小儿肺炎支原体脑炎40例临床分析

Central Nervous System Infection of Mycoplasma Pneumoniae in 40 Children

目的探讨小儿肺炎支原体(MP)脑炎的临床表现、诊断、疗效及预后。方法分析40例肺炎支原体脑炎患儿的临床资料,按起病原因不同分为两组,第1组18例,以发热、头痛、呕吐为首发症状,病程中始终无咳嗽;第2组22例,以发热、咳嗽等为首发症状,病程第7～12天出现神经系统症状。两组患儿均应用PCR法检测脑脊液(CSF)MP-DNA,采用颗粒凝聚试验检测其血清MP特异性IgM和IgG抗体,并行脑电图及头颅影像学检查。总结小儿肺炎支原体脑炎的临床特点。结果①肺炎支原体(MP)导致的脑炎多见于5岁以上儿童,以发热(40/40例)、头痛(29/40例)、嗜睡(28/40例)及呕吐(25/40例)等为主要表现,惊厥(5/40例)少有发生;有呼吸道症状者在病程的7～12d出现神经系统症状。②第1组患儿CSF-MP-DNA阳性,同期血MP特异性IgM和IgG抗体均为阴性;第2组患儿出现神经系统症状后,CSF-MP-DNA阴性,MP特异性IgM和IgG抗体均阳性。③脑电图异常(慢波)25例,6例患儿MRI呈脑灰质多灶异常信号,脑室旁斑片状高信号,经阿奇霉素抗感染、甘露醇降颅压及解痉等治疗,患儿均痊愈出院。结论 MP是引起小儿中枢神经系统感染的病原体之一,其中枢神经系统症状可在肺炎病程中或无肺部症状时出现,其临床症状与病毒性脑炎鉴别困难。脑脊液MP-DNA检测阳性及血清MP特异性IgM和IgG抗体增高,对确诊MP感染,指导治疗预后评估有主要意义。肺炎支原体脑炎通常预后良好。

Objective To investigate the clinical manifestations,diagnosis,curative effect and prognosis of central nervous systern（CNS）infection caused by Mycoplasma pneumoniae（MP）.Methods 40 children with CNS infection of MP were enrolled in the observation.The characteristics of children were determined by clinical symptoms.The children were classified into 2 groups according to cause of disease：Group 1（18 cases）had fever,headache and vomiting as the initial symptoms,but cough didn＇t appear during the whole course of disease.Children in group 2 had fever and cough as the inital symptoms,and symptoms of central nervons system were found after 7-12 days.Specific IgM and IgG antibody from serum was assayed by particle agglutination test and MP DNA from cerebrospinal fluid（CSF）was detected by polymerase Chain reaction（PCR）in all children.Electroen-cephalogram and cranial imaging examinations were performed.Results ①The majority children with MP infection in CNS were older than 5 years.The clinical manifestations included fever（40/40 cases）,headache（29/40 cases）,lethargy（28/40 cases）and vomiting（25/40 cases）.However,convulsion（5/40 cases）was rare.②MP DNA in CSF was positive and specific IgM,IgG antibody in serum was negative in group 1;Children in group 2 had fever and cough as the initial symptoms,and neural L symptoms appeared afterwards.However,MP DNA in CSF was negative and specific IgM and IgG antibody of serum was positive in group 2.③Other founding included abnormal electroencepha Logram（slow wave）in 25 children,multi-focus abnormal signal in ectocinerea and patching high signal near encephalocoelemain in MRI in 6 children.All children recovered completely after treatment with antibiobics,dehydration therapy and antispasmodism.Conclusion MP was one of the pathogens of CNS infection in childhood.CNS symptoms can occur with or without respiratory infection.The etiopath-ogenisis of encephalitis was difficult to distinguish MP from virus.Positive MP DNA in CSF and positive specific IgM and IgG antibody in serum was helpful to diagnosis MP infections and its treatment.Children with MP infection in CNS usually recovered well and had a good prognosis.