儿童肺炎支原体坏死性肺炎30例临床分析

Clinical analysis of 30 children with mycoplasma pneumoniae necrotizing pneumonia

目的分析儿童肺炎支原体坏死性肺炎(MPNP)的临床特征、治疗方法及预后。方法收集自2017年12月—2019年12月昆明市儿童医院呼吸内科收治住院的30例MPNP患儿的临床资料,回顾性分析其临床表现、实验室检查结果、影像学特征、支气管镜下表现、治疗过程及预后情况。结果30例MPNP患儿中男12例,女18例,年龄4.5~12.3(7.4±2.3)岁;发热天数8~20(12.7±3.3)d,有气促体征且需要氧疗者8例,呼吸衰竭需要机械辅助通气2例。MPNP患儿外周血WBC为7.2~21.7(11.43±3.51)×109/L,中性粒细胞(N)为22.7%~78.3%(49.69±16.50%),降钙素原(PCT)为0.26~2.17(0.39±0.33)mg/L,高敏C反应蛋白(hs-CRP)10~156(81.07±35.89)mg/L。影像学检查:病初均为大叶实变影,1~3周实变区出现含气囊腔、薄壁空洞,其中24例出现胸腔积液。支气管镜检查示支气管黏膜及支气管壁有黏膜充血水肿伴滤泡样增生26例,合并支气管黏膜糜烂出血样改变8例;合并支气管黏膜大片坏死物覆盖10例;合并支气管壁结构破坏4例。支气管镜检查管腔内大量黏稠分泌物26例,合并黏液栓生成12例,合并血性分泌物4例,合并坏死赘生物生成6例。30例MPNP患儿经抗生素、糖皮质激素、丙种球蛋白、支气管镜介入等治疗预后均良好,住院天数为15~27(19.20±3.28)d,影像学大部分病灶吸收时间为60~270(140.00±78.29)d。结论MPNP发热时间、住院时间、影像学吸收时间均较长,支气管镜下表现严重且多样化,多数伴有胸腔积液,急性发热期CRP显著升高,预后大多良好。

Objective To analyze the clinical features,treatment methods and prognosis of Mycoplasma pneumoniae necrotizing pneumonia(MPNP)in children.Methods The clinical data of 30 children with MPNP admitted to the Department of Respiratory Medicine of Kunming Children’s Hospital from December 2017 to December 2019 were collected to retrospectively analyze their clinical manifestations,laboratory findings,imaging features,bronchoscopy,and the course of treatment and prognosis.Results Among 30 children with MPNP,12 were males and 18 were females,with an average age of 4.5 to 12.3(7.4±2.3)years;the average number of days of fever was 8 to 20(12.7±3.3)days,and 8 cases had signs of shortness of breath and needed oxygen therapy,Respiratory failure required mechanical ventilation in 2 cases.The peripheral blood WBC of children with MPNP was 7.2~21.7(11.43±3.51)×109/L,the percentage of neutrophils was 22.7%~78.3%(49.69±16.50%),and the procalcitonin(PCT)was 0.26~2.17(0.39±0.33)mg/L,high sensitivity C-reactive protein(hs-CRP)10~156(81.07±35.89)mg/L.Imaging examination:At the beginning of the disease,it was with large leaf consolidation.Within 1 to 3 weeks,there were cavities with air sacs and thin walls in the consolidation area,and pleural effusion appeared in 24 cases.Bronchoscopy showed 26 cases of bronchial mucosa and bronchial wall with mucosal congestion and edema with follicular hyperplasia,8 cases with bronchial mucosal erosion and bleeding;10 cases with bronchial mucosa large necrosis coverage;4 cases with bronchial wall structure destruction.Bronchoscopy examined many viscous secretions in the lumen of 26 cases,combined with mucus thrombus formation in 12 cases,combined with bloody secretions in 4 cases,and combined with necrotic neoplasms in 6 cases.The prognosis of 30 children with MPNP was good after antibiotics,glucocorticoids,gamma globulin,bronchoscopy intervention and other treatments.The average hospital stay of MPNP was 15~27(19.20±3.28)days.The absorption time of most lesions in imaging is 60~270(140.00±78.29)days.Conclusion MPNP has a long fever time,hospitalization time,and imaging absorption time.The bronchoscopy performance is serious and diverse,most of which are accompanied by pleural effusion.The CRP is significantly increased during the acute fever period,and the prognosis is mostly good.