儿童肺炎支原体肺炎并发基底动脉尖综合征1例报告
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摘要
目的探讨儿童肺炎支原体肺炎合并基底动脉尖综合征的临床特点。方法回顾分析1例肺炎支原体肺炎合并基底动脉尖综合征患儿的临床资料,并复习相关文献。结果女性患儿,6岁,以发热、单侧肢体活动不灵活起病。血清肺炎支原体抗体逐次升高;肺部CT提示大片炎性实变;头颅MRI示多发性脑梗死。给予抗感染及抗凝、溶栓、降颅压等综合对症治疗后,患儿病情仍进行性加重,出现昏迷、咳嗽无力、吞咽困难、面神经麻痹、双瞳孔不等大。患儿虽生命体征平稳,但生活不能自理,仍在康复中。结论肺炎支原体肺炎常伴有高凝状态及自身免疫异常,并发基底动脉尖综合征者预后差。
Objective To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia(MPP) complicated with "top of the basilar" syndrome(TOBS) in children. Method The clinical data of MPP complicated with TOBS in a child were retrospectively analyzed, and the related literature was reviewed. Results A 6-year-old girl developed fever and inflexible movement in unilateral limb, and serum Mycoplasma pneumoniae antibody increased gradually. Lung CT showed a large area of inflammatory consolidation. Brain magnetic resonance imaging(MRI) showed multiple cerebral infarctions. After the symptomatic treatment of anti-infection, anticoagulation, thrombolysis and intracranial pressure reduction, the girl's condition continued to worsen and she presented with coma, cough weakness, dysphagia, facial nerve paralysis and bilateral pupillary inequality. Although the vital signs of the child were stable, she could not take care of herself and was still recovering. Conclusion MPP is often accompanied by hypercoagulative state and autoimmune abnormalities, and the prognosis of patients combined with TOBS is poor.
Objective To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia(MPP) complicated with "top of the basilar" syndrome(TOBS) in children. Method The clinical data of MPP complicated with TOBS in a child were retrospectively analyzed, and the related literature was reviewed. Results A 6-year-old girl developed fever and inflexible movement in unilateral limb, and serum Mycoplasma pneumoniae antibody increased gradually. Lung CT showed a large area of inflammatory consolidation. Brain magnetic resonance imaging(MRI) showed multiple cerebral infarctions. After the symptomatic treatment of anti-infection, anticoagulation, thrombolysis and intracranial pressure reduction, the girl's condition continued to worsen and she presented with coma, cough weakness, dysphagia, facial nerve paralysis and bilateral pupillary inequality. Although the vital signs of the child were stable, she could not take care of herself and was still recovering. Conclusion MPP is often accompanied by hypercoagulative state and autoimmune abnormalities, and the prognosis of patients combined with TOBS is poor.
引文
[1]王立东,沈婷.重症支原体肺炎并发脑梗死致一侧偏瘫个案分析[J].中国急救医学,2015,35:132-133.
[2]王全,蒋健飞,赵德育.肺炎支原体肺炎发生肺外并发症的危险因素[J].中华实用儿科临床杂志,2013,28(10):749-751.
[3]杨凤华,王华,张俊梅,等.儿童肺炎支原体感染相关性脑梗死[J].实用儿科临床杂志,2012,27(24):1869-1873.
[4]Arnold M,Nedeltchev K,Schroth G,et al.Clinical and radiological predictors of recanalisation and outcome of 40patients with acute basilar artery occlusion treated with intraarterial thrombolysis[J].J Neurol Neurosurg Psychiatry,2004,75(6):857-862.
[5]梁庆成,肖兴军,王维治.儿童基底动脉尖综合征一例报告[J],中国神经免疫学和神经病学杂志,2004,11(5):263.
[6]Blanchard E,Raherison C.Asthma and Mycoplasma pneumonia[J].Rev Mal Respir,2010,27(8):890-897.
[7]Bao Y,Li X,Wang K,et al.Central retinal artery occlusion and cerebral infarction associated with mycoplasma pneumonia infection in children[J].BMC Pediatr,2016,16(1):210.
[8]金尾静,张维溪,张海邻,等.支原体肺炎合并栓塞23例诊治分析[J].中国小儿急救医学,2013,12(20):615-618.
[9]Kalicki B,Sadecka M,Wawrzyniak A,et al.Absence of inferior vena cava in 14-year old boy associated with deep venous thrombosis and positive Mycoplasma pneumoniae serum antibodies--a case report[J].BMC Pediatr,2015,15:40.
[10]刘燕,杨晓丽,高爱梅.支原体肺炎并肺栓塞、下肢静脉血栓1例临床分析[J].山西医科大学学报,2014,45(6):541-543.
[11]Zhuo Z,Li F,Chen X,et al.Mycoplasma pneumonia combined with pulmonary infarction in a child[J].Int J Clin Exp Med,2015,8(1):1482-1486.
[12]Halaby R,Popma CJ,Cohen A,et al.D-Dimer elevation and adverse outcomes[J].J Thromb Thrombolysis,2015,39(1):55-59.
[13]朱晨曦,杨京华,李杰,等.血浆D二聚体检测在肺炎支原体肺炎中的临床意义[J].中国医药,2014,9(6):808-810.
[14]Leonardi S,Pavone P,Rotolo N,et al.Stroke in two children with Mycoplasma pneumoniae infection.A causal or casual relationship?[J].Pediatr Infect Dis J,2005,24(9):843-845.
[15]Narita M.Pathogenesis of neurologic manifestations of Mycoplasma pneumoniae infection[J].Pediatr Neurol,2009,41(3):159-166.
[16]Hwang MH,Damte D,Lee JS,et al.Mycoplasma hyopneumoniae induces pro-inflammatory cytokine and nitric oxide production through NFkB and MAPK pathways in RAW264.7 cells[J].Vet Res Commun,2011,35(1):21-34.
[17]Hsia BJ,Ledford JG,Potts-Kant EN,et al.Mast cell TNFreceptors regulate responses to Myeoplasma pneumoniae in surfaetant protein A(SP-A)-/-mice[J].J Allergy Clin Immunol,2012,130(1):205-214.
[18]Arae K,Hirata M,Kurata S,et al.Mycoplasma pneumoniae induces interleukin-8 production via the epidermal growth factor receptor pathway[J].Microbiol lmmunol,2011,55(10):748-750.
[19]Choi SY,Lim JW,Shimizu T,et al.Reactive oxygen species mediate Jak2/Stat3 activation and IL-8 expression in pulmonary epithelial cells stimulated with lipid-associated membrane proteins from Mycoplasma pneumoniae[J].Inflamm Res,2012,61(5):493-501.
[20]Ryu JS,Kim HJ,Sung IY,et al.Posterior cerebral artery occlusion after Mycoplasma pneumoniae infection associated with genetic defect of MTHFR C677T[J].J Child Neurol,2009,24(7):891-894.
[21]Senda J,Ito M,Atsuta N,et al.Paradoxical brain embolism induced by Mycoplasma pneumoniae infection with deep venous thrombus[J].Intern Med,2010,49(18):2003-2005.
[22]Tanir G,Aydemir C,Yilmaz D,et al.Internal carotid artery occlusion associated with Mycoplasma pneumoniae infection in a child[J].Turk J Pediatr,2006,48(2):166-171.
[23]Lee CY,Huang YY,Huang FL,et al.Mycoplasma pneumoniae-associated cerebral infarction in a child[J].JTrop Pediatr,2009,55(4):272-275.
[24]王维,申昆玲.肺炎支原体肺炎合并脑梗死三例分析[J].中华儿科杂志,2009,47(12):946-949.
[25]Caplan LR.“Top of the basilar”syndrome[J].Neurology,1980,30(1):72-79.
[26]徐继森,贾玉臻,王淑静.基底动脉尖综合征[J].医学综述,2006,11(12):1400-1401.
[27]张习文,刘占标,杜秀玉,等.低龄患儿脑梗死一例[J].中国全科医学,2011,14(7):2456-2457.
[28]阎艳,杨丽慧,薛寿儒.32例基底动脉尖综合征临床分析[J].浙江临床医学,2015,(217):206-207.
[29]张柏根.下肢深静脉血栓形成的诊断与治疗[J].中华医学杂志,2013,93(21):1604-1606.
[30]吴爱民,陈强,刘建梅,等.糖皮质激素在儿童难治性肺炎支原体肺炎中的应用[J].中华实用儿科临床杂志,2014,29(10):797-799.
[2]王全,蒋健飞,赵德育.肺炎支原体肺炎发生肺外并发症的危险因素[J].中华实用儿科临床杂志,2013,28(10):749-751.
[3]杨凤华,王华,张俊梅,等.儿童肺炎支原体感染相关性脑梗死[J].实用儿科临床杂志,2012,27(24):1869-1873.
[4]Arnold M,Nedeltchev K,Schroth G,et al.Clinical and radiological predictors of recanalisation and outcome of 40patients with acute basilar artery occlusion treated with intraarterial thrombolysis[J].J Neurol Neurosurg Psychiatry,2004,75(6):857-862.
[5]梁庆成,肖兴军,王维治.儿童基底动脉尖综合征一例报告[J],中国神经免疫学和神经病学杂志,2004,11(5):263.
[6]Blanchard E,Raherison C.Asthma and Mycoplasma pneumonia[J].Rev Mal Respir,2010,27(8):890-897.
[7]Bao Y,Li X,Wang K,et al.Central retinal artery occlusion and cerebral infarction associated with mycoplasma pneumonia infection in children[J].BMC Pediatr,2016,16(1):210.
[8]金尾静,张维溪,张海邻,等.支原体肺炎合并栓塞23例诊治分析[J].中国小儿急救医学,2013,12(20):615-618.
[9]Kalicki B,Sadecka M,Wawrzyniak A,et al.Absence of inferior vena cava in 14-year old boy associated with deep venous thrombosis and positive Mycoplasma pneumoniae serum antibodies--a case report[J].BMC Pediatr,2015,15:40.
[10]刘燕,杨晓丽,高爱梅.支原体肺炎并肺栓塞、下肢静脉血栓1例临床分析[J].山西医科大学学报,2014,45(6):541-543.
[11]Zhuo Z,Li F,Chen X,et al.Mycoplasma pneumonia combined with pulmonary infarction in a child[J].Int J Clin Exp Med,2015,8(1):1482-1486.
[12]Halaby R,Popma CJ,Cohen A,et al.D-Dimer elevation and adverse outcomes[J].J Thromb Thrombolysis,2015,39(1):55-59.
[13]朱晨曦,杨京华,李杰,等.血浆D二聚体检测在肺炎支原体肺炎中的临床意义[J].中国医药,2014,9(6):808-810.
[14]Leonardi S,Pavone P,Rotolo N,et al.Stroke in two children with Mycoplasma pneumoniae infection.A causal or casual relationship?[J].Pediatr Infect Dis J,2005,24(9):843-845.
[15]Narita M.Pathogenesis of neurologic manifestations of Mycoplasma pneumoniae infection[J].Pediatr Neurol,2009,41(3):159-166.
[16]Hwang MH,Damte D,Lee JS,et al.Mycoplasma hyopneumoniae induces pro-inflammatory cytokine and nitric oxide production through NFkB and MAPK pathways in RAW264.7 cells[J].Vet Res Commun,2011,35(1):21-34.
[17]Hsia BJ,Ledford JG,Potts-Kant EN,et al.Mast cell TNFreceptors regulate responses to Myeoplasma pneumoniae in surfaetant protein A(SP-A)-/-mice[J].J Allergy Clin Immunol,2012,130(1):205-214.
[18]Arae K,Hirata M,Kurata S,et al.Mycoplasma pneumoniae induces interleukin-8 production via the epidermal growth factor receptor pathway[J].Microbiol lmmunol,2011,55(10):748-750.
[19]Choi SY,Lim JW,Shimizu T,et al.Reactive oxygen species mediate Jak2/Stat3 activation and IL-8 expression in pulmonary epithelial cells stimulated with lipid-associated membrane proteins from Mycoplasma pneumoniae[J].Inflamm Res,2012,61(5):493-501.
[20]Ryu JS,Kim HJ,Sung IY,et al.Posterior cerebral artery occlusion after Mycoplasma pneumoniae infection associated with genetic defect of MTHFR C677T[J].J Child Neurol,2009,24(7):891-894.
[21]Senda J,Ito M,Atsuta N,et al.Paradoxical brain embolism induced by Mycoplasma pneumoniae infection with deep venous thrombus[J].Intern Med,2010,49(18):2003-2005.
[22]Tanir G,Aydemir C,Yilmaz D,et al.Internal carotid artery occlusion associated with Mycoplasma pneumoniae infection in a child[J].Turk J Pediatr,2006,48(2):166-171.
[23]Lee CY,Huang YY,Huang FL,et al.Mycoplasma pneumoniae-associated cerebral infarction in a child[J].JTrop Pediatr,2009,55(4):272-275.
[24]王维,申昆玲.肺炎支原体肺炎合并脑梗死三例分析[J].中华儿科杂志,2009,47(12):946-949.
[25]Caplan LR.“Top of the basilar”syndrome[J].Neurology,1980,30(1):72-79.
[26]徐继森,贾玉臻,王淑静.基底动脉尖综合征[J].医学综述,2006,11(12):1400-1401.
[27]张习文,刘占标,杜秀玉,等.低龄患儿脑梗死一例[J].中国全科医学,2011,14(7):2456-2457.
[28]阎艳,杨丽慧,薛寿儒.32例基底动脉尖综合征临床分析[J].浙江临床医学,2015,(217):206-207.
[29]张柏根.下肢深静脉血栓形成的诊断与治疗[J].中华医学杂志,2013,93(21):1604-1606.
[30]吴爱民,陈强,刘建梅,等.糖皮质激素在儿童难治性肺炎支原体肺炎中的应用[J].中华实用儿科临床杂志,2014,29(10):797-799.