成人肺炎支原体肺炎临床特征分析

Analysis of clinical characterization of Mycoplasma pneumoniae pneumonia in adults

目的分析成人肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)的临床特征。方法选择2023年4月1日至2023年11月30日我院收治的经靶向高通量测序(targeted next-generation sequencing,tNGS)病原学检测诊断MPP患者74例,PaO_(2)≤80 mmHg 22例为观察组,PaO_(2)≥80 mmHg 52例为对照组,分析患者的临床特征。结果74例中女48例(64.86%),好发年龄18~44岁55例(74.32%),主要临床症状咳嗽74例(100.00%),咳痰67例(90.54%),发热60例(81.08%)。无基础疾病者61例(82.43%),检出大环内酯类耐药基因57例(77.03%),MP单一感染68例(91.89%)。观察组较对照组最高体温>38℃[20例(90.91%)vs.32例(61.54%)]、PaO_(2)[(72.42±11.12)vs.(92.93±11.07)]mmHg、MP均一化序列数[(37241.82±20530.88)vs.(24352.08±16835.32)]差异有统计学意义(P<0.05),性别、年龄、入院前病程>7 d、临床症状、肺部啰音、pH、PaCO_(2)、HCO_(3)^(-)、抗生素暴露史、基础疾病史、住院天数、检出耐药基因及MP单一感染无统计学意义(P>0.05);两组白细胞[(8.06±1.91)vs.(6.63±1.82)]×10^(9)/L、中性粒细胞[(5.86±1.85)vs.(4.41±1.58)]×10^(9)/L、C-反应蛋白[(48.21±47.09)vs.(31.55±19.64)]mg/L差异有统计学意义(P<0.05);单核细胞、淋巴细胞差异无统计学意义(P>0.05)。两组胸部CT病灶分布部位、病变形态、纵隔淋巴结肿大、胸腔积液差异无统计学意义(P>0.05)。结论成人MPP女性多于男性,好发于无基础疾病的年轻人,临床表现不特异,主要症状为咳嗽、咳痰、发热。MPP大环内酯类耐药基因突变率高,少数为混合感染,出现中高程度发热、tNGS检出MP均一化序列数高、炎性标志物升高时有发生低氧血症甚至进展为重症倾向应以重视。

Objective To analyze the clinical characterization of Mycoplasma pneumoniae pneumonia(MPP)in adults.Methods The clinical data of 74 MPP patients diagnosed by targeted next-generation sequencing(tNGS)pathogenetic testing in the Department of Respiratory and Critical Care Medicine of the Affiliated Guangdong Second Provincial General Hospital were retrospectively analyzed from April 1,2023,to November 30,2023,and divided into 22 cases of hypoxia(PaO_(2)≤80 mmHg)in the observation group and 52 cases of non-hypoxia(PaO_(2)≥80 mmHg)in the control group,to explore the clinical characteristics of adult MPP.Results Among the 74 patients with MPP,48 cases(64.86%)were females,the prevalent age group was 18 to 44 years old in 55 cases(74.32%),and the main clinical symptoms were cough in 74 cases(100.00%),cough sputum in 67 cases(90.54%),and fever in 60 cases(81.08%).There were 61 cases(82.43%)without underlying disease,57 cases(77.03%)with detection of macrolide resistance gene,and 68 cases(91.89%)with MP mono-infection.The differences in maximum body temperature>38℃[20 cases(90.91)vs.32 cases(61.54)],PaO_(2)[(72.42±11.12)vs.(92.93±11.07)]mmHg and the number of MP homogenization sequences[(37241.82±20530.88)vs.(24352.08±16835.32)]between the observation group and the control group were statistically significant(P<0.05),and the differences in gender,age,duration of illness>7 days before admission,clinical symptoms,pulmonary rales,pH,PaCO_(2),HCO_(3)^(-),history of antibiotic exposure,underlying disease history,days of hospitalization,detection of drug-resistant genes,and MP single infection were not statistically significant(P>0.05),and the differences in leukocytes[(8.06±1.91)vs.(6.63±1.82)]×10^(9)/L,neutrophils[(5.86±1.85)vs.(4.41±1.58)]×10^(9)/L,and C-reactive protein[(48.21±47.09)vs.(31.55±19.64)]mg/L between the two groups were statistically significant(P<0.05),while the differences in monocytes and lymphocytes were not statistically significant(P>0.05).There was no statistically significant difference in the distribution site of chest CT lesions,lesion morphology,mediastinal lymph node enlargement,and pleural effusion between the two groups of patients(P>0.05).Conclusion Adult MPP patients are more often female than male,and occur in young people without underlying diseases,with nonspecific clinical manifestations,mainly cough,sputum,and fever.MPP patients have a high rate of mutations in macrolide-resistant genes,and a few of them have co-infections,with a tendency to develop hypoxemia or even progress to severe disease when they have a moderately high degree of fever,a high number of MP homogenization sequences on tNGS,and an elevated number of inflammatory markers.