儿童肺炎支原体肺炎的临床特征分析
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摘要
目的探讨儿童肺炎支原体(MP)肺炎的临床特征。方法将确诊为MP肺炎的228例患儿,按年龄分为<5岁组121例、≥5岁组107例,比较两组患儿临床表现、实验室及影像学检查结果。结果所有患儿无神经、肾脏、关节、皮肤等其他肺外临床表现;与≥5岁组相比,<5岁组患儿出现发热和WBC异常的比例明显降低(均P<0.05),而出现喘息、肺部啰音、肌酸激酶同工酶(CK-MB)增高的比例明显增高(均P<0.05);两组患儿C反应蛋白(CRP)增高、降钙素原(PCT)增高、ALT增高的比例比较,差异均无统计学意义(均P>0.05)。两组患儿胸部X线片提示多有改变,<5岁组以肺部斑片状影多见(63.64%),≥5岁组以肺部大片状阴影多见(39.25%);两组患儿胸腔积液的比例比较,差异无统计学意义(P>0.05)。结论儿童MP肺炎的临床表现多种多样,<5岁组患儿更易出现喘息、肺部啰音等局部症状,胸部X线片以肺部斑片状影多见;≥5岁组患儿更易出现发热及胸部X线片肺部大片状阴影。
Objective To analyze the clinical characteristics of Mycoplasma pneumoniae(MP) pneumonia in children. Methods Clinical data of 228 children with MP pneumonia were retrospectively reviewed, including 121 cases aged <5 years and 107 cases aged ≥5 years. The clinical features, laboratory results and imaging findings were analyzed and compared between two age groups. Results There were no clinical manifestations of nervous system, kidney, joint and skin in all cases. Compared with the ≥5 years age group, the proportion of fever and abnormal WBC in the <5 years group was significantly lower, while the proportion of wheezing, pulmonary rales and increased creatine kinase isoenzyme-MB(CK-MB) level was significantly higher(P<0.05). There were no significant differences in the percentage of increased CRP, PCT and ALT between the two groups(P >0.05). Chest X-ray showed that pulmonary patchy shadow was more common in <5 years group(63.64%) and pulmonary large patchy shadow was more common in ≥5 years group(39.25%). There was no significant difference in the proportion of pleural effusion between the two groups(P >0.05). Conclusion The clinical manifestations of MP pneumonia in children aged <5 years are prone to have local symptoms and pulmonary patchy shadow is more common in chest radiography; while children ≥5 years are prone to have fever and large infiltration shadows of chest radiography.
Objective To analyze the clinical characteristics of Mycoplasma pneumoniae(MP) pneumonia in children. Methods Clinical data of 228 children with MP pneumonia were retrospectively reviewed, including 121 cases aged <5 years and 107 cases aged ≥5 years. The clinical features, laboratory results and imaging findings were analyzed and compared between two age groups. Results There were no clinical manifestations of nervous system, kidney, joint and skin in all cases. Compared with the ≥5 years age group, the proportion of fever and abnormal WBC in the <5 years group was significantly lower, while the proportion of wheezing, pulmonary rales and increased creatine kinase isoenzyme-MB(CK-MB) level was significantly higher(P<0.05). There were no significant differences in the percentage of increased CRP, PCT and ALT between the two groups(P >0.05). Chest X-ray showed that pulmonary patchy shadow was more common in <5 years group(63.64%) and pulmonary large patchy shadow was more common in ≥5 years group(39.25%). There was no significant difference in the proportion of pleural effusion between the two groups(P >0.05). Conclusion The clinical manifestations of MP pneumonia in children aged <5 years are prone to have local symptoms and pulmonary patchy shadow is more common in chest radiography; while children ≥5 years are prone to have fever and large infiltration shadows of chest radiography.
引文
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[10]Liu Y,Ye X,Zhang H,et al.Characterization of macrolide resistance in Mycoplasma pneumoniae isolated from children in Shanhai,China[J].Diagn Microbiol Infect Dis,2010,67(4):355-358.DOI:10.1016/j.diagmicrobio.2010.03.004.
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[13]李少丽,孙红妹.肺炎支原体大环内酯类抗生素全球耐药现状和耐药机制研究进展[J].中华微生物学和免疫学杂志,2018,38(5):395-399.DOI:10.3760/cma.j.issn.0254-5101.2018.05.011.
[14]Zhang Y,Zhou Y,Li S,et al.The clinical characteristics and predictors of refractory mycoplasma pneumoniae pneumonia in children[J].PLoSOne,2016,11(5):e0156465.DOI:10.1371/journal.pone.0156465.
[15]梅淑芬,张园园,周云连,等.学龄前期儿童难治性肺炎支原体肺炎临床特征及危险因素分析[J].浙江医学,2018,40(11):1202-1205.DOI:10.12056/j.issn.1006-2785.2017.40.11.2018-219.
[2]Jain S,Williams DJ,Arnold SR,et al.Community-acquired pneumonia requiring hospitalization among US children[J].N Engl J Med,2015,372(9):835-845.DOI:10.1056/NEJMoa14045870.
[3]符跃强.重症肺炎支原体感染多系统的危重表现[J].中华实用儿科临床杂志,2018,33(12):881-884.DOI:10.3760/cma.j.issn.2095-428x.2018.12.001.
[4]中华医学会儿科分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015版)[J].2015,30(17):1304-1308.DOI:10.3760/cma.j.issn.2095-428X.2015.17.006.
[5]赵胃胃,赵华,王鑫.儿童肺炎支原体肺炎发病机制的研究进展[J].中华临床医师杂志,2015,9(20):3759-3762.DOI:10.3877/cma.j.issn.1674-0785.2015.20.020.
[6]孙红,孙红妹.肺炎支原体直接损伤及其免疫学致病机制研究进展[J].中华微生物学和免疫学杂志,2015,31(1):65-68.DOI:10.3760/cma.j.issn.0254-5101.2015.01.014.
[7]赵德育,陈慧中,杨倩媛,等.临床征象对识别儿童社区获得性肺炎支原体肺炎价值的系统综述[J].中华儿科杂志,2016,54(2):104-110.DOI:10.3760/cma.j.issn.0578-1310.2016.02.008.
[8]江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015:1280-1282.
[9]祁红梅,刘继凯,路娟.125例儿童肺炎支原体肺炎临床分析[J].中华实验和临床病毒杂志,2018,32(3):302-304.DOI:10.3760/cma.j.issn.1003-9279.2018.03.019.
[10]Liu Y,Ye X,Zhang H,et al.Characterization of macrolide resistance in Mycoplasma pneumoniae isolated from children in Shanhai,China[J].Diagn Microbiol Infect Dis,2010,67(4):355-358.DOI:10.1016/j.diagmicrobio.2010.03.004.
[11]Zhao F,Liu G,Wu J,et al.Surveillance of macrolide-resistant Mycoplasma pneumoniae in Beijing,China,from 2008 to 2012[J].Antimi crob Agents Chemother,2013,57(3):1521-1523.DOI:10.1128/AAC.02060-12.
[12]肖金红,朱翠明.支原体对宿主细胞的免疫逃逸机制研究进展[J].国际免疫学杂志,2011,34(5):245-248.DOI:10.3760/cma.j.issn.1673-4394.2011.05.001.
[13]李少丽,孙红妹.肺炎支原体大环内酯类抗生素全球耐药现状和耐药机制研究进展[J].中华微生物学和免疫学杂志,2018,38(5):395-399.DOI:10.3760/cma.j.issn.0254-5101.2018.05.011.
[14]Zhang Y,Zhou Y,Li S,et al.The clinical characteristics and predictors of refractory mycoplasma pneumoniae pneumonia in children[J].PLoSOne,2016,11(5):e0156465.DOI:10.1371/journal.pone.0156465.
[15]梅淑芬,张园园,周云连,等.学龄前期儿童难治性肺炎支原体肺炎临床特征及危险因素分析[J].浙江医学,2018,40(11):1202-1205.DOI:10.12056/j.issn.1006-2785.2017.40.11.2018-219.