不同年龄儿童肺炎支原体肺炎的临床特征

Clinical characteristics of Mycoplasma pneumoniae pneumonia in children of different ages

目的探讨不同年龄段儿童肺炎支原体肺炎（MPP）的临床特征、实验室检测结果及影像学表现的差异。方法收集2017年温州市中西医结合医院收治的164例1个月～14岁MPP患儿的临床资料，根据年龄分为1个月～3岁组（46例）、〉3～14岁组（118例），回顾性分析2组患儿临床特征、实验室检查结果及影像学表现。结果1．与1个月～3岁组比较，〉3～14岁组患儿发热[97.5%（115/118例）比84.8%（39/46例）]、长热程[48.3%（57/118例）比23.9%（11/46例）]及高热[83.1%（98/118例）比52.2%（24/46例）]更多见，而喘息[2.5%（3/118例）比43.5%（20/46例）]、气促及呼吸困难[0.8%（1/118例）比15.2%（7/46例）]、肺部干啰音[1.7%（2/118例）比60.9%（28/46例）]、湿啰音[50.0%（59/118例）比69.6%（32/46例）]更少见，差异均有统计学意义（均P〈0.05）。2.1个月～3岁组MPP患儿血小板计数、肌酸激酶同工酶（CK－MB）及乳酸脱氢酶（LDH）[316.0（229.3，372.3）×109/L、25.70（17.70，31.98） U/L、346.5（310.3，388.3） U/L]较〉3～14岁组患儿[266.0（205.8，317.8）×109/L、21.50（15.75，28.00） U/L、303.0（173.0，352.0） U/L]高，而〉3～14岁组患儿C反应蛋白（CRP）、红细胞沉降率（ESR）[12.66（9.16，19.44） mg/L、23.00（17.75，29.00） mm/1 h]较1个月～3岁组[2.46（0.54，11.63） mg/L、14.00（10.00，20.25） mm/1 h]高，差异均有统计学意义（均P〈0.05）。3.不同年龄段患儿MPP胸部影像学特征表现多样化，其中1个月～3岁组患儿双肺受累[80.4% （37/46例）]较〉3～14岁组[55.9%（66/118例）]更多见，差异有统计学意义（P〈0.01）；1个月～3岁组患儿病变多表现为肺小叶实质浸润[82.6%（38/46例）]，而〉3～14岁组更易出现肺段/叶实变[33.1%（39/118例）]，差异有统计学意义（P〈0.01）。结论婴幼儿MPP易出现喘息、气促、呼吸费力及肺部啰音，CK－MB及LDH升高，影像学以双肺受累、肺小叶实质浸润为主。年长儿MPP热程长，更易出现高热，CRP、ESR升高，肺段/叶的实变多见。

Objective To investigate the clinical, laboratory and imaging characteristics of children with Mycoplasma pneumoniae pneumonia （MPP） in different age groups.Methods One hundred and sixty-four children whose ages were 1 month to 14 years old with MPP hospitalized at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine in 2017 were enrolled as study objects.All children were classified into 2 groups： 1 month to 3 year-old group（46 cases） and 〉3 to 14 year-old group（118 cases）. The clinical features, main laboratory and imaging findings of 2 groups were retrospectively analyzed and compared.Results（1） Compared with 1 month to 3 year-old group, 〉3 to 14 year-old group had more patients with fever [97.5% （115/118 cases） vs.84.8%（39/46 cases）], longer duration of fever [48.3%（57/118 cases） vs.23.9%（11/46 cases）] and higher fever [83.1%（98/118 cases） vs.52.2%（24/46 cases）], but less patients with wheezing [2.5%（3/118 cases） vs.43.5%（20/46 cases）], shortness of breath and dyspnea [0.8% （1/118 cases） vs.15.2%（7/46 cases）], dry rale [1.7%（2/118 cases） vs.60.9%（28/46 cases）] and wet pulmonary rale [50.0% （59/118 cases） vs.69.6%（32/46 cases）], and the differences were statistically significant （all P〈0.05）. （2） The increase of platelet count, creatine kinase isoenzyme （CK-MB） and lactate dehydrogenase （LDH） in 1 month to 3 year-old group of MPP[316.0（229.3, 372.3）×109/L, 25.70（17.70, 31.98） U/L, 346.5（310.3, 388.3） U/L]were more common than those in 〉3 to 14 year-old group [266.0（205.8, 317.8）×109/L, 21.50（15.75, 28.00） U/L, 303.0（173.0, 352.0） U/L], while the increase of C reactive protein （CRP） and erythrocyte sedimentation rate （ESR） in 〉3 to 14 year-old group [12.66（9.16, 19.44） mg/L, 23.00（17.75, 29.00） mm/1 h]were more common than those in 1 month to 3 year-old group[2.46（0.54, 11.63） mg/L, 14.00（10.00, 20.25） mm/1 h], and there were significant statistical differences （all P〈0.05）. （3） The MPP imaging features of children in different age groups were diverse.In 1 month to 3 year-old group, the double lung involvement [80.4%（37/46 cases）] was more obvious than that in〉3 to 14 year-old group [55.9%（66/118 cases）], and the difference was statistically significant （P〈0.05）. The lesions of 1 month to 3 year-old group were more common in lobular pulmonary [82.6%（38/46 cases）], while in 〉3 to 14 year-old group, the radiographic findings were predominant with consolidation in the segment or lobe of the lung [33.1%（39/118 cases）], and the difference was statistically significant （P〈0.01）.Conclusions Younger than 3 year-old children with MPP are prone to wheezing, shortness of breath, dyspnea and lung rale, while the rise of CK-MB and LDH is common.Imaging is mainly involved in double lung involvement and pulmonary lobule infiltration.The older the children with MPP are, the longer the fever duration is, and more common is the higher fever.The older the children, the more more easily they have the relative increase of CRP and ESR, and at the same time they are more likely to have the consolidation of the lung segment or lobe.