早期不同影像学表现下儿童肺炎支原体肺炎的临床特征及相关因素分析

Analysis of Clinical Characteristics and Related Factors of Pediatric Mycoplasma pneumoniae Pneumonia with Different Imaging Manifestations in Early-Stage

摘要: 目的：通过对比早期不同影像学表现下儿童肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia, MPP)的临床特征及相关因素，探讨早期影像学检查在儿童肺炎支原体肺炎中的诊断价值。方法：回顾性分析2023年7月~2024年7月于重庆市第七人民医院儿科入院治疗的MPP患儿的病例，共184例，收集一般情况、临床特征、实验室检查、影像学表现、药物治疗情况及预后情况等资料。根据患儿胸部CT的影像学表现分为两组：(1) 肺部表现呈点状或小斑片状浸润影为A组；(2) 肺部表现呈节段性或大叶性实质浸润影为B组。记录并分析各组临床资料并进行比较。结果：184例MPP患儿中影像学上肺部表现呈点状或小斑片状浸润影的A组患儿103例，占比55.98%，中位数年龄为6.83岁，其中男49例，女54例；影像学上肺部表现呈节段性或大叶性实质浸润影的B组患儿81例，占比44.02%，中位数年龄为7.00岁，其中男38例，女43例。两组患儿的性别、年龄进行比较，差异无统计学意义(p > 0.05)。B组患儿在热程、热峰的程度上[5.00 (4.00, 6.00), 39.50 (39.10, 39.80)]高于A组患儿[3.00 (2.00, 3.00), 38.70 (38.50, 39.20)]，差异均有明显统计学意义(均p < 0.001)。B组患儿发生胸腔积液并发症为18例，占比22.22%，发生率明显高于A组患儿的6例占比5.83%，差异具有统计学意义(p = 0.001)。在实现早期诊断治疗情况下，两组患儿在病程天数、混合感染发生率、入院24 h内乳酸脱氢酶水平、药物治疗类型、药物治疗天数以及预后评估等方面进行比较，发现差异无明显统计学意义(p > 0.05)。结论：早期肺部表现呈节段性或大叶性实质浸润影的MPP患儿临床症状重，并发症发生率高，发展为重症的可能性大，因此，尽早完善影像学检查可以为临床尽早识别及干预儿童MPP提供依据，有利于临床早期治疗，从而有效避免患儿进一步发展成为重症肺炎支原体肺炎(severe Mycoplasma pneumoniae pneumonia, SMPP)或难治性肺炎支原体肺炎(refractory Mycoplasma pneumoniae pneumonia, RMPP)。

Abstract: Objective: By comparing the differences in clinical characteristics and related factors of early pediatric Mycoplasma pneumoniae pneumonia (MPP) with different imaging manifestations, and to discuss the value of early imaging of MPP. Methods: Cases of pediatric MPP admitted to the Department of Pediatrics of Chongqing Seventh People’s Hospital from July 2023 to July 2024 were retrospectively analyzed, with a total of 184 cases, to collect data on general condition, clinical features, laboratory examination, imaging manifestations, drug treatment, and prognosis. The children were divided into two groups according to the imaging manifestations of chest CT: (1) Group A with punctate or small patchy infiltrating shadows in the lung manifestations; (2) Group B with segmental or lobular parenchymal infiltrating shadows in the lung manifestations. The clinical data of each group were recorded analyzed and compared. Results: Among the 184 cases of pediatric MPP, 103 children in group A showed punctate or small patchy infiltrating shadows in the lungs on imaging, accounting for 55.98% of the total, with a median age of 6.83 years, of which 49 were male and 54 were female, and 81 children in group B showed segmental or lobular parenchymal infiltrating shadows in the lungs on imaging, accounting for 44.02% of the total, with a median age of 7.00 years, of which 38 were male and 43 cases were female. The gender and age of the children in both groups were compared, and there was no statistically significant difference (p > 0.05). The children in group B had a higher degree of heat duration and peaks [5.00 (4.00, 6.00), 39.50 (39.10, 39.80)] than children in group A [3.00 (2.00, 3.00), 38.70 (38.50, 39.20)]. There was a statistically significant difference between the two groups (p < 0.001). In group B, there were 18 cases of pleural effusion complications, accounting for 22.22% of the total, which was significantly higher than the 6 cases in group A, accounting for 5.83% of the total, and the difference was statistically significant (p = 0.001). In the case of early diagnosis and treatment, the comparison of the two groups of children in terms of the number of days of the disease, the incidence of mixed infections, lactate dehydrogenase level within 24 h of admission, the type of drug therapy, the number of days of drug therapy, drug resistance, and prognosis assessment, there was no statistically significant difference between the two groups (p > 0.05). Conclusion: The cases of pediatric MPP who show segmental or lobar parenchymal infiltration have severe clinical symptoms and high complication rates, and are more likely to develop further into severe cases. Improvement of early imaging examination can provide a basis for clinical early identification and intervention of pediatric MPP, which is significant and conducive to early clinical treatment. Early diagnosis and treatment can effectively prevent children from developing severe Mycoplasma pneumoniae pneumonia (SMPP) and refractory Mycoplasma pneumoniae pneumonia (RMPP).