肺炎支原体肺炎合并嗜肺军团菌感染29例

Mycoplasma pneumoniae pneumonia complicated with Legionella pneumophila infection in 29 children

目的总结肺炎支原体肺炎（MPP）合并嗜肺军团菌（LP）感染患儿的临床特点。方法选取2011年8月至2012年2月上海交通大学附属上海市第六人民医院儿科收治的MPP住院患儿62例。采用被动凝集法检测血清特异性MP-IgM、IgG抗体。采用间接免疫荧光法检测血清噬肺LPl型-IgM抗体。将患儿分为2组，MPP并LP感染组29例，MPP组33例。观察2组患儿在性别、年龄、临床表现、住院时间、肺外并发症、肺部影像学方面的差异，并应用SAS6．12软件对其结果进行分析。结果MPP并LP感染组及MPP组中，患儿有发热者分别为29例、33例，咳嗽者29例、33例（均占100．0％）；肺部阳性体征者分别为23例、2l例（分别占79．3％、63．6％），无肺部体征者分别为6例、12例（分别占20．7％、36．4％）；并肺外并发症者分别为21例、16例（72．4％、48．5％）。胸部x线和（或）胸部CT表现：支气管肺炎分别为18例、22例（62．1％、66．7％），大叶性肺炎分别为8例、8例（27．6％、24．2％），间质性肺炎分别为0例、2例（0．0、6．1％），肺不张分别为2例、0例（6．9％、0．0），胸腔积液分别为1例、1例（3．4％、3．0％）。2组患儿在性别、年龄、出现肺部哕音例数、肺部影像学、肺外并发症发生率方面比较，差异均无统计学意义（P均〉0．05）。MPP合并LP感染组患儿的发热天数、咳嗽天数、肺部哕音持续天数、住院时间、CRP升高患者例数和粒细胞减少症患儿数均高于MPP组，差异均有统计学意义（P均〈0．05）。结论MPP并LP感染患儿与MPP患儿相比，发热、咳嗽时间长，肺部哕音吸收延迟，住院时间长，临床症状及体征相对较严重。

Objective To summarize the clinical features of mycoplasma pneumoniae pneumonia（MPP） complicated with legionella pneumophila（LP） infection in children. Methods Sixty-two cases of MPP were admitted in the Department of Pediatrics, the Sixth People＇s Hospital of Shanghai Affiliated to Shanghai Jiaotong University from Aug. 2011 to Feb. 2012 were enrolled. Serum antibodies of MP（ IgM, IgG） were determined by passive agglutination method and serum antibody（IgM） of LP serogroup-1 was detected by indirect immunofluorescence method. The patients were divided into 2 groups（29 patients in MPP group complicated with LP infection and 33 patients in MPP group）. Gender, age, clinical symptoms, duration of hospitalization, extra pulmonary complications and chest iconography were compared between the 2 groups. The SAS 6.12 software was used to analyze the data. Results Of the children in MPP complicated with LP infection group and MPP group,29 cases and 33 cases（ 100.0%, 100.0% ） had cough and fever, 23 cases and 21 cases（79.3% ,63.6% ） had pulmonary crackles and（or） wheezing,6 cases and 12 cases（20.7%, 36.4% ） had no pulmonary signs,21 cases and 16 cases （72.4% ,48.5% ） had extra pulmonary complications. Chest X-ray （or/and chest CT）revealed bronchopneumonia in 18 cases and 22 cases （62.1% ,66.7% ）, lobar pneumonia in 8 cases and 8 cases （27.6% ,24.2 % ）, interstitial pneumonia in 0 case and 2 cases （0.0,6.1% ）, atelectasis in 2 cases and 0 case（6.9% ,0.0）, and pleural effusion in 1 case and 1 case （3.4%, 3.0% ）. Compared with MPP group, the significant differences were found in febrile days, cough days,pulmonary rales duration and length of stay in MPP with LP infection group（ all P 〈 0.05 ）. The number of elevated CRP cases and granulocytopenia in the MPP group with LP was higher than that in the MPP group（P 〈 0.05）. But no significant difference was found in gender, age, the cases of pulmonary rales or the chest iconography type （ all P 〉 0.05 ）. Conclusions Compared with MPP children, MPP with LP children had longer febrile and cough days, severe pulmonary rales and duration of hospitalization. The clinical symptoms and signs were much severe in MPP patients with LP infection patients.