不同胸部影像学表现的肺炎支原体肺炎儿童的肺功能变化特征

Features of lung dysfunction in children with Mycoplasma pneumoniae pneumonia with different chest imaging findings

摘要:

目的 探讨不同胸部影像学改变的肺炎支原体肺炎（MPP）患儿肺功能异常的特点。方法 根据胸部影像学结果将确诊为MPP 的215 名患儿分为支气管肺炎组（125 例）、大叶性肺炎组（69 例）和间质性肺炎组（21 例），比较3 组间肺功能检测指标用力肺活量（FVC）、第1 秒时间用力呼出气体容量（FEV1）、最高呼气流速（PEF）和最大呼气中段流速（MMEF 25%~75%）的差异。结果 支气管肺炎组患儿急性期PEF（实测值和实测值/ 预计值）明显低于其他两组患儿；大叶性肺炎组患儿急性期MMEF 25%~75% 显著低于其他两组；间质性肺炎组患儿急性期FVC 明显低于其他两组患儿。3 组患儿恢复期肺功能与急性期比较，除大叶性肺炎组患儿FEV1 无明显好转外，其他指标均明显改善。结论 胸部影像学为支气管肺炎改变的MPP 患儿主要表现为大气道功能受损；大叶性肺炎改变者以小气道功能受损更为明显；间质性肺炎改变患儿既有阻塞性通气功能障碍，又有限制性通气功能障碍。

Abstract:

Objective To explore the features of pulmonary dysfunction in children with Mycoplasma pneumoniae pneumonia (MPP) with different chest imaging findings. Methods The clinical data from 215 children with MPP were reviewed. These patients were grouped based on chest image findings (bronchopneumonia, n=125; lobar pneumonia, n=69; interstitial pneumonia, n=21). Lung function parameters including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and the maximum mid-expiratory flow rate (MMEF 25%-75%) were compared between the groups. Results In the acute stage, patients with bronchopneumonia had significantly lower PEF values (measured value and measured value/predicted value) than the other two groups of patients, children with lobar pneumonia had a significant lower MMEF 25%-75% than other patients, and children with interstitial pneumonia had a significantly lower FVC. All patients experienced an improvement in lung function parameters except FEV1 of the lobar pneumonia group in the recovery stage. Conclusions Various features of pulmonary dysfunction can be observed among children with MPP with different chest imaging findings. Patients with bronchopneumonia mainly exhibit large airway dysfunction. The ones with lobar pneumonia mainly suffer small airway dysfunction, and those with interstitial pneumonia demonstrate both airway obstruction and restrictive ventilatory dysfunction.