儿童重症肺炎支原体肺炎的临床特点及影像学表现分析

Clinical Features and Imaging Findings of Severe Mycoplasma Pneumoniae Pneumonia in Children

目的总结分析儿童重症肺炎支原体肺炎的临床特点和影像学表现。方法收集2016年6月至2018年6月入院就诊的重症肺炎支原体肺炎患儿60例作重症组,同时选取同期65例轻症肺炎支原体肺炎患儿作轻症组,对比两组患儿的临床表现、体征、实验室检测指标等临床资料,并分析重症肺炎支原体肺炎患儿影像学表现的特点。结果与轻症组相比,重症组患儿临床特点以心动过速、大环内酯类抗生素治疗无效、平均热程长为主,病变特点以大片状阴影为主,重症组患儿血清中CRP、D-二聚体水平显著增加(P<0.05),并出现肺不张、胸腔积液、坏死性肺炎或肺脓肿等肺内并发症,还会累及呼吸、神经、血液、消化、泌尿等系统出现功能障碍;同时,随访发现重症组患儿转归情况明显差于轻症组;典型重症肺炎支原体肺炎影像学显示患儿症状好转后,仍存在肺组织结构的损伤。结论重症肺炎支原体肺炎儿童临床表现为:症状重、发热时间长、肺部出现大片状阴影,易发生肺内并发症,且伴有明显其他系统功能受损,及时干预控制病情,有助于患儿早日康复,且需要长期随访观察其预后。

Objective To summarize and analyze the clinical features and imaging findings of severe mycoplasma pneumoniae pneumonia in children. Methods 60 children with severe mycoplasma pneumoniae pneumonia who were admitted to the hospital from June 2016 to June 2018 were enrolled as severe group. 65 children with mild mycoplasma pneumoniae pneumonia in the same period were enrolled as mild group. The two groups were compared. Clinical data such as clinical findings, physical signs and laboratory test indexes were compared between the two groups. The features of imaging findings in children with severe mycoplasma pneumoniae pneumonia were analyzed. Results Compared with mild group, the clinical features in severe group were characterized by tachycardia, ineffective treatment with macrolide antibiotics and long mean fever process. The lesions were characterized by large-scale shadows. The levels of CRP and D-dimer in serum were significantly increased in severe group(P<0.05). There were pulmonary complications such as atelectasis, pleural effusion, necrotizing pneumonia or lung abscess. And respiratory, nervous, blood, digestion and urinary systems were also involved, leading to dysfunctions. At the same time, follow-up found that outcomes in severe group were significantly worse than those in mild group. The typical imaging features of severe mycoplasma pneumoniae pneumonia showed that there was still lung tissue structure damage after symptoms were improved. Conclusion The clinical findings of children with severe mycoplasma pneumoniae pneumonia are as follows: severe symptoms, long fever time, large-scale shadows in the lungs, prone to intrapulmonary complications, complicating with obvious other system function impairment, timely intervention and control to the disease helps quick recovery of children. And long-term follow-up is needed to observe prognosis.