细菌和肺炎支原体感染的儿童坏死性肺炎临床特征及预后对比分析

Comparative analysis of clinical characteristics and prognosis of children with necrotizing pneumonia infected by bacteria and Mycoplasma pneumoniae

目的比较细菌和肺炎支原体感染的儿童坏死性肺炎(NP)临床特征及预后的差异。方法回顾性分析大连医科大学附属大连市中心医院2012年1月至2019年6月69例NP患儿的临床资料。其中,细菌感染NP 27例(细菌感染组),肺炎支原体感染NP 42例(肺炎支原体组)。比较两组患儿的临床症状和体征、肺外并发症、实验室检查、影像学检查、治疗、转归及随访等。结果两组肺部啰音率、呼吸音减低率和总发热时间比较差异无统计学意义(P>0.05);细菌感染组气促发生率明显高于肺炎支原体组[77.8%(21/27)比14.3%(6/42)],差异有统计学意义(P<0.01)。两组各肺外并发症发生率比较差异无统计学意义(P>0.05)。细菌感染组白细胞、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素(IL)-10明显高于肺炎支原体组,肿瘤坏死因子(TNF)-α和干扰素(IFN)-γ明显低于肺炎支原体组,差异有统计学意义(P<0.05);两组中性粒细胞、乳酸脱氢酶(LDH)和IL-6比较差异无统计学意义(P>0.05)。细菌感染组出现坏死时间明显早于肺炎支原体组[(14.5±4.2)d比(21.7±6.4)d],差异有统计学意义(P<0.05);两组胸腔积液发生率比较差异无统计学意义(P>0.05),但是细菌感染组胸腔积液分隔的发生率明显高于肺炎支原体组[70.4%(19/27)比2.4%(1/42)],差异有统计学意义(P<0.01)。两组抗生素应用时间、CRP恢复正常时间和住院时间比较差异无统计学意义(P>0.05);细菌感染组吸氧率和胸腔闭式引流率明显高于肺炎支原体组[88.9%(24/27)比35.7%(15/42)和25.9%(7/27)比11.9%(5/42)],白细胞恢复正常时间和PCT恢复正常时间明显长于肺炎支原体组[(12.8±4.1)d比(9.2±2.0)d和(10.5±2.5)d比(7.6±1.9)d],支气管肺泡灌洗率明显低于肺炎支原体组[25.9%(7/27)比76.2%(32/42)],差异有统计学意义(P<0.01或<0.05)。两组坏死病灶吸收时间比较差异无统计学意义(P>0.05)。结论细菌感染NP相对于肺炎支原体感染NP临床过程严重、坏死时间出现更早、病程更长,但经积极对症、抗感染治疗患儿大多数能获得良好预后。

Objective To compare the clinical characteristics and prognosis of children with necrotizing pneumonia(NP)infected by bacteria and Mycoplasma pneumoniae(MP).Methods The clinical data of 69 children with NP from January 2012 to June 2019 in Dalian Central Hospital Affiliated to Dalian Medical University were retrospectively analyzed.Among them,there were 27 cases of bacterial infection NP(bacterial infection group)and 42 cases of MP infection NP(MP group).The clinical symptoms and signs,extrapulmonary complications,laboratory examination,imaging examination,treatment,outcome and follow-up were compared between 2 groups.Results There were no significant differences in the rale rate,respiratory tone reduction rate and total fever time between 2 groups(P>0.05);the incidence of shortness of breath in bacterial infection group was significantly higher than that in MP group:77.8%(21/27)vs.14.3%(6/42),and there was statistical difference(P<0.01).There were no significant differences in the incidence of extrapulmonary complications between 2 groups(P>0.05).The white blood cell,C-reactive protein(CRP),procalcitonin(PCT)and interleukin(IL)-10 in bacterial infection group were significantly higher than those in MP group,the tumor necrosis factor(TNF)-αand interferon(IFN)-γin bacterial infection group were significantly lower than those in the MP group,and there were statistical differences(P<0.05).There were no significant differences in neutrophils,lactate dehydrogenase(LDH)and IL-6 between 2 groups(P>0.05).The time of necrosis in bacterial infection group was significantly earlier than that in MP group:(14.5±4.2)d vs.(21.7±6.4)d,and there was statistical difference(P<0.05);there was no significant difference in the incidence of pleural effusion between 2 groups(P>0.05),but the incidence of pleural effusion separation in bacterial infection group was significantly higher than that in MP group:70.4%(19/27)vs.2.4%(1/42),and there was statistical difference(P<0.01).There were no significant differences in antibiotic application time,CRP recovery time and hospital stay between 2 groups(P>0.05);the oxygen uptake rate and closed thoracic drainage rate in bacterial infection group were significantly higher than those in MP group:88.9%(24/27)vs.35.7%(15/42)and 25.9%(7/27)vs.11.9%(5/42),the recovery times of WBC and PCT in bacterial infection group were significantly longer than that in MP group:(12.8±4.1)d vs.(9.2±2.0)d and(10.5±2.5)d vs.(7.6±1.9)d,the bronchoalveolar lavage rate was significantly higher than that in MP group:25.9%(7/27)vs.76.2%(32/42),and there were statistical differences(P<0.01 or<0.05).There was no significant difference in the absorption time of necrotic lesions between 2 groups(P>0.05).Conclusions Compared with MP infection,the clinical process of bacterial infection NP is serious,the necrosis time appears earlier,and the course of disease is longer.However,most of the children with NP can obtain a good prognosis after active symptomatic and antiinfective treatment.