儿童禽流感肺炎与细菌性肺炎的胸部放射征象分析

目的]探讨儿童H3N1型禽流感病毒性肺炎与细菌性肺炎的胸部放射表现特点。方法]回顾性分析2例经世界卫生组织确认为H3N1型禽流感病毒感染患者胸部放射表现，并与65例儿童细菌性肺炎进行对比。结果]本组2例H3N1型禽流感病毒性肺炎患者初期表现为单发片絮状渗出病变，密度高，边缘模糊，短期内病灶变化快；进展期由下至上扩展到多个肺叶、肺段，进展迅速；恢复期病变由弥漫性多发病变逐转变为局限病变；磨玻璃样密度病变影存在于各期。细菌性肺炎多无此特点，细菌性肺炎初期多为单发片状渗出病变，进展期病变局限于肺段、肺叶，恢复期多从近肺门侧开始吸收，病灶吸收较禽流感病毒性肺炎快，且吸收完全。结论]儿童H3N1型禽流感病毒性肺炎的胸部放射表现具有一定特征性，放射动态观察则是与儿童细菌性肺炎鉴别诊断的重要手段。

Chest Radiological Findings of Children with Avian Influenza Pneumonia and Bacterial Pneumonia

Objective] To explore the chest radiological manifestations of children of Hs N1 avian influenza pneumonia with those of bacterial pneumonia. Methods] The pulmonary radiological findings in 2 patients with H5 N1 avian influenza virus infection confirmed by World Health Organization were retrospectively ana- lyzed, and were compared with those of 65 patients with bacterial pneumonia. Results] The initial radio- graphic features of 2 patients with pneumonia caused by avian influenza were local flocculation lesion with high density, edge unsharpness and rapid changes in a short time in single lung lobe. The lesions of lung of these two patients spread rapidly into the other lobes and segments form up to down in progression, but the diffusion lesions turned to local lesions in recovery stage, and the mat-surface glass like image appeared in each stage. The radiological characteristics of bacterial pneumonia were different form those of avian influenza pneumonia. The images of bacterial pneumonia were lamellar lesion in single lung lobe in initial stage and local lesions in the lobe and segment in progression. The lesions of bacterial pneumonia were absorbed near the hilum of lung and more quickly than those of avian influenza pneumonia. Conclusion] There are some radiographic charac- teristics in children with Hs N~ avian influenza virus infection. Serial chest radiographs may assist the diagnosis of pneumonia caused by avian influenza. However, the final diagnosis still depends on the epidemiological history and laboratory findings.