儿童肺炎支原体肺炎细菌性肺炎所致塑型性支气管炎15例临床分析

目的 分析儿童肺炎支原体肺炎和（或）细菌性肺炎所致塑型性支气管炎的临床特点。方法 回顾性收集2007年1月至2010年3月在首都医科大学附属北京儿童医院诊断为塑型性支气管炎患儿的临床资料。依据其感染病原分为肺炎支原体肺炎组、肺炎支原体肺炎合并细菌感染组和细菌性肺炎组。分析3组患儿临床表现（发热、咳嗽、肺部体征、发热峰值及发热持续时间等）、实验室检查（WBC、CRP、转氨酶和病原培养等）、胸部CT、支气管镜所见气道黏膜损害、支气管塑型分泌物栓病理学检查和治疗情况。结果 15例塑型性支气管炎患儿进入分析，年龄2~15岁。肺炎支原体肺炎组5例，肺炎支原体肺炎合并细菌感染组6例，细菌性肺炎组4例。3组患儿均急性起病，均以发热和咳嗽为主要表现入院。①肺炎支原体肺炎组均无急性呼吸窘迫和肺外阳性体征；肺炎支原体肺炎合并细菌感染组需呼吸支持者和伴肺外阳性体征者均为1/6例；细菌性肺炎组需呼吸支持者和伴肺外阳性体征者均为3/4例。②3组胸部CT检查均提示单侧或双侧肺实变，肺不张和胸腔积液肺炎支原体肺炎组分别为1/5例和3/5例，肺炎支原体肺炎合并细菌感染组分别为3/6例和5/6例，细菌性肺炎组分别为3/4例和1/4例。③3组支气管镜检查均可见气道黏膜充血和肿胀，但程度和范围以肺炎支原体肺炎合并细菌感染组和细菌性肺炎组为著；气道黏膜局部损害以肺炎支原体肺炎合并细菌感染组为著，其中2例伴支气管通气不良，有远端支气管闭塞可能。④3组支气管镜检查均有支气管树样塑型分泌物栓栓取出，病理组织学分型均为Ⅰ型。结论 与细菌性肺炎相比，肺炎支原体肺炎在全身炎症反应较轻时即可发生塑型性支气管炎。肺炎支原体肺炎所致塑型性支气管炎的气道黏膜损害较轻，支气管塑型分泌物栓较短，应及时行支气管镜检查以协助诊治。

Plastic bronchitis caused by mycoplasma pneumoniae pneumonia and bacterial pneumonia in children: 15 cases clinical analysis

Objective To explore the clinical features of plastic bronchitis in children with mycoplasma pneumoniae pneumonia and(or) bacterial pneumonia. Methods The study retrospectively reviewed the records of the children with plastic bronchitis who were admitted to Beijing Children's Hospital from January 2007 to March 2010. Subjects were divided into three groups based on the pathogen culture results: mycoplasma pneumoniae pneumonia group, mycoplasma pneumoniae pneumonia with bacterial infections group and bacterial pneumonia group. The data of the three groups such as clinical manifestations, roentgenographic findings, airway mucosal lesions seen through the bronchoscope and the histopathological findings of the bronchial cast were analyzed. Results Fifteen children with plastic bronchitis aged from 2 to 15 years were enrolled into the study. There were 5 cases in mycoplasma pneumoniae pneumonia group, 6 cases in mycoplasma pneumoniae pneumonia with bacterial infections group and 4 cases in bacterial pneumonia group. The children in mycoplasma pneumoniae pneumonia group did not have dyspnea and the extrapulmonary positive signs. One case in mycoplasma pneumoniae pneumonia with bacterial infections group needed NCPAP treatment, and 1 case had extrapulmonary positive signs. Three cases in bacterial pneumonia group needed NCPAP or mechanical ventilation treatment, and 3 cases had extrapulmonary positive signs. Consolidation was the common finding in the CT scan of the lung in all the patients, and 1 case with atelectasis, 3 cases with pleural effusion in mycoplasma pneumoniae pneumonia group; 3 cases with atelectasis, 5 cases with pleural effusion in mycoplasma pneumoniae pneumonia with bacterial infections group; 3 cases with atelectasis, 1 case with pleural effusion in bacterial pneumonia group. Bronchoscopy was performed in all the 15 cases and bronchial casts were removed. Under flexible bronchoscope, the most common mucosal lesions in the three groups were hyperemia and edema, and the severe mucosal lesions were found in children in mycoplasma pneumoniae pneumonia with bacterial infections group (2 cases with segmental bronchi dysventilation). All bronchial casts were type 1 according to Seear's classification in histopathological findings.