成人支原体肺炎并发溶血性贫血一例并文献复习

目的 提高临床医生对成人支原体肺炎并发溶血性贫血的认识.方法 报道1例成人支原体肺炎并发溶血性贫血病例,以mycoplasma pneumonia、hemolytic anemia、adult及case report为检索词,检索时限为1967年1月至2011年3月,通过PubMed检索系统进行检索;同时以“肺炎,支原体,溶血性贫血,成人”为检索词,检索时限为1978年1月至2011年3月,通过万方数据库对中文文献进行检索,共检索出相关临床资料完整的病例报告9篇.结合国内外文献报道的9例同类病例的临床资料进行分析.结果 患者女,29岁,因“发热伴咳嗽、咳痰15 d,血红蛋白下降2d”入院.X线胸片示左下肺渗出性病变,发病第14天外周血血红蛋白下降,最低至83 g/L,网织红细胞为0.04,同时室温下抽出的静脉血在试管中凝集,血清支原体抗体IgM阳性,冷凝集素滴度为1∶256.经抗感染治疗2周后血红蛋白含量恢复正常,肺部病变消失,诊断为支原体肺炎并发溶血性贫血.复习国内外文献报道的9例临床资料完整的成年病例,10例中男6例,女4例,年龄29 ～60岁,8例在发病第8～18天出现溶血性贫血,10例均出现血冷凝集素滴度增高(其中7例＞1∶1024),2例发生血管内栓塞.10例中9例痊愈,1例死亡.结论 支原体肺炎并发溶血性贫血多发生在发病第8～18天,与冷凝集素滴度增高相关,部分病例同时出现血管内栓塞.多数病例预后良好,少数重症病例预后不良.

Mycoplasma pneumonia associated with hemolytic anemia: case report and literature review

Objective To improve the understanding of hemolytic anemia secondary to Mycoplasma pneumonia.Methods One case of hemolytic anemia secondary to Mycoplasma pneumonia in an adult was reported.With “Mycoplasma pneumonia,hemolytic anemia,adult,case report” as the search terms,and the search time ranged from 1967.1 to 2011.3 for PubMed and 1978.1 to 2011.3 for Wanfangdata,9 cases of similar clinical cases in the literatures were reviewed.Results A 29 year-old female patient was admitted to the hospital because of fever with cough and sputum production for 15 days.The chest X-ray showed pneumonia on the left lower lung.On day 14,the patient' s hemoglobin decreased,to a minimum of 83 g/L,and the reticulocyte was 0.04,and the blood agglutinated in the tube.The IgM antibody for mycoplasma was positive,and the cold agglutinin titer was 1∶ 256.After antibiotic therapy,the level of hemoglobin increased and the lesions of the lung recovered.The diagnosis was mycoplasma pneumonia associated with hemolytic anemia.Nine adult cases of mycoplasma pneumonia associated with hemolytic anemia were collected by review of the literature.Of the 10 cases,6 was male and 4 was female,age was from 29 to 60.In 8 of the 10 cases,hemolytic anemia occurred in 8 - 18 days,and the cold agglutinin titer increased in all cases,1∶1024 or more in 7 cases.Endovascular thrombosis occurred in 2 cases.Nine patients recovered and 1 died.Conclusion Hemolytic anemia secondary to Mycoplasma pneumonia often occurs during 2 - 3 weeks of illness.Hemolysis is related to the high titer of cold agglutinin.Endovascular thrombosis can occur in some cases,and the majority of patients have a good prognosis,but death can occur in very severe cases.