小儿肺炎支原体感染肺外损害79例诊治分析

目的 分析肺炎支原体感染伴肺外损害的临床特点,探讨其诊断和治疗.方法 对79例肺炎支原体感染伴肺外损害患儿临床表现、实验室检查、治疗效果进行回顾性分析.结果 79例患儿均有发热、咳嗽,查肺炎支原体IgM抗体均为阳性.胸部X线检查:两肺纹理增粗模糊39例,支气管肺炎21例,肺部实变影19例.肺外损害:发热伴消化系统症状30例(37.9%),其中B超检查示肝肿大1例;心血管系统表现(心悸、胸闷、心肌酶增高)26例;血液系统损害13例,其中白细胞减少10例,轻度贫血2例,血小板减少1例;胸腔积液3例;伴皮肤损害3例;伴有神经系统症状者2例;伴有泌尿系统损害者2例.均给予阿奇霉素5～10 mg·kg-1·d-1,静脉滴注,对阿奇霉素耐药者给予红霉素静脉滴注,合并细菌感染者给予头孢类等抗生素.经过2～4周的治疗,79例患儿全部治愈,肺外并发症均消失,异常化验指标恢复正常.结论 支原体感染可致支原体肺炎,同时可致肺外多器官系统损害,临床应提高认识,早期诊断并早期应用大环内酯类抗生素规范治疗.

Clinical Features of Extra-pulmonary Injuries in 79 Children with Mycoplasma Pneumoniae Infection

Objective To explore the clinical features of extra-pulmonary complications in children with mycoplasma pneumoniae infection.Methods The clinical manifestations,laboratory results,treatment,and outcomes of 79 children with mycoplasma pneumoniae infection accompanied with extra-pulmonary injuries were retrospectively analyzed.Results All patients had atypical fever and coughs.Chest X-ray showed thickened and blurred textures in bilateral lungs in 39 children,branchopneumonitis in 21 patients and 19 cases with lobar pneumonia.The IgM antibody to mycoplasma pneumoniae was positive in all patients.Extra-pulmonary injuries included fever with gastrointestinal symptoms（n=30）,enlarged liver（n=1）,cardiovascular symptoms（n=26）,hematological damage（n=13）,which consists of 10 cases with leucopenia,2 cases with slight anemia and 1 case with thrombocytopenia;pleural effusion（n=3）,skin lesions（n=3）,neurological symptom（n=2） urinary system injuries（n=2）.Azithromycin（5～10 mg·kg-1·d-1）were intravenously given to most cases while to those azithromycin resistant erythromycin were given and other antibiotics were also used if mixed infection occured.Conclusion Mycoplasma pneumonia can induce mycoplasma pneumoniae pneumonia and multisystem injury outside the lung.Early Application of macrolide antibiotics is required.