小儿肺炎支原体感染164例临床分析

CLINICAL ANALYSIS OF 164 CASES OF MYCOPLASMA PNEUMONIAE (MD) INFECTED CHILD

目的:探讨小儿肺炎支原体(mycoplasma pneumoniae,MP)感染的临床特点及总结诊治经验。方法:回顾性分析164例MP感染患儿的资料,MP-IgM采用颗粒凝聚法试验检测,抗体滴度高于1∶80为阳性,以确诊MP感染。阳性者采用静脉滴注红霉素30mg/(kg.d),3￣5天后改阿奇霉素序贯治疗或单用阿奇霉素l0mg/(kg.d),服3天停4天,共2～3疗程。其它采用对症治疗,如解热、止咳、平喘等。结果:本组病例男86例,女78例,男女之比为1.1∶1。年龄:婴幼儿47例,学龄前儿童67例,学龄期儿童50例。年龄最小10月,表现为上呼吸道感染56例,支气管炎44例,肺炎64例。本组病例均以发热(82.9%)、咳嗽(95%)、喘息(12%)为主要症状。可伴有神经系统、消化系统、皮肤、泌尿系统等改变。肺部体征相对轻,胸部X线表现较重,本组164例均MP-IgM阳性,抗生素用阿奇霉素序贯治疗,减少了红霉素的副作用,且阿奇霉素具有组织渗透性强,服药次数少,作用时间长,副作用小,依从性好及抗生素后效应强等优点。结论:①MP感染临床表现无特异性,所以除呼吸系统症状外,出现多系统表现时,应引起重视。②微量颗粒凝聚法测定血清HP-IgM特异性强、敏感性高,可作为诊断MP感染的主要方法。③阿奇霉素序贯治疗有效。

Objective：To approach the clinic feature of mycoplasma pneumoniae （MP） infected child and to summarize the experience of diagnosis and therapy. Methods： The documents of 164 MP infected children were analyzed retrospectively. MP-IgM was detected by the microamount particle coacervation test.The antibody titer higher than 1：80 was regarded as positive and as the final diagnosis. The positive ones were given erythromycin 30mg/ （kg.d） by intervenous drop infusion, and changed to azithromycin after 3-5 days as sequential therapy.Or only use azithromycin 10 mg/（kg.d）,orally for 3 days and ceased 4 days,Altogether 2-3 courses of treatment were given. The others received by symptomatic treatment,such as relieving fever, stopping coughing, relieving wheeze, and so on. Results： There were 86 male and 78 female cases（1.1：l）. Age： 47 infants, 67 preschool children, 50 school age children. The youngest child was 10 months old. The clinical appearance： 56 upper respiratory infection, 44 bronchitis, 64 pneumonia. The cardinal symptom is fever （82.9%）, cough （95%）, gasping （12%）, mean while accompanying with the change of nervous system, digesive system, skin, and urinary system. The physical sign on lung was relatively not serious, but the appearance of X-ray on chest is relatively serious. All of 164 cases were positive on MP-IgM. The side effect of azithremycin was lower than that of erythromycin. Conclusion：（1）There are no specificity in MP infection.If muhisystem display is emerged besides the symptom of respiratory system, it must be thought highly of. （2）The microamount particle coacervation to measure serum HP-IgM is strong specific and highly sensitive. It can be the principal method to diagnose MP infection. （3）Azithromycin sequential therapy is valid.