儿童肺炎支原体肺炎的临床和实验室检查特征分析

Analysis of clinical features in children with mycoplasma pneumoniae pneumonia

目的分析儿童肺炎支原体肺炎(MP)的临床特征,为临床准确诊断和治疗提供依据。方法收集2010年1月—2011年5月在新疆医科大学第一附属医院儿科收住的肺炎支原体肺炎97例患儿的临床资料,按患儿年龄分组:<1岁组11例,1～3岁组17例,3～5岁组41例,>5岁组28例。按患儿肺炎的类型和严重程度,分为支气管肺炎组(55例),大叶性肺炎组(42例)。采用酶联免疫吸附试验在入院时和出院时分别进行血清学检测,抗体滴度≥1∶80为阳性。比较各组患儿的临床和实验室检查特点。结果 97例中有39例(40.2%)入院时MP-IgM阴性,出院时阳性,58例(59.8%)血清学检查阳性患儿MP-IgM滴度升高4倍以上。血清学阳转者出院时的MP-IgM平均滴度为1∶160(1∶80～1∶2 560)。血清学阳性者入院时的MP-IgM平均滴度为1∶160(1∶80～1∶640),出院时为1∶640(1∶80～1∶2560)。发病的高峰年龄为3～5岁,>5岁患儿更容易引起大叶性肺炎和胸腔积液,且发热时间长,伴随白细胞和淋巴细胞计数下降及ESR和CRP升高。结论肺炎支原体肺炎患儿的临床特征与年龄密切相关,由于血清学阳转率比较高以及假阳性的存在,应重视双份血清学检查在临床确诊中的价值。

Objectives To analyse the clinical and laboratory test date in children with mycoplasma pneumoniae pneumonia（MP） for purpose of correct diagnosis and treatment.Methods From January 2010 to May 2011,97 cases of mycoplasma pneumoniae pneumonia from the First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively.A total of 97 children with MP were grouped by age： ≤1 years of age（11 patients）,1~3 years of age（17 patients）,3~5 years of age（41 patients）,and ≥5 years of age（28 patients）.They were also grouped by pneumonia pattern and severity： bronchopneumonia group（55 patients） and lobar pneumonia group（42 patients）.The diagnosis of MP was made by examinations at both admission and discharge by the enzyme linked immunosorbent assay（≥1∶80）.Clinical and laboratory test features were compared among these groups.Results Thirty nine patients（40.2%） were seroconverters（i.e.,IgM-negative at admission and IgM-positive at discharge）,and 58 patients（59.8%） showed increased antibody titers more than four times during hospitalization.The median titers in seroconverters at discharge were 1∶160（1∶80~1∶2 560） The median titers of both assays in seropositive patients were 1∶160（range,1∶80~1∶640） at admission,and 1∶640（1∶80~1∶2 560） at discharge,respectively.In our study,the peak incidence with MP was at 3~5 years of age.Compared with the younger groups,the patients with lobar pneumonia and pleural effusion were ≥5 years of age patients who and had longer fever duration and lower white blood cell and lymphocyte counts,but higher C-reactive protein（CRP） and erythrocyte sedimentation rate（ESR）.Conclusion In MP,age of patient was intimately related to the clinical feature.Because of a higher rate of seroconverters and the existence of false-positives,the paired IgM antibodies serologic test of all children with pneumonia may be mandatory for definitive diagnosis of MP.