5~13岁儿童不同胸部影像学表现的肺炎支原体肺炎急性期患者的肺功能比较

doi:10.19983/j.issn.2096-8493.20250148

摘要/Abstract

摘要：

目的: 探讨不同胸部影像学表现的5~13岁儿童肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia, MPP)急性期患者的肺功能特点。方法: 选取2024年9月至2025年2月在临沂市人民医院儿童呼吸科住院治疗的MPP患者133例作为研究对象。按照胸部影像学特点分为大叶性肺炎组65例、非大叶性肺炎组68例。对比两组肺功能检测参数的差异。结果: 比较两组患者最大肺活量(maximal vital capacity,VCmax)、用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in the first second,FEV₁)、呼气峰值流速(peak expiratory flow,PEF)(实测值/预计值)<80%;一秒率(FEV₁ to vital capacity ratio,FEV₁/FVC)(实测值/预计值)<94%;用力呼气25%肺活量的瞬间流量(forced expiratory flow at 25% of FVC,MEF25)、用力呼气50%肺活量的瞬间流量(forced expiratory flow at 50% of FVC,MEF50)、用力呼气75%肺活量的瞬间流量(forced expiratory flow at 75% of FVC,MEF75)、最大呼气中期流量(maximal midexpiratory flow,MMEF75/25)(实测值/预计值)<65%。大叶性肺炎组患儿VCmax、FVC、FEV₁(实测值/预计值)分别为(67.45±14.10)%、(70.09±14.95)%、(69.60±15.34)%,均明显低于非大叶性肺炎组[分别为(73.09±14.45)%、(76.12±15.55)%、(75.68±16.85)%],差异均有统计学意义(t值分别为-2.280、-2.278、-2.172,P值均<0.05)。累及单叶组患儿VCmax、FVC、FEV₁、MEF75(实测值/预计值)分别为(72.79±11.60)%、(75.29±12.67)%、(74.31±13.88)%、(58.94±23.70)%,均明显高于累及多叶组[分别为(61.21±14.36)%、(64.01±15.30)%、(64.11±15.35)%、(45.69±18.58)%],差异均有统计学意义(t值分别为3.596、3.251、2.811、2.477,P值均<0.05)。结论: 5~13岁儿童不同胸部影像学表现的MPP在急性期存在混合性通气功能障碍,既有限制性通气功能障碍,也有阻塞性通气功能障碍,同时存在小气道损伤;大叶性肺炎的患者肺通气功能受损情况更为明显,累及多叶相比累及单叶肺功能受损情况更明显。

关键词: 支原体, 肺炎, 儿童, 呼吸功能试验

Abstract:

Objective: To explore the characteristics of pulmonary function corresponding to different imaging manifestations in children aged 5-13 with Mycoplasma pneumoniae pneumonia (MPP) during the acute phase. Methods: A total of 133 children hospitalized with MPP in the Department of Pediatric Respiratory Medicine at Linyi People’s Hospital between September 2024 and February 2025 were enrolled. Based on chest imaging features, they were divided into a lobar pneumonia group (65 cases) and a non-lobar pneumonia group (68 cases). Pulmonary function parameters were compared between the two groups. Results: In both groups, the maximal vital capacity (VCmax), forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and peak expiratory flow (PEF)(measured/predicted values) were below 80%; the FEV₁ to vital capacity ratio (FEV₁/FVC)(measured/predicted value) was below 94%; and the forced expiratory flow at 25%, 50%, and 75% of FVC (MEF25, MEF50, MEF75) as well as maximal midexpiratory flow (MMEF75/25)(measured/predicted values) were below 65%. In the lobar pneumonia group, the VCmax, FVC, and FEV₁ (measured/predicted values) were (67.45±14.10) %, (70.09±14.95) %, (69.60±15.34) %, significantly lower than those in the non-lobar pneumonia group ((73.09±14.45) %, (76.12±15.55) %, (75.68±16.85) %). The differences were statistically significant (t-values were -2.280, -2.278, -2.172, respectively, all P-values <0.05). In children with single-lobe involvement group, the VCmax, FVC, FEV₁, and MEF75 (measured/predicted values) were (72.79±11.60) %, (75.29±12.67) %, (74.31±13.88) %, (58.94±23.70) %, significantly higher than those in the multiple-lobe involvement group ((61.21±14.36) %, (64.01±15.30) %, (64.11±15.35) %, (45.69±18.58) %). The differences were statistically significant (t-values were 3.596, 3.251, 2.811, 2.477, respectively, all P-values <0.05). Conclusion: During the acute phase of MPP, children aged 5-13 years with different chest imaging exhibit mixed ventilatory dysfunction, including both restrictive and obstructive ventilatory dysfunction, accompanied by small airway impairment. Patients with lobar pneumonia demonstrate more severe pulmonary function impairment, and multi-lobe involvement is associated with greater dysfunction compared to single-lobe disease.

Key words: Mycoplasma pneumoniae, Child, Respiratory function tests

中图分类号:

R725.6

李忠强, 吴雪郡, 李睿, 吕高梅, 任治娟, 杨慧敏, 葛云鹏, 徐磊磊, 侯凌云, 邢宇阁. 5~13岁儿童不同胸部影像学表现的肺炎支原体肺炎急性期患者的肺功能比较[J]. 结核与肺部疾病杂志, 2025, 6(6): 678-683. doi: 10.19983/j.issn.2096-8493.20250148

Li Zhongqiang, Wu Xuejun, Li Rui, Lyu Gaomei, Ren Zhijuan, Yang Huimin, Ge Yunpeng, Xu Leilei, Hou Lingyun, Xing Yuge. Comparison between different imaging presentations and pulmonary function in children aged 5-13 with Mycoplasma pneumoniae pneumonia during the acute phase[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(6): 678-683. doi: 10.19983/j.issn.2096-8493.20250148

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组别	非大叶性肺炎组(68例)	大叶性肺炎组(65例)	统计检验值	P值
性别[例(构成比,%)]			χ²=3.262	0.071
男性	42(61.8)	30(46.2)
女性	26(38.2)	35(53.8)
年龄(岁,$\bar{x}±s$)	6.94±1.67	7.35±2.00	t=1.291	0.199
身高(cm,$\bar{x}±s$)	126.74±11.95	128.17±14.24	t=0.630	0.530
体质量(kg,$\bar{x}±s$)	28.77±9.55	27.92±10.47	t=-0.489	0.626

肺功能指标	非大叶性肺炎组(68例)	大叶性肺炎组(65例)	Z值	P值
VCmax[L,M(Q₁,Q₃)]	1.36(0.99,1.63)	1.29(0.59,1.51)	-1.146	0.252
FVC[L,M(Q₁,Q₃)]	1.35(0.99,1.63)	1.27(0.90,1.48)	-1.204	0.229
FEV₁[L,M(Q₁,Q₃)]	1.13(0.90,1.39)	1.08(0.77,1.30)	-1.125	0.260
PEF[L/s,M(Q₁,Q₃)]	2.25(1.80,2.75)	2.20(1.61,2.62)	-0.903	0.367
MEF25[L/s,M(Q₁,Q₃)]	2.04(1.57,2.50)	1.98(1.40,2.51)	-0.972	0.331
MEF50[L/s,M(Q₁,Q₃)]	1.33(1.00,1.64)	1.35(0.86,1.78)	-0.052	0.959
MMEF75[L/s,M(Q₁,Q₃)]	0.64(0.44,0.82)	0.66(0.37,0.83)	-0.124	0.901
MMEF75/25[L/s,M(Q₁,Q₃)]	1.15(0.85,1.39)	1.14(0.80,1.53)	-0.322	0.748
FEV₁/FVC[%,M(Q₁,Q₃)]	84.60(79.18,90.38)	85.18(80.93,91.33)	-0.405	0.685

肺功能指标	非大叶性肺炎组(68例)	大叶性肺炎组(65例)	t值	P值
VCmax	73.09±14.45	67.45±14.10	-2.280	0.024
FVC	76.12±15.55	70.09±14.95	-2.278	0.024
FEV₁	75.68±16.85	69.60±15.34	-2.172	0.032
PEF	62.77±16.63	59.02±14.45	-1.384	0.169
MEF25	62.80±18.82	58.47±16.88	-1.395	0.166
MEF50	58.09±19.68	57.37±19.55	-0.211	0.833
MEF75	54.72±23.09	52.83±22.34	-0.479	0.633
MMEF75/25	58.28±20.77	54.86±19.19	-0.984	0.327

肺功能指标	累及单叶(35例)	累及多叶(30例)	Z值	P值
VCmax[L,M(Q₁,Q₃)]	1.37(0.99,1.51)	1.19(0.86,1.44)	-1.421	0.155
FVC[L,M(Q₁,Q₃)]	1.35(0.95,1.48)	1.18(0.85,1.44)	-1.250	0.211
FEV₁[L,M(Q₁,Q₃)]	1.13(0.77,1.32)	1.02(0.74,1.29)	-0.941	0.347
PEF[L/s,M(Q₁,Q₃)]	2.23(1.64,2.57)	2.18(1.47,2.92)	-0.395	0.693
MEF25[L/s,M(Q₁,Q₃)]	2.00(1.42,2.51)	1.94(1.26,2.49)	-0.375	0.708
MEF50[L/s,M(Q₁,Q₃)]	1.39(0.88,1.79)	1.31(0.78,1.72)	-0.724	0.469
MMEF75[L/s,M(Q₁,Q₃)]	0.70(0.47,0.85)	0.60(0.33,0.82)	-1.448	0.148
MMEF75/25[L/s,M(Q₁,Q₃)]	1.18(0.82,1.57)	1.09(0.64,1.39)	-0.809	0.418
FEV₁/FVC[%,M(Q₁,Q₃)]	84.51(78.68,93.01)	85.96(81.78,90.31)	-0.520	0.603

肺功能指标	累及单叶(35例)	累及多叶(30例)	t值	P值
VCmax	72.79±11.60	61.21±14.36	3.596	0.001
FVC	75.29±12.67	64.01±15.30	3.251	0.002
FEV₁	74.31±13.88	64.11±15.35	2.811	0.007
PEF	61.08±13.18	56.62±15.69	1.245	0.218
MEF25	60.27±16.61	56.36±17.21	0.931	0.355
MEF50	59.85±20.40	54.49±18.43	1.104	0.274
MEF75	58.94±23.70	45.69±18.58	2.477	0.016
MMEF 75/25	58.67±20.72	50.43±16.47	1.754	0.084