小儿支原体肺炎病情轻重的相关因素研究

Factors Related to the Severity of Symptoms in Children Mycoplasma Pneumoniae Pneumonia

目的探讨影响小儿支原体肺炎(MPP)病情轻重的相关因素。方法选取2005—2009年广元市中心医院儿科住院的诊断为MPP患儿186例,分别在入院和出院时进行血清颗粒凝集法(MAA)和冷凝集试验(CAT)检查,根据年龄分为:≤2岁组(28例),3～5岁组(79例),≥6岁组(79例)。根据肺炎类型分为:支气管肺炎组(94例),节段性/大叶性肺炎组(92例)。≥6岁患儿按肺炎轻重程度分为支气管肺炎组(25例),中度节段性/大叶性肺炎组(31例),重度节段性/大叶性肺炎组(23例)。回顾性分析患儿的发病年龄、临床症状、肺损伤程度、实验室检查指标及血清转化率。结果≤2岁组、3～5岁组、≥6岁组患儿发热持续时间>7 d、支气管肺炎、节段性/大叶性肺炎、白细胞计数、中性粒细胞、淋巴细胞、血小板计数、C反应蛋白(CRP)水平比较,差异均有统计学意义(P<0.05)。支气管肺炎组和节段性/大叶性肺炎组患儿年龄、发热持续时间、住院时间、白细胞计数、中性粒细胞、淋巴细胞、淋巴细胞绝对计数、血小板计数、CRP、红细胞沉降率(ESR)及血清转化率比较,差异均有统计学意义(P<0.05)。≥6岁患儿支气管肺炎组、中度节段性/大叶性肺炎组、重度节段性/大叶性肺炎组住院时间、CRP水平及血清转化率比较,差异均有统计学意义(P<0.05)。结论年龄较大的MPP患儿,其发热持续时间较长,且肺损伤症状较重。肺损伤程度与当时诊断性IgM抗体是否缺失及淋巴细胞计数是否降低有关。因此,快速配对血清IgM抗体检测对小儿支原体肺炎的早期确诊非常重要。

Objective To evaluate factors influencing the severity of MPP.Methods 186 MPP children admitted to Guangyuan Center hospital from 2005 to 2009 were involved into the study.Indirect microparticle agglutinin assay and cold agglutinins titer were conducted at both admission and discharge.A total of 186 children with MPP were grouped by age： ≤ 2 years of age（28 patients）,3~5 years of age（79 patients）,and ≥ 6 years of age（79 patients）.They were also grouped by pneumonia pattern： bronchopneumonia group（94 patients） and segmental/lobar pneumonia group（92 patients）.In addition,the children aged≥6 years（79 patients） were classified into three groups based on the severity of pneumonia： bronchopneumonia group（25 patients）,mild segmental/lobar group（31 patients）,and severe segmental/lobar group（23 patients）.Ages,clinical symptoms,pulmonary lesions,laboratory findings and seroconversion rate of the 186 children with MPP were retrospectively analyzed.Results The fever in the three age groups all lasted ≥7 days.There were significant differences among the three different age groups in bronchopneumonia,segmental/lobar,white blood cell count,neutrophil,lymphocyte,platelet count and C-reactive protein values（P0.05）.The age,duration of fever,hospitalization,WBC count,neutrophil,lymphocyte,absolute lymphocyte count,platelet count,CRP,ESR and seroconversion rate were significantly different between the bronchopneumonia group and the segmental/lobar group（P0.05）.Hospitalization,CRP and seroconversion rate were significantly different among the bronchopneumonia group,the mild segmental/lobar group and the severe segmental/lobar group（P0.05）.Conclusion In MPP,older children had longer fever and more severe pulmonary lesions.The severity of pulmonary lesions was associated with the absence of diagnostic IgM antibodies and lymphocyte count.Rapid pairing IgM serologic test is of great importance for early diagnosis of MPP.