論文No1745
Correlation between clinical features, high-resolution computed tomography findings, and a visual scoring system in patients with pneumonia due to Mycoplasma pneumoniae
Takeshi Saraya, Kosuke Ohkuma, Yayoi Tsukahara, Takayasu Watanabe, ... Hajime Takizawa
Respiratory Investigation, Volume 56, Issue 4, July 2018, Pages 320-325
＜背景＞
マイコプラズマ肺炎(MP)は市中肺炎の主な原因である。
我々は臨床的特徴、特に低酸素血症と高解像度CT(HRCT)での面積の関連について評価を検討した。
＜方法＞
杏林大学病院で2006年1月から2013年11月までの15歳以上のMPの医療カルテを後ろ向きに検討し、
2013年1月から2014年9月までの肺炎球菌肺炎と比較した。
＜結果＞
MPは65名、肺炎球菌肺炎は32名同定した。
HRCTのデータはMPで42名、肺炎球菌肺炎で32名が利用可能だった。
すべての低酸素血症患者でデータ利用可能だった。
低酸素血症は肺炎球菌肺炎(14/32, p = 0.008)の方がMP(5/39)よりも有意に多かった。
HRCTの可視化スコアは両群で有意に低酸素血症と関連していたが、
低酸素血症患者ではMPの方が肺炎球菌肺炎よりも有意に可視化スコアが高かった。
MPは全可視化スコアと血清炎症マーカー
(C-reaction protein [r = 0.43, p = 0.025] and lactate dehydrogenase [r = 0.466, p = 0.016])と有意に正の相関を示した。
両群で中葉、下葉のスコアは上葉スコアよりも有意に高く、ゾーン優位性を示唆した。
＜感想＞
マイコプラズマ肺炎で低酸素を示す患者では、HRCTの感染領域面積は肺炎球菌肺炎よりも多く、低酸素はCRPやLDHと正の相関を示していたようです。
Mycoplasma pneumoniae (MP) is the primary cause of community-acquired pneumonia. We aimed to evaluate the correlation between clinical features, with special reference to hypoxemia and the total affected area obtained using high-resolution computed tomography (HRCT).
Methods
Medical records of MP pneumonia patients > 15 years of age at Kyorin University Hospital between January 2006 and November 2013 were reviewed retrospectively and compared to patients with Streptococcus pneumoniae pneumonia, diagnosed between January 2013 and September 2014.
Results
We identified 65 and 32 patients with MP- and S. pneumoniae pneumonia, respectively. HRCT data were available for 42 and 32 patients with MP- and S. pneumoniae pneumonia, respectively. Data were available for all hypoxemic patients. Hypoxemia was significantly higher in patients with S. pneumoniae (14/32, p = 0.008) than those with MP (5/39). Total visual score on HRCT correlated significantly with hypoxemia in both groups, but showed significantly higher scores with MP- than with S pneumoniae pneumonia in hypoxemic patients.
MP pneumonia showed significant positive correlation between the total visual score and serum inflammatory markers (C-reaction protein [r = 0.43, p = 0.025] and lactate dehydrogenase [r = 0.466, p = 0.016]). In both groups, individual scores in the middle and lower lung fields were significantly higher than in the upper field, suggesting zonal predominance.
Conclusions
This study provides the first evidence that the total affected area on lung HRCT was more with MP compared to S. pneumoniae pneumonia in hypoxemic patients and positively correlated with hypoxemia and serum inflammatory markers.