临床荟萃

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110例儿童重症肺炎支原体肺炎临床特点分析

  

  1. 福建医科大学附属福建省妇幼保健院 儿科,福建 福州 350001
  • 出版日期:2017-06-05 发布日期:2017-06-01
  • 通讯作者: 通信作者:王程毅,Email: chenqin8601@163.com

Clinical characteristics of 110 children with severe Mycoplasma pneumoniae pneumonia

  1. Department of Pediatrics,Fujian Provincial Maternity and Children’s Hospital of
    Fujian Medical University,Fuzhou 350001,China
  • Online:2017-06-05 Published:2017-06-01
  • Contact: Corresponding author: Wang Chengyi,Email: chenqin8601@163.com

摘要: 目的 了解儿童重症肺炎支原体肺炎临床特点,为临床诊治提供参考。方法 对2014年1月-2015年12月福建省妇幼保健院儿童病房重症肺炎支原体肺炎儿童进行回顾性分析。结果 110例重症肺炎支原体肺炎患儿中0~1岁组43例,>1~3岁组39例,>3~5岁组18例,>5岁组10例;不同季节重症MPP感染率不同,夏季发病最多;各年龄组咳嗽、肺部啰音比例依次减低(P<0.05);各年龄组白细胞计数差异有统计学意义(P<0.05);C反应蛋白(CRP)、乳酸脱氢酶差异无统计学意义;随着年龄的增大,患儿出现肺部合并症(肺脓肿、胸腔积液、肺气肿、气胸)和右侧肺部病变比例逐渐增多(P<0.05); 110例重症MPP患儿共检出病毒52例(47.3%),其中埃伯斯坦(EB)病毒感染最多23例(20.9%),其次巨细胞病毒(CMV)18例(16.4%),各年龄组混合病毒感染分布不平均; 110例在应用强有力抗生素的基础上经加用肾上腺糖皮质激素,部分联用静脉滴注免疫球蛋白后均取得了肯定的治疗效果。结论 儿童重症MPP呈全年散发,以夏季多见;不同年龄阶段的儿童重症MPP临床特征存在不同,同时还存在混合感染现象。重症支原体肺炎CRP、LDH均明显升高。早期识别临床有重症肺炎支原体肺炎发展趋势的患儿,辅以联合治疗,可减少后遗症的发生。

关键词: 肺炎, 支原体;体征和症状;治疗;儿童

Abstract: Objective  To study the clinical characteristics of severe Mycoplasma pneumoniae pneumonia (MPP) in children, and to provide a basis for diagnosis and treatment. Methods  Retrospective analysis was performed on the epidemiological and clinical data of  the children who were hospitalized due to severe MPP from January 2014 to December 2015 in the hospital. Results  Among the 110 children who were hospitalized due to severe MPP, 43 cases were between 0 and 1 years old, 39 cases >13 years old, 18 cases >35 years  old and 10 cases  >5 years  old. The incidence of MPP varied with the seasons and was significantly highest in summer. With the growing of ages, the proportion of children with cough, with rale all decreased,the proportion of pulmonary complications(including lung abscess, hydrothorax,emphysema and pneumothorax)  and pathological change of right lung both increased(P<0.05).White blood cell count (WBC) differed significantly among four groups (P<0.05). Creactive protein(CRP)  and lactate dehydrogenase increased, but there were no statistical significance among different groups. A total of 110 patients were tested for other respiratory etiology, and coinfection was diagnosed in a total of 52 cases(47.3%). EB virus was the most common(23 cases,20.9%), followed by cytomegalovirus (18 cases,16.4%). The coinfection features of severe MPP were different among children of different ages. The therapeutic effects of antibacterial agents, glucocorticoid and intravenous immunoglobulin in treating 110 severe MPP were positive. Conclusion  Severe MPP is sporadic throughout the whole year, with a higher incidence in summer. The clinical features of  severe MPP are different among children of different ages, and there are mixed infections of MPP and respiratory viruses. CRP and lactate dehydrogenase were significantly higher in children of severe MPP. Early recognition and combined treatment can reduce the occurrence of sequelae.

Key words: pneumonia, mycoplasma, signs and symptoms, therapy;children