MP感染在儿童哮喘急性发作中对临床的影响
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摘要
目的探讨肺炎支原体感染在儿童哮喘急性发作过程中的影响。方法选择本院儿科病房收治的确诊支气管哮喘急性发作患儿,肺炎支原体感染组27例,非肺炎支原体感染组37例。记录临床特点及肺功能。结果合并肺炎支原体感染的哮喘急性发作患儿有更多的肺外表现,包括:发热、皮疹、消化道症状、泌尿系症状及肝功能损害等,病例中发热为首发症状的肺炎支原体感染组明显高于单纯哮喘急性发作组,差别有统计学意义(P<0.001);在MP感染及非MP感染组患儿实验室检查中除LDH有明显差异,其他实验室指标:肝酶水平,CRP均无明显差异。肺炎支原体感染患儿存在限制性通气功能障碍,与非肺炎支原体感染的哮喘急性发作对比差别有统计学意义(P<0.001)。结论肺炎支原体感染在哮喘急性发作中起重要作用,导致哮喘患儿临床表现更为复杂。
Objective To explore the impact of clinical features and immune-pathogenesis of MP infection childhood asthma.Methods Totally 64 patients with asthma acute exacerbation(27 children with MP infection,37 children with no MP infection) were selected as study group, 20 health children were selected as control group. Clinical features were recorded, pulmonary function was measured in the study group.Results(1)There was significant difference of clinical features and extrapulmonary complications of MP infection(P<0.001);(2)In the laboratory examination of MP infection and non MP infection group, there was significant difference except for LDH. Other laboratory indexes: liver enzyme level, C reactive protein were not significantly different.(3)There was significant difference of pulmonary function with FVC% of MP infection(P<0.001).Conclusion Mycoplasma pneumoniae was a influence on clinical features on patients of asthmatic children.
Objective To explore the impact of clinical features and immune-pathogenesis of MP infection childhood asthma.Methods Totally 64 patients with asthma acute exacerbation(27 children with MP infection,37 children with no MP infection) were selected as study group, 20 health children were selected as control group. Clinical features were recorded, pulmonary function was measured in the study group.Results(1)There was significant difference of clinical features and extrapulmonary complications of MP infection(P<0.001);(2)In the laboratory examination of MP infection and non MP infection group, there was significant difference except for LDH. Other laboratory indexes: liver enzyme level, C reactive protein were not significantly different.(3)There was significant difference of pulmonary function with FVC% of MP infection(P<0.001).Conclusion Mycoplasma pneumoniae was a influence on clinical features on patients of asthmatic children.
引文
[1] 中华医学会儿科学分会呼吸学组《中华实用儿科临床杂志》编辑委员会,儿童支气管哮喘诊断与防治指南[J].中华实用儿科临床杂志,2015,54(3):167-181.
[2] 儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1 304-1 308.
[3] 尚云晓.肺炎支原体感染与儿童哮喘[J].中国实用儿科杂志,2011,26(4):250-252.
[4] Hassan J,Irwin F,Dooley S,et al.Mycoplasma pneumoniae infection in a pediatric population:Analysis of soluble immune markers as risk factors for asthma[J].Human Immunology,2008,69:851-855.
[5] Teig N,Anders A,Schmidt C,et al .Chlamydophila pneumoniae and Mycoplasma pneumoniae in respiratory speciments of children with chronic lung diseases [J].Thorax,2005,60(11):962-966.
[6] 徐慧香,张慧燕,车大钿,等.哮喘急性发作与呼吸道感染的关系[J].实用儿科临床杂志,2007,22(4):271-276.
[7] 章惠彬,童其田.支原体感染与儿童哮喘急性发作关系的探讨[J].现代实用医学,2010,22(8):934-935.
[8] 相云,尚云晓,韩晓华,等.肺炎支原体感染诱发儿童哮喘的临床特征分析[J].中国实用儿科杂志,2009,24 (12):951-953.
[9] Specjalski K.Role of Chlamydia pneumoniae and Mycoplasma pneumoniae infections in the course of asthma[J].Pneumonol Alergol Pol,2010,78(4):284-295.
[10] Sutherland ER,Martin RJ.Asthma and atypical bacterial infection[J].Chest,2007,132(6):1 962-1 966.
[11]陈莉莉,刘金荣,赵顺英,等.常规剂量甲泼尼龙治疗无效的儿童难治性肺炎支原体肺炎的临床特征和治疗探讨[J].中华儿科杂志,2014,52(3):172-176.
[12]Oshima K,Kakizawa S,Nishigawa H,et al.Reductive evolution suggested from the complete genome sequence of a plant-pathogenic phytoplasma[J].Nat Genet,2004,36(1):27-29.
[13]El Sayed Zaki,Raafat,El Metaal.Relevance of serology for Mycoplasma pneumoniae diagnosis compared with PCR and culture in acute exacerbation of bronchial asthma[J].Am J Clin Pathol,2009,131(1):74-80.
[14]Johnston SL,Martin RJ.Chlamydophila pneumoniae and Mycoplasma pneumoniae:A Role in Asthma Pathogenesis[J].Am J Respir Crit Care Med,2005,172(9):1 078-1 089.
[15]Metz G,Kraft M.Effects of atypical infections with Mycoplasma and Chlamydia on asthma[J].Immunol Allergy Clin North Am,2010,30(4):575-585.
[16]魏文凭,张晗,尚云晓.肺功能检查在儿童难治性肺炎支原体肺炎诊疗中的意义[J].国际儿科学杂志,2016,43(5):413-416.
[2] 儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1 304-1 308.
[3] 尚云晓.肺炎支原体感染与儿童哮喘[J].中国实用儿科杂志,2011,26(4):250-252.
[4] Hassan J,Irwin F,Dooley S,et al.Mycoplasma pneumoniae infection in a pediatric population:Analysis of soluble immune markers as risk factors for asthma[J].Human Immunology,2008,69:851-855.
[5] Teig N,Anders A,Schmidt C,et al .Chlamydophila pneumoniae and Mycoplasma pneumoniae in respiratory speciments of children with chronic lung diseases [J].Thorax,2005,60(11):962-966.
[6] 徐慧香,张慧燕,车大钿,等.哮喘急性发作与呼吸道感染的关系[J].实用儿科临床杂志,2007,22(4):271-276.
[7] 章惠彬,童其田.支原体感染与儿童哮喘急性发作关系的探讨[J].现代实用医学,2010,22(8):934-935.
[8] 相云,尚云晓,韩晓华,等.肺炎支原体感染诱发儿童哮喘的临床特征分析[J].中国实用儿科杂志,2009,24 (12):951-953.
[9] Specjalski K.Role of Chlamydia pneumoniae and Mycoplasma pneumoniae infections in the course of asthma[J].Pneumonol Alergol Pol,2010,78(4):284-295.
[10] Sutherland ER,Martin RJ.Asthma and atypical bacterial infection[J].Chest,2007,132(6):1 962-1 966.
[11]陈莉莉,刘金荣,赵顺英,等.常规剂量甲泼尼龙治疗无效的儿童难治性肺炎支原体肺炎的临床特征和治疗探讨[J].中华儿科杂志,2014,52(3):172-176.
[12]Oshima K,Kakizawa S,Nishigawa H,et al.Reductive evolution suggested from the complete genome sequence of a plant-pathogenic phytoplasma[J].Nat Genet,2004,36(1):27-29.
[13]El Sayed Zaki,Raafat,El Metaal.Relevance of serology for Mycoplasma pneumoniae diagnosis compared with PCR and culture in acute exacerbation of bronchial asthma[J].Am J Clin Pathol,2009,131(1):74-80.
[14]Johnston SL,Martin RJ.Chlamydophila pneumoniae and Mycoplasma pneumoniae:A Role in Asthma Pathogenesis[J].Am J Respir Crit Care Med,2005,172(9):1 078-1 089.
[15]Metz G,Kraft M.Effects of atypical infections with Mycoplasma and Chlamydia on asthma[J].Immunol Allergy Clin North Am,2010,30(4):575-585.
[16]魏文凭,张晗,尚云晓.肺功能检查在儿童难治性肺炎支原体肺炎诊疗中的意义[J].国际儿科学杂志,2016,43(5):413-416.