不同类型儿童肺炎支原体肺炎的临床表现和实验室检查特点

Clinical Manifestations and Laboratory Examination Characteristics of Different Types of Mycoplasmal Pneumoniae Pneumonia in Children

目的探讨不同类型儿童肺炎支原体肺炎(MPP)的临床表现及实验室检查的特点。方法收集2019年1月至2020年1月寿光市人民医院儿科收治的486例MPP患儿的临床资料。根据肺部影像学表现将MPP患儿分为大叶性肺炎型MPP(LP-MPP)组(232例)、支气管肺炎型MPP(BP-MPP)组(170例)、间质性肺炎型MPP(IP-MPP)组(84例),其中BP-MPP组、IP-MPP组、LP-MPP组急性期患儿分别有51例、22例、80例。比较各组一般情况、临床表现、并发症情况和入院时患儿血液学实验室指标[白细胞计数、中性粒细胞百分比、淋巴细胞百分比、嗜酸粒细胞计数、血小板计数、C反应蛋白(CRP)、乳酸脱氢酶(LDH)、丙氨酸转氨酶(ALT)],以及各组急性期MPP患儿肺功能检测结果[用力肺活量(FVC)占预计值百分比(FVC%pred)、第1秒用力呼气量(FEV_(1))占预计值百分比(FEV_(1)%pred)、呼气峰值流量(PEF)占预计值百分比(PEF%pred)、最大呼气中期流量(MMEF)占预计值百分比(MMEF%pred)],分析不同类型MPP患儿的临床表现和实验室检查特点。结果三组性别和肺不张、胸腔积液、呕吐、皮疹并发症、多器官功能受损占比比较差异无统计学意义(P>0.05)。三组年龄、发热程度分布以及喘息、咳嗽、低氧血症、肺部啰音、心肌损害、腹泻、肝损害、电解质紊乱占比比较差异有统计学意义(P<0.05),其中LP-MPP组年龄大于BP-MPP组和IP-MPP组[(6.9±2.2)岁比(3.9±1.2)岁、(2.8±1.2)岁](P<0.05),IP-MPP组年龄小于BP-MPP组[(2.8±1.2)岁比(3.9±1.2)岁](P<0.05);LP-MPP组热程长于BP-MPP组、IP-MPP组[(5.2±2.1)d比(4.5±2.0)d、(4.2±2.4)d](P<0.05),BP-MPP组和IP-MPP组热程比较差异无统计学意义(P>0.05)。三组白细胞计数、中性粒细胞百分比、淋巴细胞百分比、CRP、LDH以及LDH升高、ALT升高占比比较差异均有统计学意义(P<0.05),嗜酸粒细胞、血小板计数比较差异无统计学意义(P>0.05)。三组急性期患儿FEV_(1)%pred比较差异无统计学意义(P>0.05),FVC%pred、PEF%pred、MMEF%pred比较差异有统计学意义(P<0.05)。各组MPP急性期患儿FEV_(1)%pred、MMEF%pred均低于80%。IP-MPP组FVC%pred明显低于BP-MPP组[(71±15)%比(81±12)%](P<0.05);LP-MPP组PEF%pred显著高于BP-MPP组和IP-MPP组[(84±11)%比(71±13)%、(78±8)%](P<0.05),而MMEF%pred显著低于BP-MPP组和IP-MPP组[(65±14)%比(75±9)%、(76±9)%](P<0.05)。结论不同类型MPP患儿在发热、呼吸道症状、肺功能变化、炎症反应强度方面存在显著差异,临床治疗可依据患儿不同临床表现和实验室检查特征进行个体化调整。

Objective To investigate the characteristics of clinical manifestations and laboratory tests of different types of Mycoplasmal pneumoniae pneumonia(MPP)in children.Methods The clinical data of 486 children with MPP admitted to the pediatric department of Shouguang People′s Hospital from Jan.2019 to Jan.2020 were collected.The MPP patients were divided into a labar pneumonia pattern MPP(LP-MPP)group(232 cases),a bronchial pneumonia pattern MPP(BP-MPP)group(170 cases),and an interstitial pneumonia pattern MPP(IP-MPP)group(84 cases)based on pulmonary imaging manifestations.Among them,there were 51 cases,22 cases,and 80 cases in the acute phase in the BP-MPP group,IP-MPP group,and LP-MPP group respectively.The general situation,clinical manifestations,complications,hematological laboratory indicators[white blood cell count,neutrophil percentage,lymphocyte percentage,eosinophil count,platelet count,C-reactive protein(CRP),lactate dehydrogenase(LDH),alanine transaminase(ALT)]of the patients at admission,as well as the lung function test results[percentage of predicted forced of forced vital capacity(FVC%pred),percentage of predicted forced of forced expiratory volume in first second(FEV_(1)%pred),percentage of predicted forced of peak expiratory flow(PEF%pred),percentage of predicted forced of maximal mid-expiratory flow(MMEF%pred)]of acute MPP patients in each group were compared,and the clinical manifestations and laboratory examination characteristics of different types of MPP patients were analyzed.Results There were no significant differences in gender,incidence of atelectasis,pleural effusion,vomiting,rash complications and multiple-organ function impairment among the three groups(P>0.05).There were statistically significant differences in age,fever degree and incidences of wheezing,cough,hypoxemia,pulmonary rales,myocardial damage,diarrhea,liver damage and electrolyte disturbance among the three groups(P<0.05).The average age of the LP-MPP group was higher than that of the BP-MPP group and IP-MPP group[(6.9±2.2)years old vs(3.9±1.2)years old,(2.8±1.2)years old](P<0.05).The average age of the IP-MPP group was lower than that of the BP-MPP group[(2.8±1.2)years old vs(3.9±1.2)years old](P<0.05).The average fever course of the LP-MPP group was longer than that of the BP-MPP group and the IP-MPP group[(5.2±2.1)d vs(4.5±2.0)d,(4.2±2.4)d](P<0.05),and there was no significant difference between the BP-MPP group and the IP-MPP group(P>0.05).There were statistically significant differences in white blood cell count,neutrophil percentage,lymphocyte percentage,CRP,LDH,and the proportion of elevated LDH and elevated ALT among the three groups(P<0.05),while there were no statistically significant differences in eosinophilic and platelet counts among the three groups(P>0.05).There was no significant difference in FEV_(1)%pred in acute stage among the three groups(P>0.05),but there was significant difference in FVC%pred,PEF%pred and MMEF%pred among the three groups(P<0.05).FEV_(1)%pred and MMEF%pred were lower than 80%in the acute stage of MPP in all groups.The FVC%pred level in the IP-MPP group was significantly lower than that in the BP-MPP group[(71±15)%vs(81±12)%](P<0.05).PEF%pred in the LP-MPP group was significantly higher than that in the BP-MPP group and IP-MPP group[(84±11)%vs(71±13)%,(78±8)%](P<0.05).MMEF%pred was significantly lower than that in the BP-MPP and IP-MPP group[(65±14)%vs(75±9)%,(76±9)%](P<0.05).Conclusion Children with different types of MPP have significant differences in fever,respiratory symptoms,changes in lung function,and intensity of inflammatory response,and the clinical treatment can be adjusted individually according to different clinical manifestations and laboratory examination characteristics.