216例儿童肺炎支原体肺炎临床特征分析

Analysis of clinical characteristics of 216 children with Mycoplasma pneumoniae pneumonia

目的分析儿童肺炎支原体肺炎(MPP)的临床特征。方法回顾性分析2023年3月至12月上海交通大学医学院附属瑞金医院无锡分院收治的216例MPP患儿的临床资料,包括临床症状、实验室检查结果以及治疗情况。结果纳入的216例MPP患儿年龄5.0(3.3,7.6)岁。48例首发症状仅咳嗽,24例首发症状仅发热,144例为两者均有;有141例伴随其他症状(包括鼻塞流涕、头痛、咽痛、乏力等)。患儿肺炎支原体核酸均阳性,其中96例肺炎支原体免疫球蛋白M阳性;有109例合并呼吸道合胞病毒、流感、人鼻病毒、腺病毒感染。72例白细胞水平高于正常范围,102例C反应蛋白水平高于正常范围。患儿入院后均给予阿奇霉素抗感染治疗,其中111例混合细菌感染患儿加用头孢类抗生素;141例难治性MPP及大环内酯类药物无反应性MPP患儿加用甲泼尼龙抗炎,其中有36例患儿由阿奇霉素更换为米诺环素治疗。结论MPP患儿首发症状主要为咳嗽、发热,部分患儿伴随鼻塞流涕、头痛、咽痛、乏力等症状,白细胞和C反应蛋白水平可能升高;MPP患儿可合并病毒感染,临床应结合患儿具体情况制订针对性的治疗方案,灵活运用抗生素以及糖皮质激素。

Objective To analyze the clinical characteristics of 216 children with Mycoplasma pneumoniae pneumonia(MPP).Methods The clinical data of 216 children with MPP admitted to Shanghai Jiaotong University School of Medicine,Ruijin Hospital Wuxi Branch from March to December 2023 were retrospectively analyzed,including clinical symptoms,laboratory test results and treatment.Results The age of 216 children with MPP was 5.0(3.3,7.6)years.The first symptom was only cough in 48 cases,fever in 24 cases,and both in 144 cases.There were 141 cases with other symptom s(including nasal congestion,runny nose,headache,sore throat,fatigue,etc.).All the children were positive for Mycoplasma pneumoniae nucleic acid,and 96 of them were positive for Mycoplasma pneumoniae immunoglobulin M.There were 109 cases with respiratory syncytial virus,influenza,human rhinovirus,adenovirus infection.The leukocyte level was higher than the normal range in 72 cases and the C-reactive protein level was higher than the normal range in 102 cases.After admission,all the children were given Azithromycin anti-infection treatment,and 111 cases of mixed bacterial infection were given cephalosporin antibiotics.141 children with refractory MPP and macrolide-unresponsive MPP were treated with Methylprednisolone and 36 of them were replaced by Azithromycin with Minocycline.Conclusion The first symptoms of MPP children are mainly cough and fever,and some children are accompanied by nasal congestion,runny nose,headache,sore throat,fatigue,and other symptoms,and the levels of white blood cells and C-reactive protein may increase.Children with MPP can be combined with viral infection,clinic should combine with the specific situation of children to develop targeted treatment plan,flexible use of antibiotics and glucocorticoids.