婴幼儿社区获得性肺炎支原体肺炎58例临床特点分析

Clinical analysis of community acquired Mycoplasma pneumoniae pneumonia in 58 infants and young children

目的:探讨婴幼儿社区获得性肺炎支原体肺炎的临床特点。方法:总结分析58例婴幼儿社区获得性肺炎支原体肺炎的临床表现、胸部X线特点、血像、MP-IgM抗体检测、治疗等临床资料。结果:婴幼儿肺炎支原体肺炎(MPP)起病急,表现为发热、刺激性干咳,大部分病例出现喘息(65%),且大多为第一次喘息发作(75%);肺部体征明显,表现为湿啰音、喘鸣音;本组资料显示MPP肺外表现主要为呕吐、腹泻等消化系统症状;胸部X线病变类型以肺间质浸润为主,58%病例双肺受累,单侧病变大多累及右中下肺(24%),多数病例外周血白细胞总数正常(60%);本组40%的病例病初1周内检测血清MP-IgM水平不高,需要进行双份血清抗体检测来诊断。所有病例均使用阿奇霉素治疗,采用序贯疗法,总疗程不少于3周;经治疗,所有病例均临床治愈,MP感染全年均有散发,好发于冬春季。结论:肺炎支原体已成为婴幼儿社区获得性肺炎的重要致病原,对于3岁以下首次喘息发作的患儿或反复喘息发作的患儿,要充分考虑肺炎支原体感染的可能,要尽早明确诊断,及早规范治疗,防止其发展为哮喘。

Objective To investigate the clinical features of community acquired Mycoplasma pneumoniae pneumonia （MPP） in infants and young children. Method Clinical manifestations and radiographic findings, blood regular test, serium MP -IgM antibody and treatment effect of 58 children under 3 years old with MPP were analyzed. Results The common clinical manifestation were fever, irritating cough mid wheezing. Most of them scattered rales and expiratory wheeze were heated on chest auscultation. Our data showed that MPP extrapulmonary manifestations were vomiting, diarrhea and other gastraintestional symptoms. The chest X - ray findings were predominant interstitial lung in. filtration and most local lesions involved right middle and lower lung zone. WBC was in the normal ranges in most patients. Serum Mt＇ - igM level was lower within 1 week of 40% cases ,but double serum antibody was positive. All patients were treated with azithromycin, using of sequential therapy. The total course was not less than 3 weeks. After treatment,all patients were clinically cured. MP infection were distribu- ted throughout the year,oceured in the winter and spring. Condusion Myeoplasma pneumoniae has become an important pathogen of com- munity acquired pneumonia in infants and young children. When the first wheezing and recurrent wheezing occur in children under 3 ）,ears old ,we might give full consideration to the posibility of MP infection. To prevent the development of asthma ,the early diagnosis and the early standard treatment are needed.