儿童肺炎支原体诱导的皮疹和黏膜炎临床特征分析

Clinical characteristics of rash and mucositis induced by Mycoplasma Pneumoniae in children

目的比较肺炎支原体(Mycoplasma pneumoniae,MP)和药物诱导的儿童Stevens-Johnson综合征(Stevens-Johnson syndrome,SJS)的临床特征、治疗管理和预后之间的差异。方法对河北省儿童医院2010-2021年收治的94例SJS和206例多形性红斑患儿进行筛选,对MP检测阳性的患儿(MP病例组,26例)与MP阴性且有明确药物因素的患儿(药物对照组,31例)进行比较分析。结果与药物对照组相比,MP病例组患儿以年长儿多见,大于72月龄儿童的占比明显高于药物对照组,且均存在黏膜受累,以眼周黏膜(n=25,96.2%)最常见。其治疗主要为大环内酯类抗生素(100%)、皮质类固醇(84.6%)、免疫球蛋白(26.9%),中毒性表皮坏死松解症严重程度评分(severity-of-illness score for toxic epidermal necrolysis,SCORTEN)在2分及以上,均使用皮质类固醇,应用静脉注射用免疫球蛋白比例随SCORTEN评分增高而升高,MP病例组患儿平均住院日短于药物对照组,未见死亡病例。结论MP相关SJS常见于学龄期儿童,眼部黏膜、口唇黏膜常受累,住院时间短,病死率低,预后更好。

Objective To compare the clinical characteristics,treatment management and prognosis of Mycoplasma pneumoniae(MP)and drug-induced Stevens-Johnson syndrome(SJS)in children.Methods The clinical data of 94 children with SJS and 206 cases with erythema multiforme admitted to our hospital from 2010 to 2021 were retrospectively analyzed,and the control group consisting of MP positive children(n=26)and MP negative children(control group,n=31)with definite drug factors was compared and analyzed.Results In this study,MP positive SJS was more common in older children,and its incidence in children over 72 months was significantly higher than control group.Mucosal involvement was found in all patients,especially periocular mucosa(n=25,96.2%).The main treatments were macrolide antibiotics(100%),corticosteroid(Cs)(84.6%)and intravenous immunoglobulin(IVIG)(26.9%).All patients with a severity-of-illness score for toxic epidermal necrolysis(SCORTEN)of 2 or above were treated with Cs.The proportion of IVIG was increased with the increase of SCORTEN.Conclusion MP-induced SJS is common in school-age children,with lower hospital stay,lower mortality,and better prognosis.The mucous membranes of the eye and mouth are often involved.