成人支原体肺炎55例临床特点及误漏诊原因分析

Analysis of Clinical Features on 55 Adult Mycoplasmal Pneumonia Cases and Cause of Misdiagnosis

目的分析成人支原体肺炎（adult mycoplasmal pneumonia,AMP）的临床特点及误漏诊原因,以提高AMP的诊断水平。方法回顾性分析我院2012年1月—2014年6月收治的55例AMP临床资料。结果本组主要表现为咳嗽、咳痰和发热,合并多种肺外表现：咽痛（45.5%）,关节、肌肉疼痛（36.4%）,头痛（27.3%）,腹泻（14.5%）,皮疹（7.3%）,耳痛（3.6%）。76.4%的患者血白细胞计数和中性粒细胞比例正常,9.1%的患者痰细菌培养阳性。影像学表现为磨玻璃影36例（65.5%）、斑片状影13例（23.6%）,病灶多累及肺上叶（69.1%）或同时累及双肺（65.5%）。肺炎支原体抗体效价多在病程第2~3周呈阳性,45例（81.8%）间隔7~14 d后复查抗体效价呈4倍或4倍以上增高。本组首诊误漏诊率74.5%（41/55）,误诊为浸润型肺结核15例（36.6%）,病毒性肺炎14例（34.1%）,急性支气管炎5例（12.2%）,过敏性肺炎2例（4.9%）,漏诊5例（12.2%）。经肺炎支原体抗体检测并结合病史、试验性抗生素治疗等综合分析确诊AMP。确诊后均首选大环内酯类抗生素治疗,其中6例治疗无效后改用氟喹诺酮类抗生素,均治愈。结论临床医师应重视AMP的诊断,对反复呼吸道感染伴随肺外表现者,常规行肺炎支原体抗体检测并动态观察,不应因单次抗体检测阴性而排除诊断。

Objective To analyze the clinical features and misdiagnosis cause of adult mycoplasmal pneumonia（ AMP） patients in order to improve the diagnosis level of AMP. Methods The clinical data of 55 AMP admitted to Changsha central hospital during Jan 2012 and June 2014 were collected and retrospectively analyzed. Results The main clinical symptoms of AMP were cough,expectoration and fever,which were combined with a variety of extrapulmonary manifestations：sore throat（ 45. 5%）,joint and,muscle pain（ 36. 4%）,headache（ 27. 3%）,diarrhea（ 14. 5%）,rash（ 7. 3%）,earache（ 3. 6%）. White blood cell counts and neutrophil percentage were mostly normal（ 76. 4%）,a small number of cases（ 9. 1%） can produce common pathogenic bacteria. Imaging manifestations were mainly ground glass opacity（ 65. 5%） and patchy shadows（ 23. 6%）. Lesions often occurred in the upper lung（ 69. 1%） or simultaneously occurred in the bilateral lung（ 65. 5%）. Mycoplasma pneumoniae antibody titers were often positive in the second week（ 54. 5%） and third week（ 36. 4%） of the course,the serum mycoplasma pneumoniae antibody titers in intervals of 7 to 14 days were 4 times or more than 4 times higher in 45 cases（ 81. 8%）. the clinical misdiagnosis rate of AMP was high（ 74. 5%,41 /45）. The misdiagnosed diseases were： 15 cases of infiltrative pulmonary tuberculosis（ 36. 6%）,14 cases of viral pneumonia（ 34. 1%）,5 cases of acute bronchitis（ 12. 2%）,2 cases of simple Streptococcus pneumoniae pneumonia（ 4. 9%）,5 cases of missed diagnosis（ 12. 2%）; macrolide antibiotics were preferred for treatment of 55 AMP patients,treatment effect of 6 cases（ 10. 9%）was invalid,but were cured after they used respiratory fluoroquinolone antibiotics. Conclusion Clinician should pay more attention to diagnosis of AMP. Routine detection of mycoplasma pneumoniae antibody is essential and dynamic observation is needed and diagnosis of the disease should not be excluded because of a single negative antibody detection.