布地奈德联合特布他林雾化吸入治疗儿童支原体肺炎的疗效

目的 探讨布地奈德联合特布他林雾化吸入治疗儿童支原体肺炎的疗效。方法 选取镇安县医院2018年1月~12月诊断为肺炎支原体的患儿100例,采用随机数字表法分为对照组和观察组,各50例。对照组给予阿奇霉素治疗,观察组在对照组基础上给予布地纳德联合特布他林雾化吸入治疗,比较两组治疗总有效率、临床症状（发热、咳嗽、肺部湿罗音）消失时间、住院时间以及临床不良反应。结果 观察组治疗总有效率（94.00%）高于对照组（80.00%）,差异有统计学意义（P＜0.05）;观察组发热消失时间（4.25±1.21）d、咳嗽消失时间（4.54±1.24）d、肺部湿罗音消失时间（4.25±1.12）d、住院时间（8.20±1.36）d短于对照组的（5.89±1.26）d、（7.48±1.72）d、（6.00±1.45）d、（11.14±2.45）d,差异有统计学意义（P＜0.05）;观察组不良反应发生率（6.00%）与对照组（8.00%）比较,差异无统计学意义（P＞0.05）。结论 布地奈德联合特布他林雾化吸入治疗可作为儿童支原体肺炎的辅助药物,可促进临床症状消退,且临床不良反应少,治疗安全有效。     

小儿肺炎支原体肺炎临床特点（232例）

目的分析小儿肺炎支原体肺炎(MPP)的临床特点、支原体抗体检测最佳时间和糖皮质激素的疗效，为小儿支原体肺炎的诊治提供依据。方法收集我院确诊的232例MPP入院患儿临床资料，回顾性分析临床特征并分组。比较发热组与非发热组住院天数；比较激素组与非激素组住院时间和入院后热退天数；分析发病1w内和1w后肺炎支原体抗体阳性率。结果 MPP主要临床症状为发热及干咳。肺部明显阳性体征仅见于36.6%的患儿。发病1w以后特异性 IgM抗体阳性率（94.05%）明显高于1w内（70.37%）（P<0.01）；激素组热退天数（3.88d）与非激素组（3.27d）无差异（P﹥0.05）。结论小儿支原体肺炎发热咳嗽症状明显而肺部体征相对较少；糖皮质激素可减轻发热症状；发病第2w后查支原体抗体阳性率高。     

小儿支原体肺炎的临床诊治体会

目的总结小儿支原体肺炎的诊疗经验。方法回顾性分析2008年1月~2011年12月我院诊治的56例小儿支原体肺炎儿的临床资料。结果56例小儿支原体肺炎临床症状主要是发热、咳嗽、干咳及气喘等;肺部听诊,部分患儿可闻及干湿性啰音;均经X线检查,表现呈多样性,肺纹理增粗紊乱、肺门阴影增浓、间歇性肺炎改变及斑片状阴影。对56例患儿均采用阿奇霉素治疗,有效率达96.43%,无明显不良反应。住院治疗9~15d后患儿顺利出院,无死亡病例。结论小儿支原体肺炎症状往往不典型,容易误诊,应尽早行X线检查和血清肺炎支原体抗体MP-IgM等检测。阿奇霉素治疗小儿支原体肺炎疗效肯定、安全可靠。     

阿奇霉素治疗小儿肺炎支原体感染52例分析

目的 探讨小儿肺炎支原体感染的临床特点及治疗.方法 回顾性总结52例确诊为肺炎支原体感染患儿的临床资料并进行总结分析.结果 本组患儿以0~3岁的婴幼儿31例,占59.62%;3岁以上患儿21例,占40.38%.发热43例,占82.69%;持续性咳嗽33例,占63.46%;多数肺部闻及湿罗音,两肺呈斑片状阴影28例,占53.84%;呈间质性损害9例,占17.3%;大片状阴影6例,占11.53%.33例(63.46%)外周血白细胞正常.婴幼儿病例中出现肺外并发症者16例,占30.76%;血清肺炎支原体特异性IgM抗体均阳性.所有病例用阿奇霉素治疗2~3周均治愈.结论 肺炎支原体感染患儿中婴幼儿为主,3岁以上患儿则肺部体征不明显,更易发生肺外并发症.血清学MP-IgM检测是早期诊断的必要手段;用大环内酯类阿奇霉素治疗效果更好,疗程短.     

儿童7型腺病毒肺炎特点分析

目的 分析儿童7型腺病毒肺炎的临床特征,以提高诊疗水平、改善预后。方法 回顾性分析2019年4月~7月我院收治的42例7型腺病毒肺炎患儿的临床资料,包括临床表现、实验室检查指标及影像学结果、恢复期肺功能检查、脏器功能受累情况、合并其他病原感染情况、治疗结局。结果 共42例患儿中,2岁以下29例（69.05%）,均有发热,热峰＞40℃ 33例（78.57%）,热程≥2周19例（45.24%）。42例患儿LDH、AST、ALT均升高,ALB降低;随着热程时间延长,LDH、AST水平升高,ALB下降,其余指标均无明显差异。影像学表现节段性实变,9例患儿初期胸片或CT表现以单侧节段性实变为主,23例患儿以双侧散发与节段性实变为主,入院1~3 d内复查胸片或CT,双侧实变迅速发展至26例（61.90%）。肺外合并症主要为血液系统损害（30.95%）为主。病原感染主要以合并肺炎支原体IgM阳性13例（30.95%）为主。呼吸支持包括鼻导管给氧9例（21.42%）,无创通气24例（57.14%）,机械通气9例（21.42%）。住院期间死亡3例,3例患儿因病情危重转至上级医院,其中2例死亡,1例遗留严重后遗症;其余36例（85.71%）治愈、好转出院。结论 儿童7型腺病毒肺炎热峰高,热程长,LDH、AST明显升高,影像学进展快,常伴肺内外各种损害。临床疑诊7型腺病毒肺炎时应尽快完善病原学,动态监测LDH、AST水平及影像学变化,及早治疗。     

肺炎支原体与病毒混合感染患儿临床研究

目的 探讨临床上儿童支原体感染与病毒感染的交叉情况,为儿童呼吸道疾病的诊治提供参考.方法 发热,呼吸道症状住院,且入院检测血清肺炎支原体抗体lgM均为阳性患儿用酶联免疫和间接荧光法进行儿童常见的多种病毒检测.结果 (1)血清降钙素原(PCT)检测,小于0.5 ng/ml的患儿385例,占81.7%.(2)柯萨奇病毒IgG(Cox-IgG)和Cox-1gM检测,514例中阳性例数分别为207例(40.3%)和183例(35.6%).(3)乙型流感病毒阳性者为2例(0.8%);副流感病毒1、2,3型的阳性率分别为0.8%、0%、和1.9%;合胞病毒(RSV)和腺病毒抗原阳性率分别为11.4%和0.8%.(4)EB病毒抗体的阳性者分别为IgM 84例(11.8%)、IgG 451例(63.6%).结论 支原体感染很少与常见的呼吸道病毒交叉感染;柯萨奇病毒与肝炎支原体(MP)感染的交叉率高达35.6%.     

儿童呼吸道感染者肺炎支原体及肺炎衣原体特异性抗体检测临床意义

目的 探究儿童呼吸道感染者肺炎支原体及肺炎衣原体特异性抗体检测临床意义。方法 选择我院2018年1月~8月收治的85例呼吸道感染患儿设为研究组,另选择同期在我院进行健康体检的85例儿童设为对照组,对照组采用ELISA法检测肺炎支原体及衣原体,研究组在此基础上行咽拭子培养法检测,比较两组肺炎支原体、衣原体抗体检出率,ELISA法与咽拭子培养法对肺炎支原体、衣原体抗体的阳性检出率,分析研究组呼吸道感染性疾病中肺炎支原体、衣原体抗体阳性分布情况。结果 研究组患儿肺炎支原体抗体MP-IgM抗体、MP-IgA抗体、MP-IgG抗体及肺炎衣原体特异性抗体CP-IgM抗体、CP-IgG抗体的检出率均高于对照组儿童,差异有统计学意义（P＜0.05）;ELISA法对肺炎支原体特异性抗体阳性的检出率为54.12%高于咽拭子培养法的36.47%,组间对比具有统计学意义（P＜0.05）;ELISA法对肺炎衣原体特异性抗体阳性的检出率为58.82%高于咽拭子培养法的37.65%,差异有统计学意义（P＜0.05）;肺炎支原体、肺炎衣原体抗体阳性在各种儿童呼吸道感染性疾病中均有表现,其中,肺炎和支气管肺炎的阳性检出率较咽炎、扁桃体炎均较高。结论 肺炎支原体、肺炎衣原体是引发肺炎和支气管肺炎感染的主要病原菌。     

儿童传染性单核细胞增多症临床特点

目的 探讨儿童传染性单核细胞增多症的临床特点及表现。方法 回顾性分析2016年1月~2019年1月我院收治的100例传染性单核细胞增多症患儿的临床资料,总结患儿性别比例、年龄分布、临床表现、合并症、预后转归、EB病毒检测结果。结果儿童传染性单核细胞增多症中男女比例为1.17:1,年龄以 3~6岁为主,发病年龄分布:＜3岁26例,3~6岁62例,＞6岁12例;发病季节分布:春季24例、夏季14例、秋季30例、冬季32例;症状表现主要为发热、咽峡炎和颈部淋巴结肿大,其它有眼险浮肿、皮疹、脾脏肿大、肝脏肿大等,不同年龄患儿的临床表现,除咽峡炎外,所有患儿发热、皮疹、淋巴结大、肝脏肿大、脾脏肿大及眼睑浮肿比例比较,差异均无统计学意义（P＞0.05）;实验室检查主要有白细胞、外周血淋巴细胞升高,外周血有异型淋巴细胞等。血清EB病毒检测结果显示衣壳抗原IgG抗体阳性率90%;EB病毒低亲和力抗体100%,EB病毒DNA 100%。结论 儿童传染性单核细胞增多症秋末至初春多发,年龄以3~6岁多见,无明显性别差异,临床症状表现多样,患儿外周血白细胞及淋巴细胞多高于正常值,血EB病毒抗体及EB病毒DNA检测有助于临床确诊该病。     

两种不同胸部X线表现的儿童支原体肺炎临床特征比较

目的：了解不同X线表现的儿童支原体肺炎(MPP)的临床特征。方法收集2011年1月~2012年12月因MP的住院患儿112例,对其临床资料进行回顾性总结分析。根据胸片表现的不同,将入选患儿分为支气管肺炎组60例与节段性肺炎组52例,比较两组患儿在临床表现上的差异。结果支气管肺炎组患儿平均年龄(2.56±1.13)岁,咳痰与喘息的症状相对明显,发热以低热为主,肺外表现以胃肠道症状为主,肺部体征较明显。节段性肺炎组患儿平均年龄(5.21±2.46)岁,临床多表现为高热,干咳明显,多不伴有喘息,肺外表现以皮损多见,肺部体征轻。结论儿童支原体肺炎胸片多表现为支气管肺炎或节段性肺炎,但两种肺炎的临床特征存在明显的差异。     

痰热浓煎剂治疗小儿支原体肺炎的临床疗效研究

目的 探讨痰热浓煎剂治疗小儿支原体肺炎（痰热闭肺证）的临床疗效。方法 选取2014年3月~2015年12月我院收治的224例小儿支原体肺炎（痰热闭肺证）患儿作为临床研究对象,采用随机数表法将患者分成研究组和对照组,每组112例。对照组患儿进行阿奇霉素治疗,研究组患儿在对照组的基础上给予痰热浓煎剂进行治疗。观察和比较两组患儿的治疗效果及症状消失情况;统计两组患儿发生不良反应的人数,计算不良反应发生率。结果 研究组治疗后总有效率为95.54%,高于对照组87.50%,差异有统计学意义（P＜0.05）;研究组患者发热、咳嗽、肺部体征消失时间及胸部Ｘ片恢复正常时间均短于对照组,统计学意义显著（P＜0.01）;两组均无不良反应的发生。结论 痰热浓煎剂对治疗小儿支原体肺炎（痰热闭肺证）有良好的治疗效果,无明显不良反应,安全性高。     

Radiographic, clinical, and prognostic features of complicated and uncomplicated community-acquired lobar pneumonia in children.

BACKGROUND AND PURPOSE: The incidence of community-acquired lobar pneumonia in conjunction with either necrosis or empyema in children has rapidly increased in recent years. This study aimed to evaluate the radiographic, clinical, and predicted factors of complicated and uncomplicated lobar pneumonia in children. METHODS: This retrospective study included 131 patients younger than 18 years of age with community-acquired lobar pneumonia treated between January 2002 and March 2005. Multiple logistic regression analysis was performed to demonstrate the risk factors of complicated lobar pneumonia. RESULTS: The proportion of children with lobar pneumonia in children increased dramatically from 7% in 2002 to 19% in 2004. Analysis revealed the presence of elevated C-reactive protein level (>12 mg/dL) [odds ratio (OR), 3.51; 95% confidence interval (CI), 1.61-7.66], persistent fever for more than 1 week before admission (OR, 1.14; 95% CI, 1.04-1.26), and multilobar (> or =2 lobes) confluent lung opacity on chest radiographs (OR, 2.83; 95% CI, 1.27-6.33) were independent predictors of the occurrence of complicated lobar pneumonia. A progressive increase in the number of penicillin-non-susceptible Streptococcus pneumoniae isolates was found during the study period. Prolonged fever was a common clinical feature of hospitalized children with lobar pneumonia. Failure of consolidative pneumonia to respond to appropriate antibiotic treatment within 4.4 days was associated with the development of necrosis or empyema. CONCLUSIONS: Complicated and uncomplicated lobar pneumonia are difficult to distinguish based on clinical symptoms at the time of admission. The presence of the above risk factors can help in the early diagnosis of complicated lobar pneumonia.     

Pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae in children - comparative analysis of clinical picture

PurposeThe aim of the study was comparative analysis of clinical picture and prevalence of pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae in children.Material and MethodsThe study involved 332 children hospitalized in the 3rd Department of Paediatric, Polish Mother's Memorial Hospital – Research Institute, due to pneumonia caused by Mycoplasma pneumoniae – group I or Chlamydophila pneumonia – group II.ResultsOver 2003-2009 period there were 1870 children hospitalized due to pneumonia, of which in 332 (17.8%) the Mycoplasma pneumoniae and/or Chlamydophila pneumoniae etiology was confirmed. Mycoplasma pneumoniae, Chlamydophila pneumoniae, and mixed infection was diagnosed in 198 (10.6%), 102 (5.5%), and 32 (1.7%) children, respectively. The dominant clinical feature in both groups was cough, observed in 186 (93.9%) and 88 (86.3%) children, respectively. Further, reddening of the throat, rhinitis, shortness of breath, fever, enlarged lymph nodes, skin lesions and dyspepsia were also observed. The frequency of specific clinical features in both groups was similar. Statistical relationship (p≤0.05) was observed only in case of skin lesions. In chest x-ray there was no statistical link as for analyzed changes. Interstitial inflammatory changes were most frequently observed.ConclusionsMycoplasma pneumoniae and Chlamydophila pneumoniae are significant etiological factors in pneumonia in children, and as such they should be taken into consideration in differential diagnosis of pneumonia in children. The clinical picture of pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae is hardly specific, with basic labs and chest x-ray of little help in differentiation of infection etiology.     

142例小儿肺炎支原体感染临床分析

目的探讨小儿肺炎支原体感染病例临床特点。方法回顾性总结142例肺炎支原体感染住院患儿的临床资料并进行统计学处理。结果婴幼儿50例，肺部出现哕音者28例，占56％，3岁以上患儿92例，肺部出现哕音者14例，占14．2％，二者之间有显著性差异（P〈0．01）；合并肺外并发症者婴幼儿14例，占28％，3岁以上患儿43例，占46．3％，二者之间差异有统计学意义（P〈0．05）。结论肺炎支原体感染患儿中婴幼儿病例以肺部表现明显且较重，而3岁以上患儿肺部体征不明显，更易发生肺外并发症，所有病例应用阿奇霉素治疗效果好，疗程短，依从性好。     

Altered chemokine profile in Refractory Mycoplasma pneumoniae pneumonia infected children

BackgroundMycoplasma pneumoniae is one of the major pathogens causing community-acquired pneumonia in children. Although usually self-limited, Mycoplasma pneumoniae pneumonia (MPP) may lead to complicated morbidity that can even be life-threatening. Upon MPP infection, alveolar macrophage becomes attracted and activated and will induce subsequent cytokine and chemokine reaction. Refractory Mycoplasma pneumoniae pneumonia (RMPP) is manifested by clinical or radiological deterioration despite proper antibiotic therapy. RMPP is characterized with excessive inflammation and may need subsequent glucocorticoid treatment. Aim: The aim of this study was to investigate the change of plasma chemokines in non-refractory Mycoplasma pneumoniae pneumonia (NRMPP) and RMPP before and after antibiotic or methylprednisolone treatment.MethodA total of 42 children with MPP were enrolled in this study. Plasma specimens were collected at admission and one to two weeks after antibiotic or methylprednisolone treatment with declined fever. Plasma specimens were then indicated to chemokines detection.ResultsMycoplasma pneumoniae pneumonia altered the chemokine profile through the observation of decreased plasma M1 related chemokines (CCL2, CCL8 and CXCL10) and increased M2 related chemokines (CCL17 and CCL22) after treatment.When the patients were divided into RMPP and NRMPP groups and the chemokines before treatment were compared, the RMPP group showed higher CXCL10 but lower CCL3 and CCL11 than the NRMPP group.ConclusionUnique changes in macrophage related chemokines is observed in the course of MPP infection. NRMPP and RMPP infection in children showed distinct manifestation in chemokine profiles.     

盐酸氨溴索联合盐酸丙卡特罗治疗小儿肺炎的效果分析

目的 研究盐酸氨溴索加盐酸丙卡特罗治疗小儿肺炎的临床效果。方法 选取2016年10月~2017年12月我院收治的小儿肺炎患者88例,随机分为研究组与对照组,每组44例。对照组给予常规治疗,研究组在对照组基础上予以口服盐酸氨溴索加盐酸丙卡特罗,对比两组患儿症状体征（喘息、咳嗽、咳痰、发热、肺部啰音）消退时间和临床疗效。结果 研究组喘息、咳嗽、咳痰、发热、肺部啰音消退时间分别为（2.66±1.08）d、（5.24±1.98）d、（3.68±1.44）d、（1.33±0.57）d、（4.53±2.14）d,均短于对照组的（4.22±2.34）d、（7.55±2.33）d、（5.43±2.50）d、（2.20±0.75）、（6.12±2.98）d,差异具有统计学意义（P＜0.05）。研究组治疗总有效率高于对照组（95.45% vs 79.55%）,差异具有统计学意义（P＜0.05）。结论 盐酸氨溴索联合盐酸丙卡特罗治疗小儿肺炎,可有效改善其临床症状,提升治疗有效率。     

Predictive value of Thomsen-Friedenreich antigen activation for Streptococcus pneumoniae infection and severity in pediatric lobar pneumonia

BackgroundMost cases of complicated pneumonia in children are caused by pneumococcal infections. Thomsen-Friedenreich antigen (TA) is present on erythrocytes, platelets and glomeruli, and it can be activated during pneumococcal infection. The aim of this study was to investigate the predictive value of TA activation for pneumococcal infection and association with the severity of complicated pneumonia.Materials and methodsPatients with lobar pneumonia were routinely tested for TA at the Department of Pediatrics, Mackay Memorial Hospital from January 2010 to December 2015. We retrospectively reviewed and analyzed their charts and data including age, sex, etiology of infection, chest tube insertion or video-assisted thoracoscopic surgery, length of hospital stay, TA activation, white blood cell count and level of C reactive protein.ResultsA total of 142 children with lobar pneumonia were enrolled, including 35 with empyema, 31 with effusion, 11 with necrotizing pneumonia and four with lung abscess. Streptococcus pneumoniae was the most commonly identified pathogen. Twenty-two patients (15.4%) had activated TA, all of whom were infected with S. pneumoniae. TA activation had 100% specificity and 100% positive predictive value for pneumococcal infection. In the multivariate analysis in lobar pneumonia, TA activation (OR, 15.8; 95% CI, 3.0–83.5; p = 0.001), duration of fever before admission (OR, 1.2; 95% CI, 1.1–1.5; p = 0.013) and initial CRP level (OR, 1.1; 95% CI, 1.0–1.1; p = 0.004) were independent predictors of empyema.ConclusionsTA activation is a specific marker for pneumococcal pneumonia and might indicate higher risk for complicated pneumonia.     

儿童难治性肺炎的早期识别与诊断

肺炎支原体肺炎（MPP）是一种常见的儿科疾病,约占小儿社区获得性肺炎的15%~20%,在流行年可达30%。难治性肺炎支原体肺炎（RMPP）是指常规大环内酯类等药物治疗1周后无效,症状持续加重的MPP,具有病情进展快、并发症多、后遗症危害等特点。如何有效早期诊断、早期干预一直是临床研究的重点。本文就儿童难治性肺炎支原体肺炎的早期识别和诊断作一综述。     

Effects of Methylprednisolone Pulse Therapy on Refractory Mycoplasma pneumoniae Pneumonia in Children

Purpose

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired pneumonia in children. The clinical course is typically self-limited and benign; however, rare cases of severe pneumonia can develop despite appropriate antibiotic therapy. We studied the effects of methylprednisolone pulse therapy on severe refractory M. pneumoniae pneumonia in children.

Methods

The clinical effects of methylprednisolone therapy were evaluated retrospectively in 12 children with severe refractory M. pneumoniae pneumonia, which was diagnosed serologically. All patients developed respiratory distress, high fever, and initial lobar pneumonic consolidation based on radiological findings. All clinical symptoms deteriorated despite appropriate antibiotic therapy. Thus, children were treated with intravenous methylprednisolone pulse therapy in addition to antibiotics.

Results

The average febrile period before admission was 4.9±1.7 days, and fever persisted in all children until steroid administration. Methylprednisolone pulse therapy (30 mg/kg) was given 5.4±2.5 days after admission. After methylprednisolone pulse therapy, clinical symptoms improved in all patients without adverse events. The fever subsided 0-2 h after initiation of corticosteroid therapy. The abnormal radiological findings resolved within 2.6±1.3 days, and the high C-reactive protein levels (6.7±5.9 mg/dL) on admission decreased to 1.3±1.7 mg/dL within 3.0±1.1 days after starting corticosteroid therapy.

Conclusions

Three-day methylprednisolone pulse therapy could be applied to treatment of refractory M. pneumoniae pneumonia despite appropriate antibiotic therapy and appeared to be efficacious and well-tolerated.