目的

探讨根据儿童肺炎支原体肺炎（MPP）患儿胸部CT 支气管充气征对实施支气管肺泡灌洗术（BAL）决策的影响。

方法

选取2023年6月1日至2024年6月30日于首都医科大学附属首都儿童医学中心收治的487例MPP患儿为研究对象。根据其首次胸部CT 检查所示肺实变病灶内是否出现支气管充气征，将其分为0级组（n=126，肺部实变病灶内无支气管充气征），1级组（n=153，肺部实变病灶内可见支气管充气征，但是仅延及病灶近1/2范围）和2级组（n=208，肺部实变病灶内可见支气管充气征，并且延及病灶外缘）。比较3组患儿一般临床资料，临床观察指标［入院时外周血C反应蛋白（CRP）水平，肺部啰音发生率和住院时间］，纤维支气管镜检查结果（呼吸道分泌物量、痰栓、支气管内树枝状塑形物征），以及复查结果（病灶完全吸收、大部分吸收及少量吸收）等指标。本研究遵循的程序经病例收集医院伦理委员会批准（审批文号：SHERLLM2024024）。因本研究为回顾性研究，申请豁免患者知情同意获得伦理委员会批准。

结果

①3组患儿性别构成比和年龄等一般临床资料比较，差异均无统计学意义（P＞0.05）。②3组患儿入院时外周血CRP水平、肺部啰音发生率和住院时间总体比较，差异均有统计学意义（P＜0.05）。3组患儿肺部啰音发生率和住院时间随着影像学检查结果显示MPP 分级增高，则均呈递增趋势（χ²_趋势=96.39、100.49，P ＜0.001）。③3组患儿呼吸道分泌物量、痰栓阳性率和支气管内树枝状塑形物发生率总体比较，差异均有统计学意义（P＜0.001）。3组患儿呼吸道分泌物量随着MPP 影像学分级程度降低而减少（χ²=273.54，P＜0.001），痰栓和塑形性支气管炎征象阳性率，亦随着MPP影像学分级程度降低而显著降低（χ²_趋势=112.94、70.96，P＜0.001）。④首次胸部CT 检查7～10 d后的复查结果显示，3组患儿病灶与首次检查结果总体比较，差异均有统计学意义（χ²=186.82，P＜0.001），随着影像学MPP分级降低，病灶吸收程度呈显著递增趋势。

结论

基于胸部CT 支气管充气征的MPP 分级方法，可对MPP患儿是否实施BAL治疗可提供决策依据。

Objective

To explore the impact of chest CT air bronchogram on decision-making regarding bronchoalveolar lavage（BAL）in children with Mycoplasmapneumoniae pneumonia（MPP）.

Methods

A total of 487 children with MPP who were diagnosed and treated at Capital Center for Children's Health，Capital Medical University between June 1，2023 and June 30，2024 were enrolled into this study.Based on the presence of air bronchogram within pulmonary consolidation lesions on the initial chest CT scan，patients were categorized into three groups：group 0（n=126，no air bronchogram within consolidation lesions），group 1（n=153，air bronchogram visible within consolidation lesions but extending to only approximately half of the lesion），and group 2（n=208，air bronchogram visible within consolidation lesions and extending to the peripheral areas）.General clinical characteristics，clinical observation indicators ［C-reactive protein（CRP）level at admission，incidence of rales，and length of hospital stay］，fiberoptic bronchoscopy findings（quantity of secretions，presence of mucus plugs，and cast formation），as well as follow-up imaging results （complete resolution，major resolution，and minor resolution），were compared among three groups.The study procedures were approved by the Ethics Committee of the hospital where the study was conducted （Approval No.SHERLLM2024024）.As this was a retrospective study，the requirement for informed consent was waived by the Ethics Committee.

Results

①There were no statistically significant differences in gender ratio and age among three groups （P ＞0.05）.②Comparative analyses of CRP levels at admission，incidence of rales，and length of hospital stay among three groups revealed statistically significant differences （P＜0.05）.The incidence of rales and the length of hospital stay showed an increasing trend with higher imaging grades，respectively（χ2_trend=96.39，100.49；P＜0.001）.③Comparative analyses of the amount of secretions，positive rate of mucus plugs，and incidence of signs of cast formation among three groups showed statistically significant differences （P＜0.001）.The amount of secretions decreased with higher imaging grades（χ²=273.54，P ＜0.001），and the positive rates of mucus plugs and signs of cast formation significantly decreased as imaging grades improved，respectively（χ²_trend=112.94，70.96；P＜0.001）.④Follow-up chest CT performed 7-10 days after the initial examination demonstrated statistically significant differences in the degree of lesion absorption among three groups（χ²=186.82，P ＜0.001），with a significant trend of greater lesion absorption associated with improvement in imaging grade.

Conclusions

The chest CT air bronchogram grading method can serve as a reference for decision-making regarding the use of BAL in children with MPP.