儿童难治性肺炎支原体肺炎临床及实验室检查特征分析

Analysis of Clinical Characteristics and Laboratory Tests with Refractory Mycoplasma Pneumoniae Pneumonia in Children

目的:研究早期判别难治性肺炎支原体肺炎(RMPP)的特征性临床表现及干预措施。方法:收集2013年10月至2014年9月在苏州大学附属儿童医院住院治疗并确诊为RMPP的63例患儿(RMPP组)以及采用抽签法抽取同期住院治疗的32例普通MPP患儿(MPP组)的临床特征及实验室检查资料,进行比较研究。结果:RMPP组患儿平均年龄高于MPP组(P<0.01),热程(16.17±4.60)d长于MPP组的(6.97±1.77)d(P<0.01);RMPP组患儿大叶性肺炎、呼吸音减低及肺部叩诊浊音、胸腔积液、肝脏损伤的发生率均高于MPP组(P均<0.05);RMPP组MP-DNA拷贝数高于MPP组(P<0.01);RMPP组外周血中WBC、中性粒细胞计数及LDH、IgG、IgA、IgM水平均高于MPP组(P均<0.05);RMPP组CRP>40 mg/L及ALT升高发生率均高于MPP组(P均<0.05);RMPP组使用支气管镜冲洗治疗的比例高于MPP组,使用大环内酯类抗生素1个疗程后退热时间及住院时间明显长于MPP组(P均<0.01)。结论:RMPP易发生于大年龄儿童,更易出现大叶性肺部炎症,MP-DNA拷贝数高,热程长,CRP>40 mg/L的比例高,胸腔积液、肝脏受损发生率高,需要支气管镜冲洗治疗的比例高,住院时间长。

Objective：To seek the early discrimination of clinical manifestations and intervention measures of refractory Mycoplasma Pneumoniae Pneumonia in children.Methods：Sixty-three cases of hospitalized children with RMPP（RMPP group） were collected from October 2013 to September 2014 in Children＇s Hospital Affiliated to Soochow University.Thirty-two cases of hospitalized children with Mycoplasma Pneumoniae pneumonia（MPP group） were collected by sortition method as control group in the same period.The data of clinical characteristics and laboratory tests were collected for comparative analysis.Results：The average age of RMPP group was higher than MPP group（P〈0.01）.The average fever period of RMPP group（16.17±4.60 days） was longer than that of MPP group（6.97±1.77 days,P〈0.01）.The incidence of lobar pneumonia,decreased breath sounds,lung percussion dullness,pleural effusion and liver damage in RMPP group were higher than those in MPP group（all P〈0.05）.The MP-DNA copies of RMPP were higher than that of MPP group（P〈0.01）.The total WBC count,neutrophil percentage,LDH,IgG,IgA and IgM in the peripheral blood of RMPP group were higher than those of MPP group（all P〈0.05）.The incidence rats of CRP40 mg/L and elevated ALT of RMPP group were higher than those of MPP group（both P〈0.05）.The cases of washing by bronchoscope,the antifebrile time after treatment of macrolide antibiotics and hospitalization days of RMPP group were significantly higher than those of MPP group（all P〈0.01）.Conculsion：RMPP is more likely to the elder children,appearing lobar lung inflammation,high MP DNA copies in BALF,long thermal process,high incidence of CRP40 mg/L,pleural effusion and liver damage,high incidence of washing treatment by bronchoscopy and long hospitalization days.