合并EB病毒感染的儿童肺炎支原体肺炎临床特点及中医证型分析

Clinical Characteristics and TCM Syndromes Analysis of Mycoplasma PneumoniaePneumonia in Children with Epstein-Barr Virus Infection

目的:分析肺炎支原体肺炎(MPP)合并EB病毒(EBV)感染患儿的中医证型分布,及各证型与发病特点、临床表现等临床资料的关系。方法:回顾性收集2020年1月-2023年1月山东省妇幼保健院儿科收治的MPP患儿的临床资料,按是否存在EBV感染,分为MP混合EBV感染患儿及单纯MP感染患儿。统计MP混合EBV感染患儿的证型分布情况,并分析临床资料与中医证型之间的关系。结果:该研究共纳入573例MPP患儿,混合EBV感染者达36.13%。MP混合EBV感染患儿在证型分布上以痰热闭肺证为主(P<0.05);发病年龄上,风热闭肺证多见于婴幼儿(P<0.05),痰热闭肺证多见于学龄前期和学龄期儿童(P<0.05);在发热特点上,痰热闭肺证患儿热程较长、热峰更高(P<0.05);痰热闭肺证患儿CRP水平显著高于其他各证型(P<0.05);在并发症上,痰热闭肺证患儿更易发生肝损害,出现肺实变,进展为重症/难治性支原体肺炎(P均<0.05),且平均住院时间最长(P<0.05)。结论:MPP混合EBV感染的患儿在辨证上以痰热闭肺证为主,学龄前期、学龄期儿童高发,痰热闭肺证患儿临床表现严重且复杂,对于MPP患儿,尤其是出现发热时间长、CRP升高、肺实变、肝损害及进展为难治性或重症MPP,辨证为痰热闭肺证时,应警惕存在EBV混合感染的可能,可进行EBV检测,有利于早期、正确地临床诊断及治疗。

Objective:To analyze the distribution of TCM syndromes in children with mycoplasma pneumoniae pneumonia(MPP)complicated with Epstein-Barr virus(EBV)infection,and the relationship between the syndromes and clinical data.Methods:The clinical data of MPP children admitted to the pediatric Department of Shandong Provincial Maternal and Child Health Care Hospital from January 2020 to January 2023 were collected retrospectively.According to the presence or absence of EBV infection,the patients were divided into MP mixed EBV infection cases and MP simple infection cases.The distribution of syndrome types in children infected with MP mixed EBV was analyzed,and the relationship between clinical data and TCM syndrome types was analyzed.Results:573 children with MPP were included in this study,and 36.13%were infected with EBV.The syndrome type distribution of MP mixed EBV infected children was mainly phlegm-heat-blocking lung syndrome(P<0.05).In terms of onset age,wind-heat-blocking lung syndrome was more common in infants(P<0.05),and phlegm-heat-blocking lung syndrome was more common in preschool and school-age children(P<0.05).In terms of febrile characteristics,the heat course was longer and the heat peak was higher(P<0.05).The level of CRP in children with phlegm-heat-blocking lung syndrome was significantly higher than that of other syndrome types(P<0.05).In terms of complications,children with phlegm-heat-blocking lung syndrome were more likely to have liver damage,lung consolidation,and progression to severe/refractory mycoplasma pneumonia(P<0.05),and the average hospital stay was the longest(P<0.05).Conclusion:The syndrome of the phlegm-heat-blocking lung is the main syndrome in MPP children with mixed EBV infection,and it is most common in children of early school age and school age.The clinical manifestations of children with phlegm-heat-blocking lung syndrome are serious and complex.For MPP children,the possibility of mixed infection of EBV should be vigilant,especially when the symptoms include prolonged fever,elevated CRP,lung compaction,liver damage,and progression to refractory or severe MPP,and the syndrome is phlegm-heat-blocking lung syndrome.Necessary EBV detection is conducive to early and correct clinical diagnosis and treatment.