儿童肺炎支原体肺炎115例临床分析

The clinical analysis of 115 children with mycoplasma pneumoniae pneumonia

目的本研究通过对118例小儿肺炎支原体肺炎(MPP)的临床资料进行分析,探讨儿童难治性肺炎支原体肺炎(RMPP)的临床特点、诊断、治疗及预后。方法收集2016年1月至2018年10月就诊于我院的MPP患儿包括:普通肺炎支原体肺炎(GMPP)组78例,RMPP组37例,分析两组患儿的临床特点、诊断、治疗及预后。结果 RMPP组患儿年龄大于GMPP组,发热时间、咳嗽缓解时间及住院时间均长于GMPP组;RMPP组患儿更容易合并其他病原体感染,C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)明显增高,血清中炎症细胞因子IL-6、IFN-γ明显高于GMPP组,IL-10低于GMPP组,差异均有统计学意义(P<0. 05);治疗7d后,RMPP组患儿影像学均提示炎症范围较前扩大。结论年长儿更容易发生RMPP;病程中对CRP、PCT、LDH、IL-6、IFN-γ、IL-10水平的监测,可用于识别有更高RMPP风险的儿童,及时联用糖皮质激素抗炎、纤维支气管镜介入解除气道内粘液栓,有助于促进疾病的恢复。

Objective To investigate the clinical features,treatment and prognosis of children with refractory mycoplasma pneumonia( RMPP) through analysis of the clinical data of 115 cases with mycoplasma pneumoniae pneumonia(MPP). Methods The retrospective analysis was performed on 115 children with MPP in our hospital between January 2016 and October 2018.There were78 children with general mycoplasma pneumonia(GMPP) and 37 children with RMPP. The clinical feature,diagnosis,treatment and prognosis were analyzed.Results Compared with the GMPP group,the RMPP group was older and had a longer fever time.The RMPP group was more likely to have other pathogen infections,and C-reactive protein(CRP),procalcitonin(PCT) and lactate dehydrogenase(LDH) were significantly increased,and serum inflammatory cytokines such as IL-6 and IFN-γ were significantly higher and IL-10 was lower than the GMPP group(P < 0. 05).After 7 days of treatment,the imaging of children in the RMPP group showed that the extent of inflammation was larger than before.Conclusion Older children are more prone to develop RMPP.Detection of CRP,PCT,LDH,IL-6,IFN-γ,and IL-10 levels during the course of the disease can be used to identify children at higher risk of RMPP.Combination of glucocorticoid with fiberoptic bronchoscopy intervention to relieve airway mucus embolism usually has dramatic beneficial effects.