儿童肺炎支原体感染大叶性肺炎的临床特点浅析

目的 了解影像学呈大叶性肺炎改变的肺炎支原体性肺炎(Mycoplasma pneumoniae pneumonia,MPP)的临床特点,帮助早期识别和诊治.方法 收集2014年10月至2016年10月期间住院部诊断为大叶性肺炎儿童173例,分为肺炎支原体(mycoplasma pneumoniae,MP)感染大叶性肺炎1 15例和非MP感染大叶性肺炎58例,分别进行临床症状、影像学、炎症指标等分析比较.结果 MP感染大叶性肺炎男55例,女60例,非MP感染大叶性肺炎男34例,女24例,两组间差异无统计学意义(P＞0.05).MP感染大叶性肺炎中3岁以内婴幼儿15例,3岁以上儿童100例,非MP感染大叶性肺炎中3岁以内婴幼儿22例,3岁以上儿童36例,两组间比较差异有统计学意义(P＜ 0.01).临床表现如高热、气促、呼吸困难等比较差异均无统计学意义(均P＞ 0.05);肺外表现差异有统计学意义(P＜0.05),主要表现为非MP感染大叶性肺炎心肌损害明显多于MP感染大叶性肺炎.影像学上非MP感染大叶性肺炎中累及2个及以上肺叶多于MP感染大叶性肺炎,差异有统计学意义(P＜0.01).血清炎症指标C反应蛋白(CRP)在非MP感染大叶性肺炎高于MP感染大叶性肺炎,差异有统计学意义(P＜0.05),外周血常规白细胞(WBC)和血清降钙素原(PCT)差异无统计学意义.经系统治疗后,172例患儿(99.4％)预后良好,1例转上级医院.结论 在大叶性肺炎早期,MP-IgM抗体滴度未增高前,可通过发病年龄、肺外表现、影像学差异以及CRP等帮助早期明确MP感染大叶性肺炎和非MP感染大叶性肺炎的诊断,并予合理及时治疗,改善患儿预后.

Clinical features of children with lobar pneumonia caused by mycoplasma pneumoniae infection

Objective To investigate clinical features of mycoplasma pneumoniae pneumonia (MPP) of the lobar pneumonia,to help early recognition,diagnosis and treatment.Methods 173 children diagnosed as lobar pneumonia in the inpatient department from October 2014 to October 2016 were divided into l 15 cases of lobar pneumonia caused by mycoplasma pneumonia (MP) infection and 58 cases of lobar pneumonia caused by non-MP infection.Compared and analyzed the clinical symptoms,imageology,and inflammation indexes respectively.Results There were 55 male cases and 60 female cases in MP group,there were 34 male cases and 24 female cases in non-MP group,without statistically significant difference between the two groups (P＞0.05).There were 15 cases under 3 years old and 100 cases over 3 years old in MP group,there were 22 cases under 3 years old and 36 cases over 3 years old in non-MP group,with statistically significant difference between the two groups (P＜0.01).There were no statistically significant differences in clinical symptoms such as high fever,shortness of breath,dyspnea between the two groups (P＞0.05);there was statistically significant difference in extrapulmonary manifestation (P＜0.05),the rate of myocardial damage in non-MP group was significantly higher than that in MP group.In terms of imageology,the rate of involving in 2 or more lobes in non-MP group was significantly higher than that in MP group (P＜0.01).The level of C-reactive protein (CRP) in non-MP group was significantly higher than that in MP group (P＜0.05),there were no statistically significant differences in the levels of peripheral white blood cell (WBC) and serum procalcitonin (PCT) between the two groups.After systemic treatment,99.4％ (172 cases) of the children had good prognosis,and l case was transferred to the superior hospital.Conclusions In the early stage of lobar pneumonia which MP-IgM antibody titer is not increased,the age,extrapulmonary manifestation,imageology differences,and serum CRP are helpful to early definite diagnosis of MP infection lobar pneumonia and non-MP infection lobar pneumonia,and reasonable and timely treatment,to improve the prognosis of children.