肺炎支原体感染诱发肺栓塞1例并文献复习

Pulmonary thromboembolism induced by Mycoplasma pneumoniae:a case report and literature review

目的探讨肺炎支原体肺炎合并肺栓塞形成的临床特点和诊断、治疗要点。方法回顾性分析1例肺炎支原体肺炎合并肺栓塞的病例资料。结果患者以发热伴咳嗽、胸痛呼吸道症状起病,在抗感染治疗的过程中反复出现胸痛、咯血、气短,动态监测D-二聚体进行性升高,行胸部强化CT发现肺动脉分支充盈缺损,明确诊断肺栓塞,同时伴抗心磷脂抗体一过性弱阳性,经低分子肝素、华法林抗凝治疗,病情好转,随访3个月肺栓塞消失。结论对明确诊断支原体肺炎,经抗支原体及对症治疗,临床症状无改善,有血栓高危因素的患者,需警惕是否合并肺栓塞,及时行胸部CT检查,做到早发现,早治疗,降低病死率及致残率。

Objective To investigate clinical features, diagnosis, and treatment of mycoplasma pneumoniae pneumonia(MPP) combined with pulmonary embolism. Methods One case with MPP associated with pulmonary embolism was retrospectively analyzed with literature review. Results The patient presented with fever,cough and chest pain respiratory symptom at the onset,while repeated chest pain,hemoptysis and dyspnea during anti-infection therapy. Thereafter,pulmonary embolism was confirmed by a series of examinations including D-dimer test which was higher to before and contrast-enhanced CT image which showed filling-defect in pulmonary artery. Serum anti-phospholipid antibody was weakly positive. Finally,the condition was improved with the treatment of anticoagulation therapy by low molecular heparin and warfarin,the pulmonary embolism disappeared after 3 months follow-up. Conclusion For the patients with Mycoplasma pneumonia,who have no improvement in clinical symptoms after antimycoplasma and symptomatic treatment,and both with high risk factors of thrombosis,it is necessary to be vigilant whether combined with pulmonary embolism,and given timely chest CT examination. Early detection and early treatment can help reduce mortality and disability.