儿童肺炎支原体感染合并肺动脉血栓形成一例并文献复习

Acute pulmonary embolism due to mycoplasma pneumoniae in children: a case report and review of the literature

目的分析儿童肺炎支原体(MP)感染合并循环血栓形成病例血栓栓塞及抗磷脂抗体(a PL)谱特点,以期提高对MP感染合并血栓栓塞事件的认识。方法报道1例肺炎支原体肺炎(MPP)合并急性肺动脉血栓形成儿童病例,并复习相关文献,纳入符合MP感染导致血栓栓塞事件的儿童,分析其临床及a PL水平变化,探讨MP感染合并血栓栓塞事件与a PL之间的关系。结果我们报道1例MPP合并急性肺动脉血栓形成和循环a PL阳性的患儿,同时检索相关文献,纳入病例14例,男8例(61.5%),年龄(7.78±2.74)岁,所有病例入院时均有肺部炎症,动脉系统栓塞7例(50%):脑动脉3例、脾动脉2例、椎动脉1例、左颈内动脉1例、双侧腘动脉1例;静脉系统栓塞7例(50%):肺动脉4例、右心房1例、左腘静脉1例、右髂外静脉1例。14例患儿中9例(64.2%)检测抗a PL:9例检测a CL、6例检测LA、4例检测抗β2GI;9例检测a CL均阳性,6例检测LA中阳性5例,4例检测抗β2GI病例中阳性3例。所有患儿均接受静脉用阿奇霉素以及治疗量抗凝治疗(持续静脉应用普通肝素钠并口服华法林)。随访3个月后,患者均痊愈,所有抗磷脂抗体均转阴。结论 MP感染合并循环血栓栓塞事件时可伴随a PL阳性,但为短暂阳性,与儿童抗磷脂综合征不同。

Objective To explore the relationship between mycoplasma pneumoniae infection and antiphospholipid antibodies （aPLs） in children. Methods We describe 1 case of a previously healthy seven-year-old boy with acute pulmonary embolism and positive aPLs associated with M. pneumoniae pneumonia （MPP） and review 13 previous reports. The clinical manifestations and changes of aPLs of 14 cases were summarized. Results Fourteen cases, 8 boys and 6 girls, aged （7.78±2.74）years old, including 7 papers published by foreign authors and 6 by domestic authors except for our report were analyzed. All the 13 cases excepted for our case had pulmonary infection and thrombosis. Arterial thrombosis occurred in 7/14 cases： cerebral arterial embolism in 3 cases, splenic arterial embolism in 2 cases and vertebral, left internal carotid and bilateral popliteal arterial in 1 case, respectively. Venus thrombosis occurred in 7/14 cases：pulmonary embolism in 4 cases and right atrium, left popliteal venous and right external iliac venous in 1 case, respectively. Antiphospholipid antibodies （aPLs） was performed in 9/14 cases：all 9 cases were detected anticardiolipin antibodies （aCL）, 6 cases were detected lupus anticoagulants （LA） and 4 cases were detected β2-glycoprotein antibodies （β2GI）. The patients received intravenous azithromycin and therapeutic anticoagulation with unfractionated heparin and then oral warfarin. After 3-month follow-up, the patients had recovery completely and aPLs were negative. Conclusion Antiphospholipid antibodies relate to thrombosis closely in children with MPP. The characteristics of aPLs in children after MP infection are transient, and thus different from in those who develop antiphospholipid syndrome.