Iwanaga Yuto, Yamasaki Kei, Nemoto Kazuki, Akata Kentaro, Ikegami Hiroaki, Uchimura Keigo, Noguchi Shingo, Nishida Chinatsu, Kawanami Toshinori, Fukuda Kazumasa, Mukae Hiroshi, Yatera Kazuhiro
Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan.
Department of Microbiology, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan.
J Clin Med. 2022 Apr 14;11(8):2201. doi: 10.3390/jcm11082201.
The study objective was to evaluate chest radiographic features that distinguish Mycoplasma pneumoniae pneumonia (MPP) from other bacterial pneumonias diagnosed based on the bacterial floral analysis with 16S rRNA gene sequencing, using bronchoalveolar lavage fluid samples directly obtained from pneumonia lesions. Patients were grouped according to the dominant bacterial phenotype; among 120 enrolled patients with CAP, chest CT findings were evaluated in 55 patients diagnosed with a mono-bacterial infection (one bacterial phylotype occupies more than 80% of all phylotypes in a sample) by three authorized respiratory physicians. Among this relatively small sample size of 55 patients with CAP, 10 had MPP, and 45 had other bacterial pneumonia and were categorized into four groups according to their predominant bacterial phylotypes. We created a new scoring system to discriminate MPP from other pneumonias, using a combination of significant CT findings that were observed in the M. pneumoniae group, and age (<60 years) (MPP−CTA scoring system). When the cutoff value was set to 1, this scoring system had a sensitivity of 80%, a specificity of 93%, a positive predictive value of 73%, and a negative predictive value of 95%. Among the CT findings, centrilobular nodules were characteristic findings in patients with MPP, and a combination of chest CT findings and age might distinguish MPP from other bacterial pneumonias.
本研究的目的是利用直接从肺炎病灶获取的支气管肺泡灌洗液体样本，评估胸部X线特征，以区分肺炎支原体肺炎（MPP）与基于16S rRNA基因测序的细菌菌群分析诊断出的其他细菌性肺炎。患者根据主要细菌表型进行分组；在120例入选的社区获得性肺炎（CAP）患者中，由三名经授权的呼吸科医生对55例诊断为单一细菌感染（一种细菌系统型在样本中占所有系统型的80%以上）的患者的胸部CT结果进行了评估。在这55例CAP患者组成的相对较小样本中，10例患有MPP，45例患有其他细菌性肺炎，并根据其主要细菌系统型分为四组。我们创建了一种新的评分系统，利用肺炎支原体组中观察到的显著CT结果与年龄（<60岁）的组合来区分MPP与其他肺炎（MPP-CTA评分系统）。当临界值设定为1时，该评分系统的敏感性为80%，特异性为93%，阳性预测值为73%，阴性预测值为95%。在CT结果中，小叶中心结节是MPP患者的特征性表现，胸部CT结果与年龄的组合可能有助于区分MPP与其他细菌性肺炎。
