婴幼儿肺炎支原体肺炎79例临床分析

Clinical analysis of Mycoplasma pneumoniae pneumonia in 79 infants and young children

目的探讨婴幼儿肺炎支原体肺炎(MPP)的临床及影像学特点和预后。方法分析79例MPP患儿的临床表现、影像学及实验室检查结果、治疗及预后。结果婴幼儿MPP 1岁以上者多见,临床表现以发热、有痰咳嗽为主,70%有喘息,半数可闻及肺部湿啰音和(或)喘鸣音,95%伴有肺外损害,其中心肌酶升高最为常见。双肺均可受累,局部病变部位以右、中下肺受累最常见,多见斑片影、片状密度增高影。病程10 d之后MP-IgM检测100%阳性。多数血细胞计数和C反应蛋白在正常范围。50%以上患儿出现CD4+细胞比值降低,73%总IgE升高。绝大多数患儿存在小气道通气功能损害。19%的患儿表现为重症/难治性肺炎,2例遗留支气管扩张和闭塞性细支气管炎(bronchiolitis obliterans,BO)改变,多数病程中出现喘息者随访1年不再发生喘息。结论除一般表现外,婴幼儿也可出现重症/难治性MPP(SMPP/RMPP)。MPP可继发免疫紊乱、小气道功能障碍,个别病例可出现BO和局限性支气管扩张。

Objective To investigate clinical manifestations and radiological findings and prognosis of Mycoplasma pneumoniae pneumonia（MPP）in younger children.Methods Clinical manifestations,radiographic fin-dings,laboratory examinations,treatment effect,and sequelae of 79 children under 3 years old with MPP were analyzed.Results MPP was seen more in young children older than 1 year old.The common clinical manifestations were cough,fever and wheezing.Some patients developed shortness of breath or dyspnea.Scattered rales and expiratory wheezes were heard on chest auscultation.Most cases had at least one extrapulmonary lesion and cardiovascular complications were the most common.Unilateral disease was as common as bilateral.The radiographic findings were predominant with patchy infiltration and consolidation with right middle and lower lung zone.Serum MP-IgM was positive in all patients after 10 days.WBC and CRP were in the normal range in most patients.More than 50% of cases showed decreased CD4＋ cells.IgE level increased in 73% of patients.Bacteria,fungi,and virus co-infection were observed in some patients.Half of the cases showed small airways obstruction.About 19% of patients developed severe or refractory MMP.The sequence of bronchiectasis,local bronchiolitis obliterans,bronchitis obliterans and asthma were found in these patients.Most cases stop wheezing after discharge from hospital.Conclusions Children younger than 3 years old might develop severe or refractory MMP.Bronchiectasis,local bronchitis obliterans and focal bronchiectasis could occur.