31例成人肺炎支原体肺炎患者的临床特征分析

Analysis on Clinical Characteristics in 31 Adult Patients with Mycoplasma Pneumoniae Pneumonia

目的分析31例成人肺炎支原体肺炎(MPP)患者的临床特征。方法选取2014年5月—2016年5月首都医科大学附属北京地坛医院收治的成人MPP患者31例作为MPP组,另选取同期非肺炎支原体(MP)感染的成人社区获得性肺炎患者31例作为对照组。比较两组患者临床表现、实验室检查指标、影像学检查结果、肺功能指标,记录MPP组患者治疗转归。结果 (1)两组患者年龄构成、发病时间比较,差异有统计学意义(P<0.05)。(2)两组患者发热、咳嗽、咽痛、乏力、胸闷、肌肉酸痛、肺部湿啰音、肺部干啰音发生率比较,差异无统计学意义(P>0.05)。(3)两组患者白细胞计数、中性粒细胞计数、嗜酸粒细胞计数、C反应蛋白(CRP)、降钙素原(PCT)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBi L)、直接胆红素(DBi L)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)比较,差异无统计学意义(P>0.05)。(4)两组患者病灶分布及磨玻璃影、斑片影、网格影、实变影检出率比较,差异无统计学意义(P>0.05)。(5)两组患者深吸气量占预计值的百分比(IC%)、第1秒用力呼气容积占预计值的百分比(FEV_1%)、用力肺活量占预计值的百分比(FVC%)、第1秒用力呼气容积与用力肺活量比值与预计值的百分比(FEV_1/FVC%)、呼气峰流速占预计值的百分比(PEF%)、75%肺活量用力呼气流速占预计值的百分比(MEF75%)、50%肺活量用力呼气流速占预计值的百分比(MEF50%)、25%肺活量用力呼气流速占预计值的百分比(MEF25%)、一口气弥散量占预计值的百分比(DLCO SB%)、肺总量占预计值的百分比(TLC%)、残气量与肺总量比值占预计值的百分比(RV/TLC%)比较,差异无统计学意义(P>0.05)。(6)MPP组患者中使用阿奇霉素治疗者4例、左氧氟沙星治疗者9例、莫西沙星治疗者18例,治疗后临床症状均好转,治疗期间未出现明显不良反应。结论 MPP冬春季发生率较高,以50岁以下中青年多见,临床表现、实验室检查指标缺乏特异性,胸部影像学检查鉴别诊断较困难,MP感染与非MP感染对成人肺功能的影响差异不大,大环内酯类、呼吸喹诺酮类抗菌药物治疗MPP有效。

Objective To analyze the clinical characteristics in 31 adult patients with Mycoplasma pneumoniae pneumonia（MPP）. Methods A total of 31 adult patients with MPP were selected as MPP group in Beijing Ditang Hospital Affiliated to Capital Medical University from May 2014 to May 2016,meanwhile a total of 31 adult patients with CAP（without Mycoplasma pneumoniae infection）were selected as control group. Clinical features,laboratory examination results,imaging examination results and index of pulmonary function were compared between the two groups,treatment outcome and prognosis were recorded in MPP group. Results（1）There was statistically significant difference in age composition and onset time between the two groups（P〈0.05）.（2）No statistically significant differences of incidence of fever,cough,pharyngalgia,lacking in strength,chest distress,muscular soreness,lung wet rale or lung dry rale was found between the two groups（P〈0.05）.（3）No statistically significant differences of WBC,neutrophil count,eosinophil count,CRP,PCT,ALT,AST,TBiL,DBiL,CK-MB or LDH was found between the two groups（P〈0.05）.（4）No statistically significant differences of lesion distribution,detection rate of ground-glass shadow,patch shadow,grid shadow or consolidation shadow was found between the two groups（P〈0.05）.（5）No statistically significant differences of IC%,FEV1%,FVC%,FEV1/FVC%,PEF%,MEF75%,MEF50%,MEF25%,DLCO SB%,TLC% or RV/TLC% was found between the two groups（P〈0.05）.（6）In MPP group,4 cases used azithromycin,9 cases used levofloxacin,and the other 18 cases used moxifloxacin,all of the 31 cases＇ clinical symptoms relieve after treatment,no one occurred any obvious adverse reactions. Conclusion Occurrence risk of MPP is relatively high in winter and spring,MPP is mainly saw young and middle-aged below 50 years old,without specific clinical features or laboratory examination results;imaging examination is relatively difficult to differentially diagnose MPP,but MP infection has no significant impact on pulmonary function compared with non-MP infection,macrolides and respiratory quinolones have certain clinical effect in treating MPP.