小儿支原体肺炎临床特征及大环内酯类抗生素疗效分析

Clinical characteristics and macrolide antibiotics treatment of mycoplasma pneumonia in children

目的探讨儿童肺炎支原体（MP）肺炎的流行病学、临床特征与大环内酯类抗生素疗效。方法统计分析198例儿童社区获得性肺炎（CAP）中56例MP肺炎的流行病学、外周血象、X线胸片和MP血清学检测结果等临床特征，以及按儿科呼吸学组制定的《儿童社区获得性肺炎管理指南（试行）》中的诊治原则，采用大环内酯类抗生素（乳糖红霉素或阿奇霉素）治疗疗效。结果（1）MP肺炎发生率约占儿童CAP的28．3％，夏秋季与冬春季发病率未见明显差异；学龄期与学龄前期儿童发生率高于婴幼儿，但也无明显统计学差异，（2）MP肺炎X线胸片显示左侧病变和C反应蛋白增高发生率分别为44．6％和46．4％，明显高于同期非MP肺炎的218％和303％（P〈001和0．05）；但血白细胞和中性粒细胞计数变化，MP肺炎与非MP肺炎问的差异无统计学意义（均P〉O05）。（3）大环内酯类抗生素治疗儿童MP肺炎和CAP总有效率分别约为893％和95．8％，差异无统计学意义（P〉0．05）；阿奇霉素和乳糖红霉素治疗MP肺炎有效率分别为892％和89．5％，差异也无统计学意义（P〉0．05）。（4）采用缓慢静脉滴注方法，大环内酯类抗生素无明显不良反应。结论MP为儿童CAP的常见病原体，乳糖红霉素和阿奇霉素疗效显著。由于大环内酯类抗生素治疗儿童MP与非MP肺炎疗效的差异无统计学意义．故可以作为基层或农村地区儿童CAP治疗的首选经验性抗生素。

Objective To review the clinical characteristics and antibiotic treatment of mycoplasma pneumonia （MP） in children. Methods Among 198 children with community acquired pneumonia （CAP）, 56 cases were diagnosed as mycoplasma pneumonia. The epidemiology, clinical manifestation, peripheral hemogram, X-ray chest film, MP-IgM of CAP patients were retrospectively analyzed. According to the Guidelines for Management of Childhood Community Acquired Pneumonia （trial version）, the patients were treated with erythromycin lactobionate or azithromycin. Results The overall incidence rate of MP was28.3%, there were no significant differences in incidence rate between seasons and age groups. The rate of chest x-ray changes of left lung in MP was 44.6%,while that of non-MP pneumonia was 21.8%（P-〈0.01）. The CRP in MP were higher than that in non-MP pneumonia （P〈0.05）. There was no difference in the changes of WBC and neutrophils count between MP and non-MP pneumonia （ P 〉0.05 ）. The total effective rate of macrolide antibiotics in treatment of MP was 89.3%, that of CAP was 95.8%（P 〉 0.05 ）. in the treatment of MP the effective rate of erythromycin lactobionate was 89.2%, that of azithromycin was 89.5%（ P 〉0.05 }. No serious side effects were observed when macrolide antibiotics were administered with slow intravenous dropping, Conclusion Macrolide antibiotics （erythromycin lactobionate or azithromycin） can be used as the primary antibiotics to treat children CAP including MP.