支原体肺炎合并肺血栓栓塞症1例临床分析

目的 探讨儿童肺炎支原体肺炎（MPP）合并肺血栓栓塞症（PTE）的临床特点和诊断、治疗要点及相关危险因素。方法 回顾性分析1例MPP合并PTE的病历资料，复习文献，探讨MPP合并PTE的诊断要点、治疗方法及血栓相关危险因素。结果 患儿为7岁女童，学龄期，以呼吸道症状起病，发热、咳嗽为主要表现，有一过性胸痛、呼吸困难及低氧血症表现，病程14天出现PTE。左下肺叩诊浊音，左侧胸部呼吸音减低，可闻及少许湿啰音。辅助检查：胸腔积液淡黄、清亮。肺炎支原体抗体IgM 1∶320，血浆D 二聚体11.8 mg/L，肺动脉造影(CTA)示左上肺动脉及右下肺动脉部分分支内充盈缺损，心脏超声检查示左肺动脉起始部血栓形成，抗核抗体（ANA）（+），狼疮抗凝物阳性，血浆蛋白S活性降低（59.5%），出凝血疾病基因突变未检出。诊断PTE、MPP、胸腔积液，拉氧头孢钠联合阿奇霉素抗感染，地塞米松抑制炎症反应，肝素钙、利伐沙班抗凝治疗后，患儿症状、体征好转，胸腔积液消失，D 二聚体逐渐下降至0.1 mg/L。结论 MPP患儿有胸痛、呼吸困难，尤其伴有D 二聚体明显升高时，要考虑合并PTE可能，CTA可明确诊断，对于存在多个危险因素或有肺栓塞高度风险的患儿应及早行CTA检查，血栓形成可能与支原体感染导致的过度炎症反应及血管内皮损伤有关。

A case report of mycoplasma pneumonia combined pulmonary thromboembolism in child

Objective To investigate the clinical characteristics, key points of diagnosis and therapeutics, and other relevant risk factors of mycoplasma pneumonia combined pulmonary thromboembolism in children. Methods A retrospective study was conducted by analyzing a child patient with mycoplasma pneumonia combined pulmonary thromboembolism, together with literature review, to investigate the clinical characteristics, key points of diagnosis and therapeutics, and other relevant risk factors of this rare incidence. Results The child patient was a 7 year old girl at school age. Her major symptom included fever, cough and discomfort in respiratory tract. Transient chest pain, dyspnea and hypoxemia appeared in her initial stage of hospitalization. The left lower lung was percussed with voiced sound. The breathing voice from left chest was reduced, while a little moist rale could be heard. Adjuvant examination: pleural effusion was light yellow and clear. Mycoplasma antibody IgM 1∶320, blood D dimer 11.8 mg/L. CTA showed filling defect in partial branches of left upper pulmonary artery and right lower pulmonary artery. Echocardiography showed thrombosis at the beginning site of left pulmonary artery, ANA (+), positive in lupus anticoagulant, decreased plasma protein S activity (59.5%). No gene mutation related to coagulation disease was detected. After admission, pulmonary thromboembolism, mycoplasma pneumonia and pleural effusion were diagnosed. Latamoxef disodium combined with azithromycin was administered to prevent infection. Dexamethasone was administered to inhibit inflammation. After anticoagulation therapy by calcium heparin and rivaroxaban, the symptoms and characteristics of the child were improved. Pleural effusion disappeared, and D dimer gradually decreased to 0.1 mg/L. Conclusion Child patient with mycoplasma pneumonia can be considered with the probability of obtaining pulmonary thromboembolism when diagnosed with chest pain, dyspnea, especially with significant elevation of D dimer concentration. Pulmonary angiography can make a definite diagnosis. CTA should be performed in children with multiple risk factors or high risk of pulmonary embolism in the early stage. Formation of thrombosis may be associated with excessive inflammation and vascular endothelial damage caused by mycoplasma infection.