中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2013年
3期
211-215
,共5页
李素荣%牟京辉%常丽%闫淯淳%袁新宇%陈慧中
李素榮%牟京輝%常麗%閆淯淳%袁新宇%陳慧中
리소영%모경휘%상려%염육순%원신우%진혜중
坏死性肺炎%肺炎支原体%体层摄影术,X线计算机%儿童
壞死性肺炎%肺炎支原體%體層攝影術,X線計算機%兒童
배사성폐염%폐염지원체%체층섭영술,X선계산궤%인동
Necrotizing pneumonia%Mycoplasma pneumoniae%Tomography,X-ray computed%Child
目的 总结肺炎支原体感染所致儿童坏死性肺炎(necrotizing pneumonia,NP)的胸部CT征象、转归,并对NP病例常见炎性指标变化特点进行初步探讨,对临床医师认识本病CT特点及时进行CT检查提供帮助.方法 回顾分析30例肺炎支原体感染所致儿童NP的胸部CT征象,分析NP大叶肺实变及相关征象随病程进展出现的动态变化；比较NP组与24例非NP对照组的炎性指标差异.结果 (1)NP组(30例)胸部CT征象:单侧大叶性实变(28例),其中20例累及1个肺叶,10例累及多个肺叶；肺空腔(27例)；增强CT扫描可见肺实变内均存在强化减低区(22例).(2)治疗过程中NP组CT征象动态变化:病程2个月复查23例,肺实变吸收2例(9％),肺内出现空腔18例(78％),胸膜增厚16例(70％),肺不张2例(9％),胸膜瘘1例(4％)；病程3个月时复查11例,肺实变吸收7例(64％),胸膜增厚10例(91％),肺内出现空腔7例(64％),肺不张5例(45％),肺叶囊性变2例(18％),胸膜瘘1例；病程3.5年时复查10例,未见肺实变,出现肺不张4例,肺叶残留囊性变4例,遗留条索状影1例.(3)NP组与对照组常见炎性指标比较,两组间在发热持续时间(d) [25.0(12～80)与11.5(7～36)]、外周血WBC峰值(×109/L)[18.1(9.8 ～27.4)与11.1(3.1～20.5)]、中性粒细胞比率[0.814(0.397 ～0.928)与0.663 (0.522 ～0.887)]、WBC异常持续时间(d)[19.5(0～67)与5.0(0～17)]、CRP峰值(mg/L) [92.1(25.6 ～235.0)与35.1(17.0 ～212.0)]、CRP异常持续时间(d)[25.0(9 ～53)与7.0(4.0～ 18.0)]差异均有统计学意义(P＜0.01).结论 肺炎支原体感染所致儿童NP胸部CT征象包括:肺叶实变以及肺实变内出现强化减低区和(或)空腔,病变吸收缓慢,转归后CT表现可大致正常或遗留条索影、肺不张或囊变.当怀疑出现坏死性改变时,密切观察某些炎性指标(如外周血WBC峰值、中性粒细胞比率、CRP峰值,发热、外周血WBC及CRP异常持续时间),有助于临床医师及时决定进行胸部CT检查,明确病变性质.
目的 總結肺炎支原體感染所緻兒童壞死性肺炎(necrotizing pneumonia,NP)的胸部CT徵象、轉歸,併對NP病例常見炎性指標變化特點進行初步探討,對臨床醫師認識本病CT特點及時進行CT檢查提供幫助.方法 迴顧分析30例肺炎支原體感染所緻兒童NP的胸部CT徵象,分析NP大葉肺實變及相關徵象隨病程進展齣現的動態變化；比較NP組與24例非NP對照組的炎性指標差異.結果 (1)NP組(30例)胸部CT徵象:單側大葉性實變(28例),其中20例纍及1箇肺葉,10例纍及多箇肺葉；肺空腔(27例)；增彊CT掃描可見肺實變內均存在彊化減低區(22例).(2)治療過程中NP組CT徵象動態變化:病程2箇月複查23例,肺實變吸收2例(9％),肺內齣現空腔18例(78％),胸膜增厚16例(70％),肺不張2例(9％),胸膜瘺1例(4％)；病程3箇月時複查11例,肺實變吸收7例(64％),胸膜增厚10例(91％),肺內齣現空腔7例(64％),肺不張5例(45％),肺葉囊性變2例(18％),胸膜瘺1例；病程3.5年時複查10例,未見肺實變,齣現肺不張4例,肺葉殘留囊性變4例,遺留條索狀影1例.(3)NP組與對照組常見炎性指標比較,兩組間在髮熱持續時間(d) [25.0(12～80)與11.5(7～36)]、外週血WBC峰值(×109/L)[18.1(9.8 ～27.4)與11.1(3.1～20.5)]、中性粒細胞比率[0.814(0.397 ～0.928)與0.663 (0.522 ～0.887)]、WBC異常持續時間(d)[19.5(0～67)與5.0(0～17)]、CRP峰值(mg/L) [92.1(25.6 ～235.0)與35.1(17.0 ～212.0)]、CRP異常持續時間(d)[25.0(9 ～53)與7.0(4.0～ 18.0)]差異均有統計學意義(P＜0.01).結論 肺炎支原體感染所緻兒童NP胸部CT徵象包括:肺葉實變以及肺實變內齣現彊化減低區和(或)空腔,病變吸收緩慢,轉歸後CT錶現可大緻正常或遺留條索影、肺不張或囊變.噹懷疑齣現壞死性改變時,密切觀察某些炎性指標(如外週血WBC峰值、中性粒細胞比率、CRP峰值,髮熱、外週血WBC及CRP異常持續時間),有助于臨床醫師及時決定進行胸部CT檢查,明確病變性質.
목적 총결폐염지원체감염소치인동배사성폐염(necrotizing pneumonia,NP)적흉부CT정상、전귀,병대NP병례상견염성지표변화특점진행초보탐토,대림상의사인식본병CT특점급시진행CT검사제공방조.방법 회고분석30례폐염지원체감염소치인동NP적흉부CT정상,분석NP대협폐실변급상관정상수병정진전출현적동태변화；비교NP조여24례비NP대조조적염성지표차이.결과 (1)NP조(30례)흉부CT정상:단측대협성실변(28례),기중20례루급1개폐협,10례루급다개폐협；폐공강(27례)；증강CT소묘가견폐실변내균존재강화감저구(22례).(2)치료과정중NP조CT정상동태변화:병정2개월복사23례,폐실변흡수2례(9％),폐내출현공강18례(78％),흉막증후16례(70％),폐불장2례(9％),흉막루1례(4％)；병정3개월시복사11례,폐실변흡수7례(64％),흉막증후10례(91％),폐내출현공강7례(64％),폐불장5례(45％),폐협낭성변2례(18％),흉막루1례；병정3.5년시복사10례,미견폐실변,출현폐불장4례,폐협잔류낭성변4례,유류조색상영1례.(3)NP조여대조조상견염성지표비교,량조간재발열지속시간(d) [25.0(12～80)여11.5(7～36)]、외주혈WBC봉치(×109/L)[18.1(9.8 ～27.4)여11.1(3.1～20.5)]、중성립세포비솔[0.814(0.397 ～0.928)여0.663 (0.522 ～0.887)]、WBC이상지속시간(d)[19.5(0～67)여5.0(0～17)]、CRP봉치(mg/L) [92.1(25.6 ～235.0)여35.1(17.0 ～212.0)]、CRP이상지속시간(d)[25.0(9 ～53)여7.0(4.0～ 18.0)]차이균유통계학의의(P＜0.01).결론 폐염지원체감염소치인동NP흉부CT정상포괄:폐협실변이급폐실변내출현강화감저구화(혹)공강,병변흡수완만,전귀후CT표현가대치정상혹유류조색영、폐불장혹낭변.당부의출현배사성개변시,밀절관찰모사염성지표(여외주혈WBC봉치、중성립세포비솔、CRP봉치,발열、외주혈WBC급CRP이상지속시간),유조우림상의사급시결정진행흉부CT검사,명학병변성질.
Objective To summarize the chest CT features and outcome of necrotizing pneumonia (NP) caused by Mycoplasma pneumoniae in children and to review the changes of common inflammatory parameters in NP patients to help clinicians understand the proper timing of CT scan.Method The imaging data from 30 cases of Mycoplasma pneumoniae pneumonia in NP group and 24 cases with non-necrotizing Mycoplasma penumoniae pneumonia (control group) were analyzed retrospectively.The changes of common inflammatory parameters in NP group and control group were compared.Result (1) The chest CT findings of NP (30 cases): 28 cases showed unilateral pneumonia,and 20 cases showed single lobar consolidation,10 cases had multiple lobes involvement; pulmonary cavities were seen in 27 cases.There were decreased enhancement areas in the consolidation (22 cases).(2) The dynamic changes of CT signs during follow-up:The CT scan performed during the 1-2 months after onset of disease (23 cases) showed that pulmonary consolidation in 2 cases (9％) were absorbed,18 cases (78％) had cavities in lung,16 cases (70％) hadpleural thickening,2 cases (9％)atelectasis and 1 case(4％)bronchopleural fistula;the CT scan performed during the 2-3 months after onset of disease (11 cases) showed pulmonary consolidation in 7 cases (64％) were absorbed,10 cases (91％) pleural thickness,7 cases (64％) with cavities in lung,5 cases (45％) atelectasis,2 cases (18％) pulmonary lobe cysts and 1 case bronchopleural fistula.The CT scan performed at 3.5 years of disease course (10 cases) showed that there were no pulmonary consolidation in any of the cases,4 cases had atelectasis,4 cases had pulmonary cysts,and 1 case had band-like scars.(3) There were significant differences between NP group and control group in the maximum peripheral blood WBC,proportion of neutrophil and C-reactive protein (CRP,mg/L) (P ＜ 0.01,0.01,0.001,respectively),and there was significant difference between the 2 groups in the duration of fever,abnormal WBC (d)and CRP (d) (P ＜ 0.001).Conclusion The chest CT features of NP caused by Mycoplasma pneumoniae in children were single lobular consolidation in most cases,NP had decreased parenchymal enhancement and cavity in the consolidation,and recovery was slow,the outcome included recovery,atelectasis or lobar cystic degeneration.The clinicians should pay more attention to the common inflammatory parameters when they suspect the Mycoplasma pneumoniae pneumonia is progressing into necrosis and make correct decision for chest CT examination.
