肺炎支原体坏死性肺炎特征和预测因素分析

Analysis of characteristics and predictors of Mycoplasma pneumoniae necrotizing pneumonia

目的总结肺炎支原体坏死性肺炎的临床、影像学特点以及支气管镜下的动态变化,提高对该病的认识。方法回顾性分析2013年1月至2017年8月首都医科大学附属北京儿童医院收治的22例肺炎支原体坏死性肺炎和16例细菌性坏死性肺炎患儿资料,比较其白细胞、中性粒细胞、C反应蛋白(CRP)等指标、影像学表现及支气管镜下的变化。结果在发热3 d内,肺炎支原体坏死性肺炎患儿中性粒细胞和CRP值分别为(74.62±5.78)%和(58.0±25.8)mg/L,明显低于细菌性肺炎(88.0±3.15)%和(164.5±96.6)mg/L,P值均<0.001;在发热4~7 d两组中性粒细胞(83.6±6.91)%、(87.68±2.89)%和CRP值(142.3±57.2)mg/L、(155.0±39.5)mg/L均明显升高,差异无统计学意义,P值均>0.05。肺炎支原体坏死性肺炎患儿白细胞总数在发病1~7 d内无明显升高。肺炎支原体坏死性肺炎患儿在发病4~11 d出现整叶或接近整叶肺实变,而细菌性坏死性肺炎患儿在发病5 d内整叶或接近整叶实变,肺炎支原体肺炎患儿多在2周以后发生肺坏死,而细菌性肺炎坏死均发生于10 d以内。肺炎支原体坏死性肺炎支气管镜下可见黏液栓阻塞和黏膜坏死,半数以上遗留支气管闭塞,而细菌性肺炎未见上述表现。结论肺炎支原体坏死性肺炎的特征为病程中外周血白细胞无明显升高,而中性粒细胞和CRP明显升高以及整叶肺实变影出现于病后4~7 d,2周内较少发生坏死,支气管镜下存在黏膜坏死,后期易出现支气管闭塞。

Objective To summarize the clinical manifestations,imaging characteristics and bronchoscopic changes in Mycoplasma pneumoniae necrotic pneumonia.MethodsAll the patients included in the study were hospitalized from January 2013 to August 2017 in our department. Leukocytes count,neutrophils count,C-reactive protein,imaging characteristics and bronchoscopic changes in 22 Mycoplasma pneumoniae necrotizing pneumonia patients were retrospectively analysed and compared with 16 necrotic bacterial pneumonia patients.ResultsThe neutrophil count and CRP value of Mycoplasma pneumoniae necrotizing pneumonia patients within the first 3 days after the onset of fever were(74.62±5.78)% and(58.0±25.8)mg/L respectively,which were significantly lower than those of necrotic bacterial pneumonia[neutrophil count at(88.0±3.15)% and CRP at(164.5±96.6)mg/L],with P<0.001. In both groups,neutrophil account and CRP value were significantly elevated in the 4 th to 7 th day after the onset of fever[neutrophil count at(83.6±6.91)% and(87.68±2.89)%,CRP at(142.3±57.2)mg/L and(155.0±39.5)mg/L respectively],and no significant difference was found between them with P>0.05. The white cell account in children with Mycoplasma pneumoniae necrotizing pneumonia didn’t increase within the first 7 days of disease onset. In Mycoplasma pneumoniae necrotizing pneumonia,consolidation of a whole lobe(or nearly a whole lobe)appeared on the 4 th to 11 th day after disease onset,while in necrotic bacterial pneumonia it appeared within the first 5 days. The necrosis of lung tissue occurred after 2 weeks of disease onset in Mycoplasma pneumoniae necrotizing pneumonia and within 10 days in necrotic bacterial pneumonia. Mucus plug obstruction and mucosal necrosis were found under bronchoscopy in necrotic mycoplasma pneumonia,and more than half of them developed bronchial obstruction,which was not found in bacterial pneumonia.ConclusionCharacteristics of Mycoplasma pneumoniae necrotizing pneumonia include increase of neutrophil count,increase of CRP and consolidation of whole lobe in the 4 th to 7 th day of disease onset,while there is no increase of white cell count;there is little lung tissue necrosis within 2 weeks of disease onset;there exists mucosal necrosis under bronchoscopy,and later bronchial obstruction is likely to occur.