摘要
目的探讨疱疹病毒抗体阳性的肺炎支原体肺炎(MPP)患儿免疫状况及临床特征。方法回顾分析2015年1月—2017年5月收治的360例2个月~16岁因MPP住院的患儿临床资料,以EB病毒(EBV)、巨细胞病毒(CMV)、单纯疱疹病毒(HSV)任一疱疹病毒IgM抗体阳性的162例患儿为抗体阳性组,另198例EBV、CMV、HSV抗体均阴性的患儿作为对照组,两组进行分析比较。结果360例MPP患儿中男188例、女172例,合并疱疹病毒IgM抗体阳性162例,其中EBV IgM阳性97例,阳性率26.9%;CMV IgM阳性39例,阳性率10.8%;HSV IgM阳性97例,阳性率26.9%。所有患儿均未予抗病毒治疗,经治疗症状缓解好转出院。抗体阳性组重症MPP、大叶性实变、并发呼吸衰竭的比例均高于对照组,血清IgM、CD4^+T细胞、CD8^+T细胞、淋巴细胞、NK细胞、白细胞计数、乳酸脱氢酶、丙氨酸氨基转移酶均高于对照组,大环内酯类抗生素使用时间长于对照组,使用激素率高于对照组,差异均有统计学意义(P均<0.05)。MPP合并2种病毒IgM抗体阳性者的血IgM和三酰甘油水平高于合并1种者,差异有统计学意义(P<0.05)。合并3种病毒IgM抗体阳性者与合并1种者比较,住院时间、发热时间、大环内酯类抗生素使用时间均有延长,血IgM、丙氨酸氨基转移酶水平更高,重症MPP发生率增高,差异均有统计学意义(P<0.05)。结论疱疹病毒IgM抗体阳性MPP患儿的炎症反应强烈,临床症状重,病程长,并发症多,需更长时间的治疗。
Objective To explore the immune status and clinical characteristics of herpes virus antibody positive Mycoplasma pneumoniae pneumonia(MPP).Method The clinical data of 360 children aged 2 months to 16 years hospitalized with MPP from January 2015 to May 2017 were retrospectively analyzed.A total of 162 children with positive antibody to epsteinbarr virus(EBV),cytomegalovirus(CMV)or herpes simplex virus(HSV)were selected as the antibody positive group.Meanwhile,198 children with negative EBV,CMV,and HSV antibodies hospitalized in the same period were enrolled in the control group.And the analysis and comparison were performed.Results In 360 children(188 boys and 172 girls)with MPP,162 children were positive for herpes virus IgM antibody,among whom 97 children(26.9%)were positive for EBV IgM,39 children(10.8%)were positive for CMV IgM,and 97 children(26.9%)were positive for HSV IgM.All the children were not given antiviral treatment,and the symptoms were relieved after the treatment.The proportions of severe MPP,lobar-like consolidation and respiratory failure in antibody positive group was higher than those in control group(P<0.05).The levels of serum IgM,CD4^+T cells,CD8^+T cells,lymphocytes,NK cells,WBC,Lactate dehydrogenase(LDH)and alanine aminotransferase(ALT)were all higher than those in control group(P<0.05).The duration of macrolide antibiotics were longer than those in control group and the rate of hormone use was higher than that of control group(P<0.05).In MPP children with two positive IgM antibodies,the serum IgM and triglyceride levels were higher than those with one positive IgM antibody,and the difference was statistically significant(P<0.05).Compared with MPP children with one positive IgM antibody,those with three positive IgM antibodies had longer hospital stay,longer fever time and longer duration of macrolides antibiotics treatment,higher levels of IgM and ALT,and higher incidence of severe MPP,and differences were statistically significant(P<0.05).Conclusions MPP children with positive IgM to herpes virus have strong inflammatory response,severe clinical symptoms,long course of disease and many complications,and thus need longer treatment.
作者
陈秋雨
陆敏
CHEN Qiuyu;LU Min(Respiratory Department,Shanghai Children's Hospital,Shanghai Jiao Tong University,Shanghai 200040,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2020年第1期1-5,共5页
Journal of Clinical Pediatrics
关键词
肺炎支原体肺炎
病毒IGM抗体
免疫紊乱
临床特征
Mycoplasma pneumoniae pneumonia
IgM of virus
immune disorder
clinical characteristic