中,与支气管肺炎型相比,实变/肺不张型患儿年龄更大,C反应蛋白、中性粒细胞/淋巴细胞比值、乳酸脱氢酶及D-二聚体水平更高(均P< 0.05),难治性MPP发生率、坏死性肺炎发生率及ICU入住率更高,住院时间更长。CT细支气管炎型患儿过敏性疾病史(29.41%)及湿啰音发生率(88.24%)为三组最高,差异有统计学意义(均P< 0.05),且为闭塞性细支气管炎的潜在高危类型。结论 MPP的X线片及CT影像学分型与临床特征及预后密切相关。X线片可作为初筛工具初步预测病情严重程度,CT能更精准识别细支气管炎等细微病变,为早期干预及远期并发症预警提供更可靠依据。
Abstract
Objective To investigate the relationship between the dual-modal imaging classification of chest X-ray and CT in children with mycoplasma pneumoniae(MPP) and their clinical features and prognosis. Methods A retrospective analysis was performed on 143 children with MPP who were admitted to Characteristics Medical Center of Chinese People’s Armed Police Force from January 1, 2023 to December 31, 2024. According to X-ray findings, the children were divided into bronchopneumonia type and consolidation/atelectasis type. Based on CT findings, they were classified into bronchopneumonia type, consolidation/atelectasis type, and bronchiolitis type. Clinical features, inflammatory indicators, and prognosis (including refractory MPP, necrotizing pneumonia, obliterative bronchiolitis, etc.) were compared among children with different imaging classifications. Results Among the 143 children, X-ray classification revealed 84 cases of bronchopneumonia type and 59 cases of consolidation/atelectasis type. CT classification identified 104 cases of consolidation/atelectasis type, 22 cases of bronchopneumonia type, and 17 cases of bronchiolitis type. In the X-ray imaging classification, compared with the bronchopneumonia type, children with consolidation/atelectasis type were older, had significantly higher levels of C-reactive protein, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and D-dimer (all P<0.05), as well as higher incidence of refractory MPP, necrotizing pneumonia, and ICU admission, and longer hospital stay. Children with CT-defined bronchiolitis type had the highest prevalence of allergic disease history (29.41%) and rales (88.24%) among the three groups (all P<0.05), and this type was identified as a potential high-risk factor for obliterative bronchiolitis. Conclusions X-ray and CT imaging classifications of MPP are closely related to clinical features and prognosis. X-ray can serve as an initial screening tool to preliminarily predict disease severity, while CT can more accurately identify subtle lesions such as bronchiolitis, providing a more reliable basis for early intervention and early warning of long-term complications.
关键词
肺炎支原体 /
儿童 /
胸部影像 /
分类 /
临床结局
Key words
mycoplasma pneumoniae /
children /
chest imaging /
classification /
clinical outcome
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参考文献
[1] Gao L, Sun Y. Laboratory diagnosis and treatment of mycoplasma pneumoniae infection in children: a review[J]. Ann Med, 2024, 56(1):2386636.
[2] 国家卫生健康委员会. 儿童肺炎支原体肺炎诊疗指南(2023年版)[J]. 传染病信息, 2023, 36(4):291-297.
[3] 刘媛媛, 杨学斌, 谢吉科, 等. 国内外儿童肺炎支原体肺炎指南药物治疗方案分析[J]. 中国医院用药评价与分析, 2025, 25(1):64-68.
[4] 姬 涛, 韩国敬, 宋玉祥, 等. 161例肺炎支原体肺炎临床特征[J]. 中华医院感染学杂志, 2025, 35(10):1478-1482.
[5] 黎芮彤, 岳玉川, 谷续洁, 等. 儿童难治性肺炎支原体肺炎风险预测模型的系统评价[J]. 中国全科医学, 2025, 28(9):1105-1114.
[6] 满晓洁, 贾玉环, 董一慧. CT影像组学鉴别儿童肺炎支原体肺炎及肺炎链球菌肺炎的价值研究[J]. 中国CT和MRI杂志, 2025, 23(2):92-94.
[7] 陈 兵, 张梦琦, 封浩然. 小儿难治性肺炎支原体肺炎临床特点、实验室指标及高分辨CT影像特点分析[J]. 中国CT和MRI杂志, 2024, 22(5):83-85.
[8] Cho Y J, Han M S, Kim W S, et al. Correlation between chest radiographic findings and clinical features in hospitalized children with mycoplasma pneumoniae pneumonia[J]. PLoS One, 2019, 14(8):e0219463.
[9] Iwanaga Y, Yamasaki K, Nemoto K, et al. Combined radiographic features and age can distinguish mycoplasma pneumoniae pneumonia from other bacterial pneumonias: analysis using the 16s rRNA gene sequencing data[J]. J Clin Med, 2022, 11(8):2201.
[10] Yang B, Zhang W, Gu W, et al. Differences of clinical features and prognosis between Mycoplasma pneumoniae necrotizing pneumonia and non-Mycoplasma pneumoniae necrotizing pneumonia in children[J]. BMC Infect Dis, 2021, 21(1):797.
[11] 穆世茵, 邹映雪, 郭永盛, 等. 儿童重症肺炎支原体肺炎发生塑形性支气管炎的预测因素[J].中华儿科杂志, 2024, 62(9):861-866.
[12] Chen J, Zhang J, Lu Z, et al. Mycoplasma pneumoniae among Chinese outpatient children with mild respiratory tract infections during the coronavirus disease 2019 pandemic[J]. Microbiol Spectr, 2022, 10(1):e0155021.
[13] 冀少华, 李春敏, 宋 晨, 等. X线联合CT在小儿支原体肺炎诊断中的应用及影像特点分析[J].中国CT和MRI杂志, 2024, 22(10):59-61.
[14] 张立霞, 朱 峰, 李传景, 等. 重症肺炎支原体肺炎患儿CRP, LDH等实验室指标的预警价值及支气管镜下特点[J].中华全科医学, 2024, 22(7):1098-1101.
[15] 陈 艳, 姚欢迎, 王 盼, 等. 儿童重症肺炎支原体肺炎早期预测指标的研究[J].中国妇幼保健, 2024, 39(2):239-242.
[16] Zhao C, Liu J, Yang H, et al. Mycoplasma pneumoniae-associated bronchiolitis obliterans following acute bronchiolitis[J]. Sci Rep, 2017, 7(1):8478.
[17] 钟玲玲, 杨 俊. 特应性体质儿童肺炎支原体肺炎的临床特点[J].山东医药, 2023, 63(3):70-73.
[18] 朱云芳, 刘亚辉, 梁 宽, 等. 肺炎支原体感染致塑型性支气管炎患儿的临床研究[J].检验医学与临床, 2023, 20(3):406-409.
[19] 成桂兰, 徐贝雪, 贾 林. 难治性肺炎支原体肺炎患儿闭塞性细支气管炎发生的影响因素及其预测价值[J].中国当代儿科杂志, 2024, 26(11):1182-1186.
[20] 中华医学会儿科学分会呼吸学组, 中国医师协会儿科医师分会儿童呼吸专业委员会, 中华儿科杂志编辑部. 感染后闭塞性细支气管炎早期筛查, 干预, 诊断和治疗专家共识(2025)[J].中华儿科杂志, 2025, 63(10):1066-1072.
基金
天津市卫生健康科技项目(TYWJ2021MS043)
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