大环内酯类耐药肺炎支原体肺炎伴肺实变患儿的临床特征

Clinical Characteristics of Macrolide-resistant Mycoplasma Pneumoniae Pneumonia Associated by Pulmonary Consolidation in Children

目的总结大环内酯类耐药肺炎支原体肺炎(MRMPP)伴肺实变患儿的临床特征及治疗,为判断疾病预后及指导治疗提供依据。方法回顾性分析2014年8月—2016年12月收治的199例肺炎支原体肺炎(MPP)伴肺实变患儿的病例资料。对肺泡灌洗液进行肺炎支原体核酸及耐药突变位点检测,根据结果分为耐药组160例和敏感组39例。比较两组临床表现、实验室指标、支气管镜下表现、治疗、住院时间的差异。结果两组在性别、年龄、入院前病程、入院前使用大环内酯类药物、白细胞(WBC)、中性粒细胞比例(N%)、C反应蛋白(CRP)、胸腔积液、肺外并发症、混合感染方面比较差异无统计学意义(P>0.05)。耐药组的热程和住院时间较敏感组延长,乳酸脱氢酶(LDH)水平高于敏感组(P<0.05);耐药组支气管镜下黏液栓阻塞发生率较敏感组高(P<0.05)。两组在是否应用糖皮质激素治疗、应用时间和剂量方面比较差异均无统计学意义(P>0.05)。结论MRMPP伴肺实变患儿的热程、住院时间长,LDH可升高,应及时给予支气管镜治疗清除黏液栓,可应用大环内酯类药物治疗,是否应用糖皮质激素治疗应根据病情严重程度决定。

Objective To summarize clinical characteristics and treatment of macrolide resistant Mycoplasma pneumoniae mycoplasma pneumoniae pneumonia(MRMPP)associated by pulmonary consolidation in children in order to provide a basis for judging prognosis and guiding treatment.Methods Clinical data of 199 children with mycoplasma pneumoniae pneumonia(MPP)associated by pulmonary consolidation admitted during August 2014 and December 2016 was retrospectively analyzed.According to the results of alveolar lavage fluid which was detected by nucleic acid and drug-resistant mutation sites of mycoplasma pneumoniae,they were divided into drug-resistant group(n=160)and drug-sensitive group(n=39).The differences in clinical manifestations,laboratory indicators,manifestations under bronchoscopy,treatment and length of hospital stay were compared between two groups.Results There were no statistically significant differences in gender,age,course of disease before admission,the use of macrolides before admission,white blood cell(WBC),neutrophil ratio(N%),C reactive protein(CRP),pleural effusion,extrapulmonary complications and mixed infection between two groups(P>0.05).In drug-resistant group,febrile course and length of hospital stay were longer,and LDH level was higher than those in drug-sensitive group(P<0.05),while incidence rate of mucous plug obstruction was higher than that in drug-sensitive group(P<0.05).There were no statistically significant differences in application of glucocorticoid therapy,usage period and dosage between two groups(P>0.05).Conclusion Children with MRMPP associated by pulmonary consolidation usually suffer from a persistent fever,a long hospital stay and high LDH level.Bronchoscopy should be timely used to remove the mucus plug.Macrolides is acceptable to be administrated,and the severity of the disease should be considered when glucocorticoid will be used.