Kim C K, Chung C Y, Kim J S, Kim W S, Park Y, Koh Y Y
Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul,Korea.
Pediatrics. 2000 Feb;105(2):372-8. doi: 10.1542/peds.105.2.372.
The clinical course of Mycoplasma pneumonia is typically mild and self-limited. There are, however, several case reports of severe complication following this illness with considerable morbidity and mortality.
This study was conducted to investigate, using high-resolution computed tomography (HRCT), the long-term pulmonary structural abnormalities after Mycoplasma pneumonia and to identify risk factors (chest radiograph findings, antibody titers, and host factors) that might increase the likelihood of developing the sequelae.
Thirty-eight children requiring hospitalization attributable to Mycoplasma pneumonia were recruited by the retrospective examination of hospital records. They underwent HRCT after an interval of 1.0 to 2. 2 years. A control group of 17 children with the history of Mycoplasma upper respiratory infection was also studied after a similar interval.
Abnormal HRCT findings were present in 37% (14/38) of the pneumonia group, compared with 12% (2/17) of the control group. The abnormalities in the pneumonia group, which appeared alone or in combination, included mosaic perfusion (n = 12), bronchiectasis (n = 8), bronchial wall thickening (n = 4), decreased vascularity (n = 1), and air trapping on expiratory scan (9 of 29 tested). The area affected by these abnormalities, usually involving 2 or more lobes, corresponded in all cases to the location of the infiltrate on chest radiograph at the time of pneumonia. Between subjects with abnormal HRCT (n = 14) and normal HRCT (n = 24) in the pneumonia group, significant differences were observed in age at the time of pneumonia (mean +/- standard deviation: 5.3 +/- 2. 0 years vs 7.7 +/- 3.4 years) and peak antimycoplasma antibody titer (geometric mean [range of 1 standard deviation]; 1:7943 [3126-19 953] vs 1:3093 [832-11 482]).
We conclude that a considerable proportion of children with history of Mycoplasma pneumonia have abnormal findings on HRCT, suggestive of small airway obstruction and that younger age and higher antibody titer at the time of pneumonia may be risk factors for these sequelae.
支原体肺炎的临床病程通常较轻且具有自限性。然而，有几例关于该疾病后出现严重并发症且伴有相当高发病率和死亡率的病例报告。
本研究旨在使用高分辨率计算机断层扫描（HRCT）调查支原体肺炎后的长期肺部结构异常，并确定可能增加后遗症发生可能性的危险因素（胸部X光片表现、抗体滴度和宿主因素）。
通过回顾医院记录招募了38名因支原体肺炎需要住院治疗的儿童。在间隔1.0至2.2年后，他们接受了HRCT检查。还对17名有支原体上呼吸道感染病史的儿童组成的对照组在类似间隔后进行了研究。
肺炎组中37%（14/38）出现HRCT异常表现，而对照组为12%（2/17）。肺炎组单独或合并出现的异常包括马赛克灌注（n = 12）、支气管扩张（n = 8）、支气管壁增厚（n = 4）、血管减少（n = 1）以及呼气扫描时的空气潴留（29例检查中有9例）。这些异常所累及的区域通常涉及2个或更多肺叶，在所有病例中均与肺炎时胸部X光片上浸润影的位置相对应。在肺炎组中HRCT异常（n = 14）和HRCT正常（n = 24）的受试者之间，在肺炎时的年龄（平均值±标准差：5.3±2.0岁对7.7±3.4岁）和抗支原体抗体滴度峰值（几何平均值[1个标准差范围]；1:7943[3126 - 19953]对1:3093[832 - 11482]）方面观察到显著差异。
我们得出结论，相当一部分有支原体肺炎病史的儿童在HRCT上有异常表现，提示小气道阻塞，并且肺炎时年龄较小和抗体滴度较高可能是这些后遗症的危险因素。
