78例儿童难治性肺炎支原体肺炎临床分析

目的探讨难治性肺炎支原体肺炎的临床特点。方法对78例确诊为肺炎支原体肺炎患儿分为普通组和难治组,回顾性分析两组间的临床特点。结果难治组发病年龄大于普通组(P0.05),性别在两组间无差异(P0.05),难治组平均热程为11.19±2.30天,明显高于普通组,其中难治组27例热程大于10天,难治组中30例患儿肺CT均表现为肺段实变,累及范围均超过1/3肺叶,肺外并发症明显高于普通组,大环内酯类抗生素联合糖皮质激素均取得较好疗效。结论对于发热时间长,肺部CT表现为肺段实变,累及范围均超过1/3肺叶,合并肺外并发症者,应考虑为难治性性肺炎支原体肺炎。     

儿童难治性支原体肺炎感染诊治中MP-DNA载量及耐药检测的意义分析

目的对MP-DNA载量及耐药检测情况进行分析,探讨其在儿童难治性支原体肺炎感染诊治中的临床意义。方法选择我院2016年12月至2017年12月儿科确诊肺炎支原体肺炎(MPP)的患者206例,根据临床特征以及治疗的效果,分为普通支原体肺炎组(普通组)100例,难治性支原体肺炎(难治组)106例,比较两组患儿咽拭子分泌物标本MP-DNA载量、耐药突变位点检测结果对于难治性支原体肺炎的早期诊断价值。结果难治组MP-DNA检测出的阳性率显著高于普通组,阴性率显著低于普通组P0.05。难治组患儿对不同抗生素耐药性显著高于普通组患儿的耐药性(P0.05);进一步对所有耐药患儿针对不同抗生素出现耐药性的耐药突变位点进行分析,2063位A→G突变对大环内脂类抗生素耐药影响更大,60%以上产生大环内脂类药物耐药的病例均检测出2063位点G突变。红霉素、阿奇霉素、罗红霉素、克拉霉素、克林霉素耐药病例基因型分布的差异有统计学意义(P0.05);而乙酰螺旋霉素、左氧氟沙星、加替沙星、司帕沙星病例基因型分布的差异有统计学意义(P0.05);对两组患儿临床及实验室特点,难治组患儿高热、肺外并发症、CRP增高、大环内酯类药物应用时间、血沉增高例数及乳酸脱氢酶显著高于普通组(P0.05);对两组MPP影像学以及并发症进行比较,两组病变发生在双侧、右上侧的分布有显著差异(P0.05);两组肺内合并症、肺不张及胸腔积液的发生率比较有显著差异(P0.05)。结论 MP-DNA载量及耐药性的检测可以对难治性支原体肺炎进行早期诊断,有一定的临床价值。     

肺炎支原体对大环内酯类抗生素耐药机制的研究近况

肺炎支原体是社区获得性肺炎的主要病原体。大环内酯类抗菌药物是治疗儿童肺炎支原体感染的首选药物。近年来我国耐大环内酯肺炎支原体比例有所下降,但仍处于高水平。耐药肺炎支原体感染造成患者发热时间、住院时间延长,并有更高的并发症发生率和抗生素治疗方案改变率,因此对肺炎支原体耐药机制的研究还需进一步深入。肺炎支原体对大环内酯类抗生素耐药机制主要与抗生素作用靶点突变、抗生素作用靶点修饰、药物主动外排、酶性失活有关。     

特应性体质儿童肺炎支原体肺炎的临床特点

目的 了解特应性体质儿童肺炎支原体肺炎的临床特点。方法 肺炎支原体肺炎的住院患儿（29天～14岁）164例,按是否存在特应性体质分为特应性体质组（77例）,以及非特应性体质组（87例）。对两组的基本信息、伴随症状体征、实验室指标、肺功能检查结果、胸部CT结果、主要治疗措施、肺外并发症及重症肺炎发生率等临床资料进行回顾性对比分析。结果 特应性体质组患儿住院时间、住院费用、家族过敏史比例、肺部啰音吸收时间、喘息发生率、喘息持续时间、血清总lgE、乳酸脱氢酶、白细胞计数、中性粒细胞绝对值、嗜酸性粒细胞绝对值、中性淋巴细胞比值、IL-6、潮气流速容量阻塞人数、吸氧治疗占比、激素使用占比、激素使用时间、肺外并发症及重症肺炎发生率均高于非特应性体质组（P均<0.05）;但淋巴细胞百分比低于非特应性体质组（P均<0.05）。结论 特应性体质肺炎支原体肺炎较非特应性体质肺炎支原体肺炎患儿病情更严重,治疗需求更高,更易发展为重症肺炎支原体肺炎。     

儿童大环内酯耐药支原体肺炎的临床特点及治疗转归

目的 了解儿童社区获得性肺炎(CAP)中支原体肺炎的临床及影像学特点,以及阿奇霉素体外耐药菌株所致支原体肺炎的治疗效果.方法 前瞻性连续入选首都医科大学附属北京朝阳医院儿科病房2010年9月1日至2011年8月31日收治的179例CAP患儿,均进行咽分泌物肺炎支原体核酸检测及肺炎支原体体外培养,培养阳性者进行体外药物敏感度测定.结果 179例CAP中确诊支原体肺炎的患儿83例(46％),肺炎支原体培养阳性45例,其中44株体外药敏试验结果显示对大环内酯类药物高度耐药(MR),1例大环内酯体外敏感.44例MR肺炎患儿的临床表现为持续性发热、咳嗽,大多为高热[(39.5±0.7)℃],咳嗽呈刺激性干咳;外周血白细胞大多正常[(8±4)×109/L],中性粒细胞比例正常或升高(0.60±0.94),ESR[(24± 14) mm/1 h]及C反应蛋白(12.8 mg/L)均增高.44例MR肺炎X线胸部正位片显示大叶性实变影10例(23％,10/44),其中左下肺3例,左肺2例,右下肺3例,右上肺2例;少量胸腔积液1例合并右下肺实变;斑片样炎性渗出影27例;肺纹理增重7例.44例MR肺炎支原体肺炎患者中19例进行了胸部CT检查,13例存在肺叶或肺段实变.44例MR肺炎平均在发病第4天接受阿奇霉素治疗,平均疗程为(9±4)d.12例初选抗生素为头孢或青霉素(1例青霉素),41例使用阿奇霉素过程中联合使用头孢或青霉素类抗生素(1例联合青霉素类抗生素).阿奇霉素治疗后平均发热时间为(6±3)d;治疗后咳嗽持续时间为(17±5)d;将44例MR肺炎患儿根据肺部影像学检查分为大叶性肺实变组及无肺实变组,大叶性肺实变组患儿发热时间及给予大环内酯类药物(阿奇霉素)后发热时间均较非实变组长,差异有统计学意义(P＜0.05).结论 肺炎支原体对大环内酯的耐药率高达98％ (44/45).MR感染合并大叶性肺实变者发热时间及给予大环内酯类药物后发热时间较非肺实变者延长.本组44例MR肺炎患儿预后良好,无肺外严重并发症.     

120例儿童支原体肺炎临床诊治分析

目的探讨儿童支原体肺炎的发病特点。方法对本院收治的120例MP肺炎进行临床分析。结果刺激性咳嗽、发热是MP肺炎的主要表现;影像学表现多样,婴幼儿以斑片状阴影多见,学龄儿以节段性、大片状阴影常见。红霉素或阿奇霉素治疗效果良好;部分重症MP肺炎,结合支气管镜下灌洗治疗和糖皮质激素,取得较好的效果。结论MP肺炎具有肺部体征与症状、肺部影像学表现不相一致特点,肺部影像学缺乏特征性表现。早期规范大环内酯类抗生素,采用多种方法联合治疗,可取得良好疗效。     

难治性肺炎支原体肺炎的肺外表现及免疫状态的临床分析

目的调查和分析难治性肺炎支原体肺炎患儿的肺外表现及免疫功能情况。方法选取难治性肺炎支原体肺炎诊断标准的60例患儿为病例组,120例为普通肺炎支原体肺炎患儿为对照组,对比观察两组患儿的肺外表现和免疫功能情况。结果病例组患儿心血管受累、消化道受累及肝脏受累均明显高于对照组(P0.01);病例组CD~+_3,CD~+_4和CD~+_4/CD~+_8水平明显低于对照组,而CD~+_8明显高于对照组(P0.01);病例组患儿IgG、IgM水平均明显高于对照组(P0.01);两组患儿C_3和C_4水平无明显的统计学差异(P0.05)。结论难治性肺炎支原体肺炎患儿肺外表现以心血管系统、肝脏及消化系统损害最为常见;免疫功能紊乱可能是导致导致难治性肺炎支原体肺炎发生的危险因素之一。     

支原体感染

儿童支气管哮喘与肺炎支原体感染的关系；康妇特栓治疗宫颈支原体、衣原体感染60例报告；泌尿生殖道感染支原体培养及耐药监测的结果分析；妊娠晚期孕妇下生殖道支原体感染及分娩结局分析；儿童大叶性肺炎支原体性肺炎126例临床分析；女性生殖道支原体合并其他致病菌感染状况调查；肺炎支原体P1重组蛋白的提取纯化及应用研究。     

儿童耐药肺炎支原体DNA拷贝量与临床预后相关性分析

目的探究儿童耐药肺炎支原体(MP)DNA拷贝量及其与临床预后的相关性。方法选取1年内反复MP感染且不规律应用大环内酯类抗菌药物≥2次的110例患儿为研究组,采集咽拭子标本进行MP培养及药敏试验,根据MP耐药情况将患儿分为耐药组(27例)和敏感组(15例),MP检测阳性患儿实施阿奇霉素序贯治疗,观察患儿的临床特点及预后情况,荧光定量PCR检测MP-DNA拷贝量,测定血清白介素-6(IL-6)、降钙素(PCT)、急性期应激反应蛋白(hs-CRP)水平及白细胞总数、血沉。结果MP培养显示,110例患儿中MP阳性感染患儿42例,阳性率38.18%,42例MP阳性中27例阿奇霉素敏感,15例耐药;耐药组治疗2周后治愈率为59.26%(17/27);4周后治愈率为77.78%(21/27);敏感组治疗2周后治愈率为100%(15/15);耐药组发热时间、住院时间均高于敏感组(P<0.05);耐药组患儿MP-DNA拷贝量、血清hs-CRP、IL-6水平显著高于敏感组(P<0.05),白细胞总数、PCT、血沉与敏感组无显著差异(P>0.05);多因素分析发现,MP-DNA拷贝量、血清hs-CRP水平是影响耐药MP感染患者预后的独立危险因素。结论儿童耐药肺炎支原体DNA拷贝量异常增加,与临床预后相关。     

检测血清C反应蛋白在小儿支原体肺炎中的临床意义

目的 探讨血清C反应蛋白(CRP)检测在小儿支原体肺炎中的临床诊断价值.方法 分别选取支原体肺炎患儿44例(支原体组),细菌性肺炎患儿43例(细菌组),同时选取来我院体检的健康儿童42名(健康组).三组儿童在体检及入院当天或次日、治疗3d、7d后,抽血2 ml进行CRP水平及阳性率检测.结果 入院或体检时,细菌组CRP检测水平高于支原体组(P＜0.05),支原体组CRP检测水平高于健康组(P＜0.05);细菌组CRP阳性率高于支原体组(P＜0.05),支原体组CRP阳性率高于健康组(P＜0.05).与治疗前相比,治疗第3、7天两组患儿CRP检测水平呈显著下降趋势,但是,支原体组CRP水平及阳性率高于健康组,细菌组CRP水平及阳性率高于支原体组,差异均有统计学意义(P＜0.05).结论 对肺炎患儿进行血清CRP检测,可以为临床诊断及治疗小儿支原体肺炎和细菌性肺炎提供可靠依据.     

Clinical characteristics and serum inflammatory markers of community-acquired mycoplasma pneumonia in children

Background

To compare the demographic and clinical features, laboratory and imaging findings in mycoplasma pneumoniae pneumonia (MPP) children with non-MPP (NMPP) children and general MPP (GMPP) children with refractory MPP (RMPP) children and analysis the relationship with the severity of disease.

Methods

The study included 265 children with MPP and 230 children with NMPP in the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from 2020 to 2021. The children with MPP included RMPP (n = 85) and GMPP (n = 180). Demographic and clinical characteristics, laboratory and imaging findings of all children were measured as baseline data within 24 h after admission and the differences between MPP and NMPP, RMPP and GMPP patients were compared. ROC curves were used to evaluate the diagnostic and predictive value of different indicators for RMPP.

Results

Fever duration and hospital stay in children with MPP were longer than those with NMPP. The number of patients with imaging features of pleural effusion, lung consolidation and bronchopneumonia in MPP group was significantly higher than that in NMPP group. Compared with NMPP group, the levels of C-reactive protein (CRP), procalcitonin (PCT), serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), lactic dehydrogenase (LDH), prothrombin time (PT), fibrinogen (FIB) and D-dimer and inflammatory cytokines (interleukin [IL]-6, IL-8, IL-10 and IL-1β) in MPP group were significantly higher (P < 0.05). The clinical symptoms and pulmonary imaging findings were more severe in RMPP group. The levels of white blood cell (WBC), CRP, PCT, SAA, ESR, alanine aminotransferase (ALT), LDH, ferritin, PT, FIB, D-dimer and inflammatory cytokines in RMPP group were higher than those in GMPP group. There was no significant difference in the level of lymphocyte subsets between the RMPP and GMPP group. IL-6, IL-10, LDH, PT, D-dimer and lung consolidation were independent risk factors for RMPP. IL-6 levels and LDH activity were good predictors of RMPP.

Conclusion

In conclusion, there were differences in clinical characteristics and serum inflammatory markers between MPP group and NMPP group, RMPP group and GMPP group. IL-6, IL-10, LDH, PT and D-dimer can be used as predictive indicators for RMPP.     

难治性支原体肺炎患儿血清穿透素3水平改变及临床意义

目的探讨难治性支原体肺炎(RMPP)患儿血清穿透素3水平改变及临床意义。方法我院住院治疗的支原体肺炎患儿166例,分为RMPP组(n=66)和MPP组(n=100)。观察急性期和恢复期血清PTX3水平改变。利用受试者工作特征曲线(ROC)分析PTX3水平对RMPP患者疾病诊断的价值。利用约登指数分析最佳切点PTX3数值。应用Pearson和Speaman线性相关和单因素回归分析PTX3与RMPP的关系。结果在RMPP和MPP患儿急性期血清PTX3和CRP水平明显高于对照组(P0.05)。RMPP组患儿血清PTX3水平明显高于MPP患者(P0.05)。重症肺炎组和非重症肺炎组患儿急性期血清PTX3和CRP水平明显高于对照组(P0.05)。重症肺炎组患儿血清PTX3水平明显高于非重症肺炎组患儿(P0.05)。通过Pearson和Speaman相关性分析后发现,PTX3水平与RMPP呈正相关(r=0.417,P=0.015)。对RMPP的诊断价值方面,PTX3表现出中等诊断价值,AUC为0.762(P=0.011)。结果发现PTX3(是否大于47.7)(OR=3.33,95%CI 1.94-6.45,P0.05)为RMPP发生的独立因素。结论 RMPP患者血清PTX3水平明显升高,是诊断RMPP的潜在生物学标记物。     

儿童支原体肺炎肺泡灌洗液检测与临床关系探讨

目的 探讨儿童支原体肺炎（MPP）支气管肺泡灌洗液（BALF）中MP-DNA基因阳性患儿的临床特征.方法 对行纤维支气管镜检查和支气管肺泡灌洗的94例MPP患儿,采用荧光实时定量PCR（FQ-PCR）检测BALF中MP-DNA基因,根据检测结果分为实验组61例（肺泡灌洗液MP-DNA阳性）与对照组33例（肺泡灌洗液MP-DNA阴性）,对两组的临床特点进行比较.结果 实验组学龄儿显著多于对照组（P〈0.05）;高热、CRP升高、胸部X线和/或CT检查肺不张及胸腔积液明显高于对照组（P〈0.05）;支气管镜下表现及BALF细胞学分类两组差异无统计学意义（P〉0.05）.结论 以学龄儿、高热、CRP升高、肺不张、胸腔积液为临床特点的MPP,BALF中 MP-DNA基因阳性多见,可能与患儿体内MP不易清除和存在较强的免疫反应有关,临床需适当延长大环内酯类抗生素治疗疗程及注重免疫治疗.     

The risk factors of children acquiring refractory mycoplasma pneumoniae pneumonia: A meta-analysis

Objectives:Refractory mycoplasma pneumoniae pneumonia (RMPP) in children has been increasing worldwide. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of RMPP to provide suggestions on prevention and controlling for children.Methods:Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0.Results:We conducted a meta-analysis of 15 separate studies. Fever for more than 10 days (odds ratio [OR] 3.965, 95% confidence interval [CI] 2.109–7.456), pleural effusion (OR 6.922, 95% CI 2.058–23.282), extra-pulmonary complications (OR 17.762, 95% CI 11.146–28.305), pulmonary X-ray consolidation ≥2/3 (OR 8.245, 95% CI 1.990–34.153), CRP >40 mg/L (OR 4.975, 95% CI 2.116–11.697) were significantly related to the risk of RMPP. We did not find an association between male sex (OR 0.808, 95% CI 0.548–1.189), LDH >410IU/L (OR 1.033, 95% CI 0.979–1.091) and the risk of RMPP.Conclusions:Fever for more than 10 days, pleural effusion, extra-pulmonary complications, pulmonary X-ray consolidation≥ 2/3 and CRP >40 mg/L are risk factors for early evaluation of RMPP.     

62例小儿重症支原体肺炎高危因素分析

目的探讨小儿重症肺炎支原体肺炎患者的危险因素。方法分析我院自收治的小儿肺炎支原体肺炎患者182例,其中62例重症支原体肺炎患者作为观察组,其余的120例普通支原体肺炎患者作为对照组,对两组的相关因素进行单因素非条件和多因素非条件的Logistic回归分析。结果单因素分析结果显示小儿重症支原体肺炎患者与年龄、ESR、CRP、MP-Ab阳性率、病变部位和大环内酯类应用时间有相关性,差异有统计学意义(P<0.05);多因素非条件的Logistic回归分析显示小儿重症支原体肺炎患者与ESR、CRP、MP-Ab阳性率、病变部位相关(P<0.05)。结论 ESR、CRP、MP-Ab阳性率、病变部位是小儿重症支原体肺炎患者的危险因素。     

95例呈肺实变肺炎支原体肺炎患儿临床研究

目的探讨呈肺实变肺炎支原体肺炎患儿不同程度肺损害时的临床表现差异。方法对我院儿科95例呈肺实变肺炎支原体肺炎患儿,依据其胸部影像严重程度分成2组,分析其临床表现差异。结果肺损害严重患儿组CRP值高于轻度肺损害组(P=0.02),其在肺外症状及MP-IgM抗体阴转阳者亦多见(P=0.04,P=0.04)。结论 MP感染后直接侵袭作用及免疫紊乱对肺损伤均有影响。     

Evaluation on blood coagulation and C-reactive protein level among children with mycoplasma pneumoniae pneumonia by different chest imaging findings

Mycoplasma pneumoniae infection may induce a systemic hypercoagulable abnormality, like organ embolism and infarction. Indexes of blood coagulation and C-reactive protein (CRP) have been reported different between healthy people and mycoplasma pneumoniae pneumonia (MPP) patients, but this difference in MPP patients with different chest imaging findings has rarely been reported.We performed a retrospective study of 101 children with MPP and 119 controls, combined with radiological examination and blood tests, to compare the blood coagulation and CRP level among MPP children with different chest imaging findings.For the MPP children with different chest imaging findings, there were significant differences in CRP, fibrinogen (FIB) and D-dimer (D-D) levels among subgroups (P = .004, P = .008 and P < .001 respectively). The CRP level in group of interstitial pneumonia was significantly higher than that in groups of bronchopneumonia and hilar shadow thickening (P = .003 and P = .001 respectively). And the FIB and D-D values in group of lung consolidation were significantly higher than that in the other 3 groups (all P < .05). When compared with controls, the white blood cell, CRP, FIB, and D-D levels in MPP children were significantly higher, and the activated partial thromboplastin time and thrombin time levels were significantly lower (all P < .05).Our results showed that CRP level changed most significantly in group of interstitial pneumonia, whereas FIB, D-D levels changed most significantly in the lung consolidation group.     

阿奇霉素联合左氧氟沙星治疗肺炎支原体感染者的临床研究

目的阿奇霉素联合左氧氟沙星治疗肺炎支原体（MP）感染者的临床研究。方法选74例MP感染者为研究对象,采用阿奇霉素联合左氧氟沙星治疗。设单纯发热无肺炎者为A组21例,设既有发热又有肺炎者为B组53例,分别测定外周血液细胞计数、C-反应蛋白（CRP）、观察体温恢复、症状消失、胸片病灶吸收及治愈天数情况。结果A组的体温恢复、症状消失、胸片病灶吸收及治愈天数情况明显优于B组（P均〈0．01）;A、B两组的中性粒细胞、CRP明显升高（P均〈0．01）,两组的白细胞总数、淋巴细胞计数均无明显差异（P均〉0．05）。两组患者经上述治疗后均治愈。结论阿奇霉素联合左氧氟沙星治疗MP感染患者,疗效确切,值得临床推广应用。     

血清C反应蛋白检测在小儿支原体肺炎诊断中的临床价值

目的探讨血清C反应蛋白(CRP)检测在小儿支原体肺炎(MP)诊断中的价值。方法 128例肺炎患儿按照病原体的不同分为支原体组(45例)、细菌组(43例)、病毒组(40例),并选择健康体检儿童40例作为对照组,比较治疗前四组研究对象血清CRP水平和检测阳性率,并比较不同病情程度MP患儿血清CRP水平和检测阳性率,治疗1周后,比较3组患儿血清CRP水平和检测阳性率。结果血清CRP水平和检测阳性率组间比较,细菌组均明显高于其他3组(P=0.0000),支原体组明显高于病毒组和对照组(P=0.0000),病毒组与对照组比较差异无显著性(P0.05)。支原体肺炎患儿中伴有全身炎症反应组血清CRP水平和阳性率均高于不伴有全身炎症反应组。治疗1周后,支原体组血清CRP水平高于病毒组(P=0.000),低于细菌组(P=0.0000),CRP检测阳性率支原体组高于病毒组(P=0.0041),低于细菌组(P=0.0223)。结论血清CRP水平检测可作为MP早期诊断和鉴别诊断的重要手段。