支原体肺炎合并栓塞23例诊治分析

目的 探讨儿童支原体肺炎合并栓塞的发生、临床特点及诊治.方法 对1990年1月至2012年12月国内外报道过的23例儿童支原体肺炎合并栓塞病例的临床资料进行回顾性分析.结果 23例支原体肺炎合并栓塞患儿年龄为4 ～ 13岁,男15例,女8例.19例单发栓塞,下肢静脉血栓4例,颈内动脉栓塞1例,脑梗死9例,心肌梗死2例,脾梗死2例,肺梗死1例;4例为多发栓塞,肺栓塞合并下肢深静脉栓塞2例,心肌梗死合并肺栓塞1例,大脑中动脉合并颈内动脉栓塞1例.8例有暂时性抗心磷脂抗体IgM阳性,其中2例合并蛋白C下降,1例合并蛋白S下降,而AT-Ⅲ缺乏1例.经过溶栓、抗凝治疗后,2例死亡,其余21例疗效良好.结论 肺炎支原体感染过程中存在高凝状态,具有血栓形成可能,尤其是具有血栓形成高危因素的患儿.早期诊断、积极抗凝、溶栓治疗是支原体肺炎合并栓塞诊治的关键.

Diagnosis and treatment of 23 cases of Mycoplasma pneumonia complicated with embolism

Objective To explore the occurence,clinical characteristics and treatment of Mycoplasma pneumonia complicated with embolism in children.Methods Twenty-three cases with Mycoplasma pneumonia complicated with embolization were retrospectively analyzed from January 1990 to December 2012.Results The ages of cases were from 4 years old to 13 years old,and fifteen cases were male,eight cases were female.Nineteen cases with single-shot embolism included four cases of lower limb venous thrombosis,one case of internal carotid artery thrombosis,nine cases of cerebral infarction,two cases of cardiac infarction,two cases of splenic infarction,one case of pulmonary infarction; and the other four cases were multiple embolism,two cases combined pulmonary embolism and lower limb deep vein thrombosis,one case combined cardiac embolism and pulmonary embolism,one case combined internal carotid artery and the brain embolism.In addition,eight cases had temporary anti-cardiolipin antibody IgM,two cases combined protein C decrease,one case merge protein S decrease,and one case was lack of AT-Ⅲ.At last,two children died,the rest all recovered well after thrombolysis and anticoagulation therapy.Conclusion Mycoplasma pneumoniae has hypercoagulative state and potentialized to thrombosis,especially for children with high risk factors of thrombosis.Early diagnosis and anticoagulation and thrombolysis treatment actively is the key to better prognosis.