川崎病患儿肺炎支原体感染的临床特征分析

Clinical characteristics of Kawasaki disease children complicated with Mycoplasma pneumoniae infections

目的观察川崎病患儿肺炎支原体感染儿童的试验室检查数据及临床意义。方法回顾性分析2012年6月-2016年6月医院儿科确诊为川崎病的683例患儿,将30例肺炎支原体感染患儿列为观察组,未感染653例列为对照组,记录患儿临床资料及试验室检查结果、临床表现等进行分析;两组患者均于治疗前、后采空腹静脉血进行实验室检查,包括白细胞计数WBC、血小板计数PLT、红细胞沉降率ESR、超敏C-反应蛋白hs-CRP、血清降钙素PCT、血清免疫球蛋白、T细胞亚群等;应用全自动血培养仪及自动微生物鉴定仪分别进行细菌培养及鉴定;对两组患儿进行血清MP-IgM检测,使用血液抗凝法检测患儿血清中的肺炎支原体抗体;根据患儿超声心动图探查冠状动脉诊断冠状动脉损伤(CAL)。结果全体患儿送检血液样本共检出革兰阳性菌23株、革兰阴性菌48株、肺炎支原体30例以及肺炎衣原体3例,病原体分布;检测肺炎支原体感染率为4.4%;全体患儿治疗后复查WBC、PLT、ESR、Hs-CRP、PCT等实验室检测,治疗后WBC、PLT、Hs-CRP均较治疗前降低(P<0.05),治疗后PCT较治疗前升高(P<0.05),观察组与对照组在Hs-CRP及PCT方面差异有统计学意义(P<0.05)。两组患儿在IgG、C3、CD8+与CD4+/CD8+差异有统计学意义(P<0.05)。观察组CAD发生率为86.7%,对照组CAD发生率为42.9%。结论川崎病合并肺炎支原体感染的患儿增加了并发冠状动脉损伤(CAD)的概率,其体液免疫和细胞免疫较未并发感染MP的KD患儿更为紊乱,建议临床上加强重视,避免漏诊延误病情。

OBJECTIVE To observe the clinical laboratory data of Kawasaki disease children complicated with Mycoplasma pneumoniae infections and analyze the clinical significance.METHODS A total of 683 children who were diagnosed with Kawasaki disease in pediatrics department from Jun 2012 to Jun 2016 were retrospectively analyzed,30 children who were complicated with M.pneumoniae infections were assigned as the observation group,and 653 children without the infection were set as the control group.The clinical data and results of laboratory examinations of the children were recorded,and the clinical manifestations were analyzed.The fasting venous blood specimens were collected for clinical laboratory examination before and after the treatment,including white blood cell（WBC）counts,platelet（PLT）counts,erythrocyte sedimentation rate（ESR）,high-sensitivity C-reactive protein（hs-CRP）,serum procalcitonin（PCT）,serum immunoglobulin,and T lymphocyte subsets.The bacterial culture was conducted by using automatic blood culture system,and the pathogens were identified with the use of automatic microorganism identification system;the serum MP-IgM was detected for the two groups of children,the serum M.pneumoniae antibodies were detected by means of blood anticoagulation method;the coronary artery damage（CAD）was diagnosed on the basis of echocardiography.RESULTS Among the pathogens isolated from the submitted blood samples,there were 23 strains of gram-positive bacteria,48 strains of gram-negative bacteria,30 strains of M.pneumoniae,and 3strains of Chlamydia pneumoniae.The incidence rate of M.pneumoniae infections was 4.4%.The clinical laboratory indexes,including WBC,PLT,ESR,hs-CRP,and PCT,were reexamined for all the children after treatment,the levels of WBC,PLT,and hs-CRP were significantly lower after the treatment than before the treatment（P〈0.05）,the PCT level was significantly higher after treatment than before treatment（P〈0.05）;there was significant difference in IgG,C3、CD8＋,or CD4＋/CD8＋between the two groups of children（P〈0.05）.The incidence rate of CAD was 86.7%in the observation group,42.9% in the control group.CONCLUSIONS.The risk of CAD is increased in the Kawasaki disease children complicated with M.pneumoniaeinfection,whose humoral immunity and cellular immunity are more disordered than those of the KD children without M.pneumoniaeinfection,and it is necessary for the hospital to pay high attention to them and avoid missed diagnosis and delay the condition.