儿童肺炎支原体肺炎误诊为咳嗽变异型哮喘临床分析

Clinical Analysis of Mycoplasma Pneumonia Misdiagnosed as Cough Variant Asthma

目的探讨儿童肺炎支原体肺炎误诊为咳嗽变异型哮喘(cough variant asthma,CVA)的原因及防范措施。方法对2012年5月—2017年1月西安交通大学第二附属医院儿科收治的肺炎支原体肺炎86例中误诊为CVA6例的临床资料进行回顾性分析,并复习相关文献。结果本组误诊率6.98%。因发热、咳嗽、咳痰及偶感喘息、气促就诊2例,因反复发热伴咳嗽、胸闷及喘息不适就诊1例,因反复发热、咳嗽、气促、胸闷及喘息不适就诊3例。6例均误诊为CVA,误诊时间3~10 d。6例按CVA治疗后效果不佳,经进一步行血清肺炎支原体Ig M抗体检测等结合相关临床表现确诊为肺炎支原体肺炎,予阿奇霉素及甲泼尼龙等治疗15~20 d后均病情明显好转出院。出院后随访1~3个月,随访期间6例预后均较好。结论肺炎支原体肺炎缺乏特异性临床和胸部影像学表现,易误诊。临床医生应加强对肺炎支原体肺炎的警惕性和对该病相关知识的认识和了解,以减少或避免其误诊误治。

Objective To investigate the misdiagnosis causes and preventive measures of children with misdiagnosed as cough variant asthma( CVA). Methods A total of 6 children with mycoplasma pneumonia misdiagnosed as CVA were enrolled in the study of 86 cases of mycoplasma pneumonia in our hospital from May 2012 to January 2017. The clinical data were retrospectively analyzed. Results Misdiagnosis rate was 6. 98%. Due to fever,cough and sputum,occasional breathing shortness of breath in 2 cases,and due to fever,with cough,chest tightness and wheezing discomfort in 1 case,and due to repeated fever,cough,shortness of breath,chest tightness and wheezing discomfort in 3 cases. Mycoplasma pneumonia was misdiagnosed as CVA. The mean misdiagnosis time was 3-10 days. All children were diagnosed as mycoplasma pneumonia by mycoplasma etiology. They were given Azithromycin combined with Methylprednisolone and other drugs symptomatic treatment after diagnosis,15-20 d after the condition was significantly improved after discharge. The follow-up time was 1 to 3 months after discharge,and all the children had a good prognosis during the follow-up period. Conclusion Mycoplasma pneumonia lacks specific clinical chest imaging findings,and is easy to be misdiagnosed. Clinicians should strengthen the awareness of mycoplasma pneumonia and knowledge of the disease-related knowledge and understanding,reduce or avoid misdiagnosis and mistreatment.