肺炎支原体肺炎合并EB病毒感染41例临床分析

Clinical analysis of 41 cases of Mycoplasma Pneumoniae pneumonia complicated with Epstein-Barr virus infection

目的探讨肺炎支原体肺炎合并EB病毒感染患儿的临床特点。方法选取2013年8月—2014年12月在上海交通大学附属第六人民医院儿科病房住院的肺炎支原体肺炎患儿94例,其中合并EB病毒感染组(观察组)41例,肺炎支原体肺炎组(对照组)53例。分析比较2组患儿在一般资料、临床表现、实验室检查、胸部影像学、肺外并发症、治疗与转归等方面的差异。结果 2组患儿年龄构成比的差异具有统计学意义(P<0.05)。住院时间、肺部啰音持续时间、重症肺炎发生率、淋巴结肿大发生率差异均具有统计学意义(P<0.01)。2组白细胞升高率(36.6%、13.2%)、胸腔积液发生率(9.8%、0.0%)、肺实变发生率(2.4%、0.0%)差异均具有统计学意义(P<0.01)。2组肝功能损害发生率(9.8%、0.0%)差异具有统计学意义(P<0.05)。2组发热时间、C反应蛋白、血沉和降钙素原升高率、肺外并发症发生率差异无统计学意义(P>0.05)。结论婴幼儿肺炎支原体肺炎更容易合并EB病毒感染;与单纯肺炎支原体肺炎患儿相比,合并EB病毒感染者肺部啰音持续时间更长,更易合并胸腔积液、肺实变、肝功能损害和淋巴结肿大,易发展为重症肺炎,住院时间更长,必要时可加用激素、免疫调节剂等治疗。

Objective To analyze the clinical features of Mycoplasma Pneumoniae pneumonia（ MPP） complicated with Epstein-Barr virus（ EBV） infection in children. Methods Total 94 cases of MPP children in our hospital from August,2013 to December,2014 were enrolled. Forty-one cases were diagnosed of MPP complicated with EBV infection（ research group）,53 cases of MPP without EBV infection were as control. The general information,clinical manifestation,auxiliary examination,extra-pulmonary complications,therapeutic method and prognosis were analyzed. Results The constituent ratio of age in both groups had statistically significant difference（ P〈0. 05）. Length of hospital stay,duration of pulmonary rales,severe pneumonia occurrence rates（ 29. 3%,5. 7%） and lymphadenectasis occurrence rates（ 41. 4%,15. 1%） of the two groups had significant differences（ P〈0. 01）. The occurrence rates of elevated white blood cell amount（ 36. 6%,13. 2%）,pleural effusion（ 9. 8%,0. 0%） and pulmonary consolidation（ 2. 4%,0. 0%） had significant differences（ P〈0. 01）. The occurrence rates of liver function damage（ 9. 8%,0. 0%） had significant difference（ P〈0. 05）. No significant difference was found between two groups in febrile time,occurrence rates of elevated C-reactive protein,erythrocyte sedimentation rate,procalcitonin,and extra-pulmonary complications（ P〈0. 05）. Conclusion The infants with MPP are more likely to be complicated with EBV infection. Compared with MPP cases,MPP complicated with EBV infection cases have longer duration of pulmonary rales and higher occurrence of pleural effusion,pulmonary consolidation,liver function damage,lymphadenectasis,severe pneumonia and longer length of hospital stay. In some cases the adoption of glucocorticoid or protopic immunomodulator may be necessary.