周虹

[摘要] 目的 探究胸部CT早期鑒别诊断小儿支原体肺炎合并链球菌肺炎的临床价值。 方法 选取2018年1月至2019年12月我院收治的肺炎患儿65例，其中血培养肺炎支原体IgM阳性但肺炎链球菌阴性患儿作为对照组（n=35），肺炎支原体IgM与肺炎链球菌均阳性患儿作为观察组（n=30），所有患儿均行胸部CT诊断，比较两组胸部CT表现及诊断结果。 结果 观察组患儿CT影响表现为磨玻璃影、支气管壁增厚、支气管血管束、网状影分别占16.67%、40.00%、33.33%、36.67%，与对照组的74.29%、100.00%、82.86%、77.14%比较，差异有统计学意义（P<0.05）;观察组患儿胸腔积液厚度、淋巴结横径分别为（13.49±4.57）mm、（11.18±1.16）mm，均高于对照组，胸腔积液占43.33%，高于对照组，差异有统计学意义（P<0.05）;观察组患儿扇形薄片影及无规律肺内实变影分别为16.67%、83.33%，与对照组的71.43%、28.57%比较，差异有统计学意义（P<0.05）。 结论 小儿支原体肺炎合并链球菌肺炎与单纯小儿支原体肺炎在CT影像上有明显差异，通过胸部CT能实现早期鉴别诊断，具有较高临床价值。

[关键词] 胸部CT;鉴别诊断;小儿支原体肺炎;链球菌肺炎;临床价值;胸腔积液

[中图分类号] R725.6          [文献标识码] B          [文章编号] 1673-9701（2021）08-0103-04

Clinical value of chest CT in the early differential diagnosis of mycoplasma pneumonia complicated with streptococcal pneumonia in children

ZHOU Hong

CT Room， Jiamusi Women and Children′s Hospital in Heilongjiang Province， Jiamusi   154000， China

[Abstract] Objective To explore the clinical value of chest CT in the early differential diagnosis of mycoplasma pneumonia complicated with streptococcal pneumonia in children. Methods A total of 65 children with pneumonia admitted to our hospital from January 2018 to December 2019 were selected. The children patients with positive results of blood culture of mycoplasma pneumoniae IgM but negative results of streptococcal pneumoniae were selected as the control group（n=35）. Children patients with positive results of both mycoplasma IgM and streptococcal pneumoniae were selected as the observation group（n=30）. All children patients were given chest CT diagnosis. The chest CT findings and diagnosis results were compared between the two groups. Results The CT imaging manifestations of ground glass shadow， bronchial wall thickening， bronchial vascular bundle and reticular shadow in the observation group accounted for 16.67%， 40.00%， 33.33%， and 36.67%， respectively， compared with those of 74.29%， 100.00%， 82.86%， and 77.14% in the control group， and the differences were statistically significant（P<0.05）; the thickness of pleural effusion and the transverse diameter of lymph nodes in the observation group were（13.49±4.57） mm and（11.18±1.16） mm， respectively， which were higher than those in the control group. Pleural effusion accounted for 43.33%， which was higher than the control group， and the differences were statistically significant（P<0.05）; the fan-shaped thin-sliced shadow and irregular pulmonary consolidation shadow in the observation group were 16.67% and 83.33%， respectively， which were significantly different from those of 71.43% and 28.57% in the control group， and the differences were statistically significant（P<0.05）. Conclusion There is a significant difference in CT images between mycoplasma pneumonia complicated with streptococcal pneumonia in children and mycoplasma pneumonia in children alone. Chest CT can achieve early differential diagnosis and has a high clinical value.

[Key words] Chest CT; Differential diagnosis; Pediatric mycoplasma pneumonia; Streptococcal pneumonia; Clinical value; Pleural effusion

作为儿科常见的肺部感染性疾病，肺炎多发于冬春季节，是5岁以下儿童死亡的主要因素，随着病情进展会累及到心血管及神经系统，若治疗不及时或治疗方案不当，会导致持续高热，影响患儿健康成长，甚至威胁患儿的生命安全[1-2]。肺炎最常见的症状为咳嗽、咳痰，还会伴有呼吸急促，甚至严重的还会有呼吸困难等表现。2岁以下较小幼儿发病急，初期表现为轻微上呼吸道感染，主要表现有发烧、咳嗽、呼吸有气促及医生听诊肺部时有固定啰音。由于病原菌不断侵入才会发展成肺炎，以往研究报道，小儿肺炎与病原体感染、过敏反應等因素密切相关[3]。小儿肺炎感染类型多，一旦出现混合感染，不仅会延长患儿病程，还会导致肺外多系统感染。临床根据病原体类型将小儿肺炎划分为支原体肺炎与链球菌肺炎，前者经过治疗很快能得到控制，当存在混合感染时会导致肺炎病情加重[4]。……