摘要
目的 分析细菌性肺炎、病毒性肺炎及支原体肺炎的高分辨率CT征象特征及鉴别要点。方法 对192例经病原学证实的单一病原体肺炎患者的高分辨率CT影像学资料进行回顾性分析。根据病原学将其分为细菌性肺炎组(n=84,43.8%)、病毒性肺炎组(n=58,30.2%)和支原体肺炎组(n=50,26.4%),对三组肺炎的临床资料、病变部位和CT征象进行比较。结果 细菌性肺炎的白细胞计数、C反应蛋白和降钙素原均显著高于病毒性和支原体肺炎(P＜0.05);支原体肺炎白细胞计数高于病毒性肺炎(P＜0.05);在病变分布上,病毒性肺炎多呈多肺叶(40/58,69%,P＜0.05)和肺外周分布(39/58,67.2%,P＜0.05);支原体肺炎多呈多肺叶(28/50,56%,P＜0.05)和肺下叶分布(31/50,62%,P＜0.05)。在CT征象上,细菌性肺炎肺实变(48/84,57.1%,P＜0.05)和含气支气管征(41/84,48.8%,P＜0.05)多见;在磨玻璃影和碎石征方面,病毒性肺炎(分别为30/58,51.7%和26/58,44.8%)和支原体肺炎(分别为31/50,62%和19/50,38%)无统计学差异(P＞0.05),但两者上述征象均较细菌性肺炎多见(P＜0.05);另外,病毒性肺炎间质增厚多见(32/58,55.2%,P＜0.05);支原体肺炎支气管壁增厚多见(29/50,58%,P＜0.05)。结论 细菌性肺炎主要表现为片状实变影常伴含气支气管征,病毒性肺炎主要表现为多叶外周性分布的磨玻璃影伴碎石征及间质增厚,支原体肺炎主要表现为双下肺分布为主的间质性炎性反应伴细支气管壁增厚。
Abstract
Objective To analyze the high resolution CT signs and differential features of bacterial pneumonia, viral pneumonia and mycoplasma pneumonia. Methods The high resolution CT imaging data of 192 patients with pneumonia confirmed by clinical examination or pathology was analyzed retrospectively. According to etiology, they were divided into the bacterial pneumonia group (n=84, 43.8%), viral pneumonia group (n=58, 30.2%) and mycoplasma pneumonia group (n=50, 26.4%). The clinical data, lesion localization and CT signs of the three groups were compared. Results The WBC count, CRP and PCT associated with bacterial pneumonia were significantly higher than those related to viral and mycoplasma pneumonia (P<0.05). The WBC count of mycoplasma pneumonia was higher than that of viral pneumonia (P<0.05). In terms of lesion distribution, viral pneumonia showed multi-lobe (40/58,69%,P<0.05) and peripheral distribution (39/58, 67.2%, P<0.05), while mycoplasma pneumonia showed multi-lobe (28/50, 56%, P<0.05) and lower lobe distribution (31/50, 62%, P<0.05). There was no significant difference in ground-glass opacity or macadam signs between viral pneumonia and mycoplasma pneumonia(P>0.05), but the above signs were more common in CT signs than in bacterial pneumonia (P<0.05). In addition, there was more intralobular interstitial thickening in viral pneumonia (32/58, 55.2%, P<0.05) and bronchial wall thickening in mycoplasma pneumonia (29/50, 58%, P<0.05). Conclusions The combination of clinical manifestations, laboratory examination and high resolution CT can contribute to the early diagnosis and differential diagnosis of bacterial, viral and mycoplasma pneumonia.
关键词
高分辨率 /
CT /
细菌 /
病毒 /
支原体 /
肺炎
Key words
high resolution /
CT /
bacteria /
virus /
mycoplasma /
pneumonia
赵志勇, 郑昊宇, 张巍.
细菌性、病毒性及支原体肺炎的高分辨率CT征象分析与鉴别[J]. 武警医学. 2020, 31(9): 774-777
ZHAO Zhiyong1, ZHENG Haoyu2, ZHANG Wei2.
High resolution CT features and differential diagnosis of bacterial pneumonia, viral pneumonia and mycoplasma pneumonia[J]. Medical Journal of the Chinese People Armed Police Forces. 2020, 31(9): 774-777
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