混合感染因素对难治性肺炎支原体肺炎的影响

Role and influence of coinfection factor to refractory Mycoplasma pneumoniae pneumonia in children

目的了解混合感染因素对难治性肺炎支原体肺炎(RMPP)的作用及影响。方法收集并分析2013年1月至2015年12月286例RMPP患儿的病史资料。依据病原检测结果将患儿分为RMPP混合感染组和单纯感染组,比较两组患儿临床特征及实验室检查结果。结果混合感染组患儿热程和住院天数分别为12.5(11.0~14.0)d、12.00(9.0~14.0)d,均明显高于单纯感染组的11.0(9.0~13.0)d、10.0(8.0~12.0)d,差异均有统计学意义(P均<0.01)。混合感染组患儿白细胞计数,中性粒细胞百分比,血小板计数,乳酸脱氢酶、C反应蛋白(CRP)>40 mg/L、CRP>100 mg/L及CK-MB升高发生率均高于单纯感染组,差异有统计学意义(P均<0.05)。混合感染组气胸、呼吸衰竭发生率高于单纯感染组,差异均有统计学意义(P均<0.05)。混合感染组血液系统损害、心肌损害、电解质紊乱发生率高于单纯感染组,差异均有统计学意义(P均<0.05)。结论混合感染会使RMPP患儿发热时间延长,全身炎症反应加重,肺内外并发症发生率升高,并增加患儿的住院时间。

Objective To study the role and influence of coinfection factor to refractory Mycoplasma pneumoniae (MP) pneumonia (RMPP) in children. Methods Clinical data and sputum specimen of 286 hospitalized children of RMPP were collected from January, 2013 to December, 2015. According to the results of pathogen detection, children were divided into RMPP coinfection group and simple MP infection group. Clinical features and laboratory tests were compared between the two groups. Results The durations of fever and hospitalization of the RMPP coinfection group were 12.5(11.0-14.0)days and 12.0(9.0-14.0)days, respectively, which were significantly longer than those of simple MP infection group, 11.0(9.0-13.0)daysand 10.0(8.0-12.0)days (Z=3.947, P<0.001, Z=3.519, P<0.001). In the RMPP coinfection group, white blood cell count, thepercentage of neutral granulocytes, pleteltes count, lactate dehydrogenase and the incidence of C-reaction protein (CRP) greaterthan 40 mg/L, and CRP greater than 100 mg/L, elevated CK-MB of were higher than those of simple MP infection group (allP<0.05), but the incidence of CRP greater than 8 mg/L and elevated ALT in the two groups showed no significant difference(both P>0.05). The incidence of pneumothorax and respiratory failure in children of RMPP coinfection group were higherthan those in the simple MP infection group (χ2=5.873, P=0.015, χ2=11.995, P=0.001), but the incidence of lobar pneumonia,pleural effusion, atelectasis in the two groups had no significant difference (all P>0.05). The incidence of blood system damage,myocardial damage, skin and joint damage and electrolyte disorders in RMPP coinfection group were higher than those of simpleMP infection group (all P<0.05). Conclusions Children with RMPP coinfection tend to be with prolonged duration of fever,increased systemic inflammation, higher incidence of pulmonary and extrapulmonary complications, and longer duration of hospitalization.