肺炎支原体感染致儿童坏死性肺炎的临床特征分析
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摘要
目的分析肺炎支原体(MP)感染致儿童坏死性肺炎的临床特征、治疗及预后。方法回顾分析2016年10月至2017年10月住院确诊为MP感染致坏死性肺炎患儿的临床资料。结果共26例患儿,男10例、女16例,平均年龄(5.76±2.60)岁。所有患儿均表现为发热、咳嗽,高热(≥39.0℃)23例(88.5%),总热程为(16.88±7.42)d;肺部听诊均为呼吸音减低。外周血白细胞计数(9.0～36.8)×10~9/L,中性粒细胞比率峰值平均(69. 2±13. 2)%,C反应蛋白(CRP)(1～202.5)mg/L;乳酸脱氢酶(LDH)平均(448±247)U/L。病初胸部影像学均表现为整叶以上均一的实变高密度影,20例(76.9%)合并胸腔积液;后期复查肺CT示均在肺实变基础上出现薄壁空洞或多发含气囊腔。纤维支气管镜检查,23例(88.5%)表现为黏液栓堵塞管腔。所有患儿均使用甲基泼尼松龙,21例2 mg/(kg·d)有效,5例调整为4 mg/(kg·d)后发热好转,平均激素应用时间为(13.08±8.38)d。中位住院天数为[16.5(7～32)]d。2例失访,24例随访半年,复查肺CT,16例肺部几乎完全恢复,5例遗留胸膜肥厚,1例支气管扩张,2例闭塞性支气管炎。结论 MP感染致儿童坏死性肺炎常表现为持续高热、呼吸音减低、肺部实变、黏液栓堵塞管腔;经积极抗感染、激素综合治疗,预后相对良好。
Objectives To analyze the clinical characteristics, treatment and prognosis of necrotizing pneumonia caused by Mycoplasma pneumoniae(MP) infection in children. Method The clinical data of children with necrotizing pneumonia cause by MP infection from October 2016 to October 2017 were retrospectively analyzed. Results A total of 26 children(10 males and 16 females) with an average age of(5.76±2.60) years, were enrolled in the study. All children were characterized by fever and cough. High fever( ≥ 39.0 ℃) was seen in 23 cases(88.5%) and the total duration of fever was(16.88±7.42) days. Pulmonary auscultation showed a reduction in respiratory sounds in all children. The range of peripheral blood leukocytes were(9.0～36.8)×10~9/L, mean peak neutrophil ratio was(69.2±13.2) %, and the range of C-reactive protein(CRP) was(1～202.5) mg/L. The mean value of lactic dehydrogenase(LDH) was(448±247) U/L. At the beginning of the disease, the chest images showed homogeneous solid high-density images over the whole lung lobe and 20 cases(76.9%) were complicated with pleural effusion. At the later stage, lung CT showed thin-walled cavities or multiple air-containing cysts on the basis of lung consolidation. Fiberoptic bronchoscopy showed lumen obstruction caused by mucus plugs in 23 cases(88.5%). All the children were treated with methylprednisolone. The dose of 2 mg/(kg·d) was effective in 21 cases and the fever was relieved in 5 cases after the dose was adjusted to 4 mg/(kg·d), and the average hormone application time was(13.08 ± 8.38) d. The median length of hospital stay was [16.5(7～32)] d. Two cases were lost to follow-up and 24 cases finished 6-month follow-up. Lung CT showed almost complete recovery of the lungs in 16 cases, residual pleural hypertrophy in 5 cases, and bronchiectasis in 1 case and bronchiolitis obliterans in 2 cases. Conclusion Necrotic pneumonia in children caused by MP infection is characterized by persistent high fever, decreased respiratory sounds, lung consolidation and mucus plugs induced lumen obstruction. The prognosis is relatively good after active anti-infection and hormone therapy.
Objectives To analyze the clinical characteristics, treatment and prognosis of necrotizing pneumonia caused by Mycoplasma pneumoniae(MP) infection in children. Method The clinical data of children with necrotizing pneumonia cause by MP infection from October 2016 to October 2017 were retrospectively analyzed. Results A total of 26 children(10 males and 16 females) with an average age of(5.76±2.60) years, were enrolled in the study. All children were characterized by fever and cough. High fever( ≥ 39.0 ℃) was seen in 23 cases(88.5%) and the total duration of fever was(16.88±7.42) days. Pulmonary auscultation showed a reduction in respiratory sounds in all children. The range of peripheral blood leukocytes were(9.0～36.8)×10~9/L, mean peak neutrophil ratio was(69.2±13.2) %, and the range of C-reactive protein(CRP) was(1～202.5) mg/L. The mean value of lactic dehydrogenase(LDH) was(448±247) U/L. At the beginning of the disease, the chest images showed homogeneous solid high-density images over the whole lung lobe and 20 cases(76.9%) were complicated with pleural effusion. At the later stage, lung CT showed thin-walled cavities or multiple air-containing cysts on the basis of lung consolidation. Fiberoptic bronchoscopy showed lumen obstruction caused by mucus plugs in 23 cases(88.5%). All the children were treated with methylprednisolone. The dose of 2 mg/(kg·d) was effective in 21 cases and the fever was relieved in 5 cases after the dose was adjusted to 4 mg/(kg·d), and the average hormone application time was(13.08 ± 8.38) d. The median length of hospital stay was [16.5(7～32)] d. Two cases were lost to follow-up and 24 cases finished 6-month follow-up. Lung CT showed almost complete recovery of the lungs in 16 cases, residual pleural hypertrophy in 5 cases, and bronchiectasis in 1 case and bronchiolitis obliterans in 2 cases. Conclusion Necrotic pneumonia in children caused by MP infection is characterized by persistent high fever, decreased respiratory sounds, lung consolidation and mucus plugs induced lumen obstruction. The prognosis is relatively good after active anti-infection and hormone therapy.
引文
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[11]Tagliabue C,Salvatore CM,Techasaensiri C,et a1.The impact of steroids given with macrolide therapy on experimental Mycoplasma pneumoniae respiratory infection[J].J Infect Dis,2008,198(8):1180-1188.
[12]蓝引乐,杨德华,陈志敏,等.甲泼尼龙治疗儿童难治性肺炎支原体肺炎的效果及患儿肺泡灌洗液细胞因子改变[J].中华儿科杂志,2015,53(10):779-783.
[13]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.
[14]Kraft M,Adler KB,Ingram JL,et al.Mycoplasma pneumonia induces airway epithelial cell expression of MUC5AC in asthma[J].Eur Respir,2008,31(1):43-46.
[2]Garcia AV,Fingeret AL,Thimmoorthi AS,et a1.Severe Mycoplasma pneumoniae infection requiring extracorporeal membrane oxygenation with concomitant ischemic stroke in a child[J].Pediatr Pulmonol,2013,48(1):98-101.
[3]Pellan M,Bastian C,Gaudelus J,et al.Pulmonary necrotizing cavity caused by Mycoplasma pneumoniae infection[J].Arch Pediatr,2013,20(10):1158-1159.
[4]Izumikawa K,Izumikawa K,Takazono T,et al.Clinical features,risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia:a review of the Japanese literature[J].J Infect Chemother,2014,20(3):18l-185.
[5]宋蕾,彭芸,刘志敏,等.儿童坏死性肺炎支原体肺炎的影像学表现[J].中国医学影像技术,2012,28(3):397-400.
[6]李素荣,牟京辉,常丽,等.肺炎支原体感染所致儿童坏死性肺炎30例胸部CT表现及转归[J].中华儿科杂志,2013,51(3):211-215.
[7]You SY,Jwa HJ,Yang EA,et a1.Effects of methyl-prednisolone pulse therapy on refractory Mycoplasma pneumoniae pneumonia in children[J].Allergy Asthma Immunol Res,2014,6(1):22-26.
[8]Barreira ER,Souza DC,Goes PF,et a1.Septic shock,necrotizing pneumonitis,and meningoencephalitis caused by Mycoplasma pneumoniae in a child:a case report[J].Clin Pediatr(Phila),2009,48(3):320-322.
[9]Arslan S,Ugurlu S,Bulut G,et al.The association between plasma D-dimer levels and community-acquired pneumonia[J].Clinics(Sao Paulo),2010,65(2):593-597.
[10]陈玲玲,成云改,陈志敏,等.肺炎支原体肺炎患儿混合感染的研究[J].中华儿科杂志,2012,50(3):211-215.
[11]Tagliabue C,Salvatore CM,Techasaensiri C,et a1.The impact of steroids given with macrolide therapy on experimental Mycoplasma pneumoniae respiratory infection[J].J Infect Dis,2008,198(8):1180-1188.
[12]蓝引乐,杨德华,陈志敏,等.甲泼尼龙治疗儿童难治性肺炎支原体肺炎的效果及患儿肺泡灌洗液细胞因子改变[J].中华儿科杂志,2015,53(10):779-783.
[13]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.
[14]Kraft M,Adler KB,Ingram JL,et al.Mycoplasma pneumonia induces airway epithelial cell expression of MUC5AC in asthma[J].Eur Respir,2008,31(1):43-46.