儿童肺炎支原体感染治疗期间并发多形红斑型药疹分析

目的研究儿童肺炎支原体感染治疗期间并发多形红斑型药疹的临床特征及实验室指标。 方法收集2014年3月至2018年3月于深圳市龙华区中心医院接受治疗期间并发多形红斑型药疹的120例肺炎支原体感染患儿的临床资料。分析其临床症状、体征，并回顾性分析其血常规、心电图、肾功能以及心肌酶等资料。给予患者抗肺炎支原体感染的相关治疗，观察疗效以及预后。 结果120例肺炎支原体感染患儿均出现全身弥漫性红斑、斑丘疹[120（100.00%）]，显著高于黏膜受累[117（97.50%）]（χ² = 3.421、P = 0.046）、发热[69（57.50%）]（χ² = 64.762、P < 0.001）、头痛[107（89.17%）]（χ² = 13.744、P < 0.001）、关节痛[94（78.33%）]（χ² = 29.159、P < 0.001）和肌肉酸痛[88（73.33%）]（χ² = 36.923、P < 0.001）患儿例数，差异均有统计学意义。120例肺炎支原体感染患儿实验室指标：白细胞升高、中性粒细胞升高、嗜酸性粒细胞升高、丙氨酸氨基转移酶升高、谷氨酰转肽酶升高、总蛋白升高、白蛋白升高、直接胆红素升高、胆碱酯酶升高、尿酸升高、肌酐升高、尿素氮升高、心电图异常和肌酸激酶升高例数分别为63例（52.50%）、46例（38.33%）、12例（10.00%）、53例（44.17%）、17例（14.17%）、30例（25.00%）、7例（5.83%）、24例（20.00%）、9例（7.50%）、23例（19.17%）、18例（15.00%）、21例（17.50%）、10例（8.33%）和11例（9.17%）。69例发热患儿于3～7 d内体温恢复正常；120例患儿3～7 d内皮损明显消退，水疱干涸；入组120例患儿的疗程最短7 d，最长51 d，平均17 d，其中1例患者因基础疾病较重，并发多脏器功能衰竭死亡。 结论儿童肺炎支原体感染治疗期间应尽量预防多形红斑型药疹的发生，一旦发现异常应立即停药，予以地塞米松等针对性干预，有效控制病情，以保证用药安全。

Analysis on polymorphic erythematous drug eruption during treatment of children with mycoplasma pneumoniae infection

ObjectiveTo investigate the clinical characteristics and laboratory indexes of polymorphic erythematous drug eruption during the treatment of children with mycoplasma pneumoniae infection. MethodsThe clinical data of 120 children with polymorphic erythematous drug eruption during the treatment of mycoplasma pneumoniae infection in Longhua District Central Hospital, Shenzhen from March 2014 to March 2018 were collected. The clinical symptoms and signs were analyzed. Data of blood routine, electrocardiogram, renal function and myocardial enzyme were analyzed, retrospectively. Patients were given anti-inflammatory treatment for mycoplasma infection, and the efficacy and prognosis were observed. ResultsAmong the 120 children with mycoplasma pneumoniae infection, all developed diffuse erythema and macular papules [120 (100.00%)], which were significantly higher than cases with mucosal involvement [117 (97.50%)] (χ² = 3.421, P = 0.046), fever [69 (57.50%)] (χ² = 64.762, P < 0.001), headache [107 (89.17%)] (χ² = 13.744, P < 0.001), joint pain [94 (78.33%)] (χ² = 29.159, P < 0.001) and muscle pain [88 (73.33%)] (χ² = 36.923, P < 0.001), all with significant differences. The laboratory results of 120 children with mycoplasma pneumoniae infection were as follows: cases with leukocyte elevated, neutrophil elevated, eosinophil elevated, alanine aminotransferase elevated, glutamate transpeptidase elevated, total protein elevated, albumin elevated, direct bilirubin elevated, cholinesterase elevated, uric acid elevated, creatinine elevated, urea nitrogen elevated, abnormal ECG and creatine kinase elevated were 63 cases (52.50%), 46 cases (38.33%), 12 cases (10.00%), 53 cases (44.17%), 17 cases (14.17%), 30 cases (25.00%), 7 cases (5.83%), 24 cases (20.00%), 9 cases (7.50%), 23 cases (19.17%), 18 cases (15.00%), 21 cases (17.50%), 10 cases (8.33%) and 11 cases (9.17%), respectively. The temperature of 69 children with fever returned to normal within 3-7 days, and the skin lesions of 120 children subsided obviously within 3-7 days, also the blisters dried up. The shortest course of treatment of 120 children was 7 days, the longest was 51 days, and the average was 17 days. One case died of multiple organ failure due to a serious basic disease. ConclusionsFor children infected with mycoplasma pneumoniae, the occurrence of polymorphic erythematous drug eruption should be prevented, and drug should be suspended immediately once abnormality occurred, and specific intervention of dexamethasone and other drugs should be administrated to effectively ensure the safety of medication.