细菌感染性肺炎患者胸部CT征象及其与患者肺部炎症情况、预后的关系

doi:10.7517/issn.1674-0475.210212

摘要/Abstract

摘要： 探讨细菌感染性肺炎患者的CT检查影像学特征与患者炎症病情、治疗结局的关系。选取100例经病原学检查明确诊断为细菌感染性肺炎的患者作为细菌组、同期100例经血清学等检查证实为病毒感染性肺炎的患者作为病毒组，对比两组患者病情进展期CT检查的影像学特征，根据患者病情危重程度将细菌组患者分为高危组和中危组，根据治疗28 d结局将细菌组患者分为存活组和死亡组，并对比肺部CT特征差异。在肺叶实变发生率、充气支气管征CT征象特征中，细菌组高于病毒组患者（P<0.05）；肺部毛玻璃影特征检出结果比较，细菌组低于病毒组患者（P<0.05）；高危组的肺叶实变、肺段实变、肺部毛玻璃影、胸腔积液、充气支气管征的发生率高于中危组患者（P<0.05）；死亡组的肺叶实变、肺段实变、胸腔积液的发生率高于存活组患者（P<0.05）；死亡组与存活组患者肺部毛玻璃影、网织条索、充气支气管征的发生率差异无统计学意义（P>0.05）。依据胸部CT检查特征，在一定程度上可以鉴定感染的病原体类型，对于细菌性肺炎患者的病情程度及预后评估有一定的参考价值。

关键词: 细菌感染, 肺炎, CT检查, 预后

Abstract: Aim of this study was to investigate the relationship between CT imaging characteristics and inflammatory condition and treatment outcome in patients with bacterial infectious pneumonia. One hundred patients who were clearly diagnosed with bacterial infectious pneumonia by pathogenic examinations were selected as the bacterial group, and 100 patients with viral infectious pneumonia confirmed by serological examinations during the same period were selected as the virus group. The imaging characteristics of the two groups of patients in the advanced stage of the CT examination were compared. According to the critical condition of the patients, the bacterial group was divided into high-risk and intermediate-risk groups, and the bacterial group was divided into survival and death groups according to the 28-day treatment outcome, and compared Differences in lung CT features. In the incidence of lung lobe consolidation and CT signs of aerated bronchial sign, the bacterial group was higher than that of the virus group (P<0.05). As to the comparison of the detection results of ground glass shadow characteristics of the lungs, the bacterial group was lower than the virus group (P<0.05). The detection rate of lung lobe consolidation, lung segment consolidation, pulmonary ground glass shadow, pleural effusion, and air bronchial signs in the high-risk group were higher than those in the intermediate-risk group (P<0.05). The incidence of lung lobe consolidation, segment consolidation, and pleural effusion in the death group were higher than those in the survival group (P<0.05). The death group and the survival group had lung glass shadows, mesh strips, and air-filled bronchial signs. There was no statistically significant difference in incidence (P>0.05). According to the characteristics of chest CT examination, the type of pathogen can be identified to a certain extent, and it has certain reference value for the disease degree and prognosis evaluation of patients with bacterial pneumonia.

Key words: bacterial infection, pneumonia, CT examination, prognosis

杨浩然, 张学勤. 细菌感染性肺炎患者胸部CT征象及其与患者肺部炎症情况、预后的关系[J]. 影像科学与光化学, 2021, 39(5): 705-710.

YANG Haoran, ZHANG Xueqin. Chest CT Signs of Patients with Bacterial Infectious Pneumonia and Their Relationship with Lung Inflammation and Prognosis[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2021, 39(5): 705-710.

参考文献

[1] 马慧, 陈复辉. 多重病因下细菌和病毒双重感染性肺炎病毒相关病原学诊断的研究进展[J]. 医学综述, 2021, 27(1):63-66.
[2] 邓芷晴, 张笑春, 李一荣, 等. 胸部CT筛查在新型冠状病毒肺炎暴发早期的价值[J]. 中华放射学杂志, 2020, 54(5):430-434.
[3] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 成人社区获得性肺炎基层诊疗指南(2018年)[J]. 中华全科医师杂志, 2019, 18(2):117-126.
[4] Chen J H, Chang S S, Liu J J, et al. Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects[J]. Thorax, 2010, 65(11):971-977.
[5] 赵建玉, 胥杰, 金建敏, 等. 合并慢性阻塞性肺疾病的病毒性肺炎患者临床特征及预后因素分析[J]. 中华结核和呼吸杂志, 2021, 44(2):88-95.
[6] 王海晶, 王小军. 实时定量PCR与传统微生物培养法诊断呼吸机相关性肺炎病原体的性能比较[J]. 临床肺科杂志, 2020, 25(6):811-815.
[7] 孙杰莲. 不同抗菌药物方案治疗艾滋病并细菌性肺炎50例临床效果观察[J]. 山西医药杂志, 2019, 48(9):1076-1078.
[8] 熊丽荣, 李海明, 方海川, 等. 老年重症肺炎多药耐药菌感染临床特点及头孢哌酮/舒巴坦联合胸腺肽α1的治疗效果[J]. 中华医院感染学杂志, 2019, 29(10):1474-1478.
[9] 年英, 吕秀云. 美罗培南联合莫西沙星对慢性阻塞性肺疾病并发感染性肺炎患者的影响[J]. 实用心脑肺血管病杂志, 2019, 27(3):87-90.
[10] 秦立霞, 李芳, 赵会海. 感染性无菌体液细菌分布及耐药性分析[J]. 临床误诊误治, 2020, 33(3):77-82.
[11] Bradshaw J L, Caballero A R, Bierdeman M A, et al. Pseudomonas aeruginosa protease IV exacerbates pneumococcal pneumonia and systemic disease[J]. mSphere, 2018, 3(3):e00212-18.
[12] 周春霞, 孙婧, 徐凤琴, 等. 流感病毒性肺炎治疗研究进展[J]. 中华医院感染学杂志, 2020, 30(2):302-307.
[13] 刘良丽, 赵飞, 朱小龙, 等. 清肺保元汤治疗细菌性肺炎的临床研究及对炎症因子的影响[J]. 重庆医学, 2019, 48(22):3823-3826.
[14] 王茹薇, 马俊荣, 莫岚. 获得性多重耐药菌感染型肺炎的耐药性观察及易感因素Logistic分析[J]. 解放军预防医学杂志, 2019, 37(9):24-25.
[15] 李晨芳, 王桦, 董昱, 等. 住院老年人细菌性肺炎多重耐药菌感染临床分析[J]. 广东药学院学报, 2019, 35(6):838-843.