儿童社区获得性肺炎支原体肺炎实验室检查特征分析

Analysis of laboratory tests characteristics of community acquired Mycoplasma pneumoniae pneumonia in children

目的分析儿童社区获得性肺炎支原体肺炎(MPP)的实验室检查特征。方法选取2016年1月至2019年6月该院收治的1~14岁社区获得性肺炎患儿457例作为研究对象,实验室检查指标包括血常规、肝功能、心肌酶谱、血清降钙素原(PCT)、超敏C反应蛋白(hsCRP)、血清特异性肺炎支原体免疫球蛋白M(MP-IgM)抗体、咽拭子MP核酸(MP-DNA)检测等。结果457例患儿中MP-IgM抗体阳性163例(35.7%),诊断为MPP,其中MP-DNA阳性138例[84.7%(138/163)]。从138例血清MP-IgM抗体、MP-DNA双阳性患儿中招募62例随访3个月,治疗后MP-IgM抗体阳性率下降趋势不及MP-DNA检出率明显。血清MP-IgM抗体滴度高低对MPP患儿白细胞、中性粒细胞、血小板计数、谷草转氨酶均无影响;高MP-IgM抗体滴度与谷丙转氨酶、乳酸脱氢酶、肌酸激酶同工酶/肌酸激酶比值升高相关。高PCT、hsCRP组患儿中出现严重影像学改变和肺外并发症者均明显多于低PCT、hsCRP组,阿奇霉素治疗后平均退热时间也明显长于低PCT、hsCRP组,差异均有统计学意义(P<0.05)。结论血清MP-IgM抗体检测和咽拭子MP-DNA检测阳性符合率较高,后者更能真实反映疗效。血清MP-IgM抗体滴度过高预示MPP患儿易发生肺外器官损伤,PCT、hsCRP显著升高者与部分临床重症表现相关。

Objective To analyze the laboratory tests features of children with mycoplasma pneumoniae pneumonia(MPP).Methods A total of 457 children patients aged 1-14 years old with community acquired pneumonia(CAP)in this hospital from January 2016 to June 2019 served as the study subjects.The laboratory indicators included the blood routine,liver function,myocardial enzyme spectrum,procalcitonin(PCT),hypersensitive C-reactive protein(hsCRP),serum anti-MP IgM(MP-IgM)and MP nucleic acid(MP-DNA)by throat swabs.Results Among 457 cases,163 cases(35.7%)were MP-IgM antibody positive and diagnosed as MPP,in which 138 cases[84.7%(138/163)]were MP-DNA positive.Sixty-two cases were recruited from 138 cases of MP-IgM and MP-DNA double positive and followed up for 3 months.After treatment,the decreasing trend of MP-IgM antibody positive was inferior to the detection rate of MP-DNA.The level of serum MP-IgM antibody titer in MPP children patients had no effects on WBC count,neutrophil count,PLT count and AST level.However,the high titer of MP-IgM antibody was correlated with the increase of ALT,LDH and CK-MB/CK ratios.The severe imaging changes and extrapulmonary complications in the high PCT or high hsCRP group were significantly more than those in the low PCT or low hsCRP group,and the average antipyretic time after azithromycin treatment was also longer than that of the PCT and hsCRP group,the differences were statistically significant(P<0.05).Conclusion Serum MP-IgM antibody detection and pharyngeal swab MP-DNA detection have high positive coincidence rates for diagnosing MPP.The MP-DNA detection can more accurately reflect the treatment effect.Serum MP-IgM antibody titer too heigh predicts that MPP children patients are easy to develop the extrapulmonary organs damage.PCT and hsCRP significant increase are correlated with the partial clinical severe manifestations.