纤维支气管镜对儿童难治性肺炎支原体肺炎的诊断治疗价值
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摘要
肺炎支原体是儿童社区获得性肺炎主要病原体之一,近年来,难治性肺炎支原体肺炎发病率越来越高,儿童用药较为有限。纤维支气管镜在儿童难治性肺炎支气管肺炎的诊断及治疗方面有重要作用。该文从支气管镜下气管内膜病变、灌洗液病原分析、细胞因子分析、支气管肺泡灌洗术、气道清理及局部注药治疗等方面来阐述纤维支气管镜对儿童难治性肺炎支原体肺炎的诊断及治疗价值。
Mycoplasma pneumoniae is one of the main pathogens of common community-acquired pneumonia in children.The incidence of refractory mycoplasma pneumoniae pneumonia has been increasing in recent years,and the drugs are limited in children. Fiberoptic bronchoscopy plays an important role in the diagnosis and treatment of refractory mycoplasma pneumoniae pneumonia in children. In this paper,the diagnostic and therapeutic value of fiberoptic bronchoscopy in the treatment of refractory mycoplasma pneumoniae pneumonia in children was expounded from the aspects of endobronchial lesions,pathogen and cytokine analysis in bronchoalveolar lavage fluid,bronchoalveolar lavage,airway cleaning and local drug injection under bronchoscopy.
Mycoplasma pneumoniae is one of the main pathogens of common community-acquired pneumonia in children.The incidence of refractory mycoplasma pneumoniae pneumonia has been increasing in recent years,and the drugs are limited in children. Fiberoptic bronchoscopy plays an important role in the diagnosis and treatment of refractory mycoplasma pneumoniae pneumonia in children. In this paper,the diagnostic and therapeutic value of fiberoptic bronchoscopy in the treatment of refractory mycoplasma pneumoniae pneumonia in children was expounded from the aspects of endobronchial lesions,pathogen and cytokine analysis in bronchoalveolar lavage fluid,bronchoalveolar lavage,airway cleaning and local drug injection under bronchoscopy.
引文
[1]中华医学会儿科学分会呼吸学组.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志,2013,51(11):856-862.
[2]韩晓华,路素坤,李书秀,等.肺炎支原体23SrRNA基因突变及其所致肺炎的临床分析[J].中国医科大学学报,2016,40(2):162-165.
[3]姚慧生,张睿,刘立云,等.肺炎支原体耐药基因检测与难治性肺炎支原体肺炎的相关性分析[J].国际儿科学杂志,2016,43(6):492-496.
[4] Ishiguro N,Koseki N,Kaiho M,et al. Therapeutic efficacy of azithromycin, clarithromycin,minocycline and tosufloxacin againstmacrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients[J]. PLo S One,2017,12(3):e0173635.
[5] Kawai Y,Miyashita N,Kubo M,et al. Therapeutic efficacy of macrolides,minocycline,and tosufloxacin against macrolide-resistant mycoplasma pneumoniae pneumonia in pediatric patients[J]. PLoS One,2013,57(5):2252-2258.
[6]赵悦彤,尚云晓.肺炎支原体肺炎常见远期并发症的研究进展[J].国际儿科学杂志,2019,1(46):36-39.
[7]中华医学会儿科学分会呼吸学组.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中国实用儿科杂志,2015,30(17):1304-1308.
[8] Korean Centers for Disease Control and Prevention,Korea National Institute of Health. Korean Antimicrobial Resistance Monitoring System annual report[J]. Chungbuk:The Centers,2011.
[9] Cardinale F,Chironna M,Dumke R,et al. Macrolide.resistant mycoplasma pneumoniae in paedatric pneumonia[J]. Eur Respir J,2011,37(6):1522-1524.
[10] Youn YS,Lee SC,Rhim JW,et al. Early additional immune modulators for mycoplasma pneumoniae pneumonia in aliIdron:An observation study[J]. Infect Chemother,2014,46(4):239-247.
[11] Shan LS,Liu X,Kang XY,et al. Effects of methylprednisolone or immunoglobulin when added to standard treatment with intravenous azithromycin for refractory mycoplasma pneumoniae pneumonia in children[J]. World J Pediatr,2017,13(4):321-327.
[12] You SY,Jwa HJ,Yang EA,et al. Effects of methylprednisolone pulse therapy on refractory mycoplasma pneumoniae pneumonia in children[J]. Allergy Asthma Immunol Res,2014,6(1):22-26.
[13]史晓云,栾海丽,张晗,等.儿童难治性肺炎支原体肺炎的支气管镜下特征及支气管肺泡灌洗液中炎症因子水平的研究[J].国际儿科学杂志,2017,12(44):867-871.
[14]郑茂,陈瑶,符佳.难治性肺炎支原体肺炎患儿的早期临床特征及相关细胞因子水平变化[J].中国医药,2017,10(12):1499-1502.
[15]徐凤琴,张琪,毕良学.支气管肺泡灌洗液肺炎支原体核酸联合血清特异性IgM检测对儿童肺炎支原体感染的诊断价值[J]. 2018,1(23):35-37.
[16]张晗,尚云晓,王植嘉,等. 1415例支气管镜下异常改变患儿的镜下病因分析[J].中国小儿急救医学,2015,10(22):704-709.
[17]周淼,钟礼立.难治性肺炎支原体肺炎诊疗分析[J].浙江临床医学,2018,11(20):1815-1817.
[18]李秀文,王运铎,张毅华.肺泡灌洗液、纤支镜刷出物及痰病原菌培养对下呼吸道感染的诊断价值[J].中国实验诊断学,2018,22(12):2091-1094.
[19]栾海丽,张晗,尚云晓.儿童肺炎支原体肺炎肺泡灌洗液中T细胞亚群及细胞因子检测的意义[J].中国小儿急救医学,2017,11(24):850-854.
[20]张新星,陈正荣,顾文婧,等.难治性肺炎支原体肺炎患儿肺泡灌洗液中sB7-H3及细胞因子表达[J].临床儿科杂志,2016,8(34):561-565.
[21]任晓婷,姜静,郭晓焕,等.电子纤维支气管镜对儿童难治性肺炎支原体肺炎的临床疗效研究[J].河北医学,2018,4(24):640-643.
[22]杨男,单丽沈,张晗,等.儿童难治性肺炎支原体肺炎的特点分析及激素治疗的疗效观察[J].国际儿科学杂志,2017,12(44):882-886.
[23]石颖玉,华山,魏文,等.纤维支气管镜联合甲泼尼龙琥珀酸钠治疗难治性支原体肺炎的临床疗效观察[J].安徽医药,2017,21(9):1699-1701.
[24]王菲,张晗,王植嘉,等.难治性肺炎支原体肺炎支气管镜肺泡灌洗术治疗时机研究[J].中国实用儿科杂志,2015,30(11):855-858.
[25]余洁明,刘海英,刘瑜,等.纤维支气管镜肺泡灌洗术不同治疗时机对难治性肺炎支原体肺炎治疗效果的影响[J].海南医学,2017,4(28):584-585.
[26]白鹏,高岳.支气管镜术在儿童难治性肺炎支原体肺炎诊治中的应用效果探讨[J].中外医疗,2018,37(7):97-99.
[27]何馨,徐波,姚志刚,等.支气管镜下刷检对儿童难治性肺炎支原体肺炎的临床价值探讨[J].临床和实验医学杂志,2017,21(17):2308-2311.
[28] AGarcia-Henriquez N,Toloza EM,Khalil F,et al. Extensive plastic bronchitis:etiology of a rare condition[J]. J Thorac Dis,2016,8(6):961-965.
[29] B DePopas EM,Veress LA,Ahmed F,et al. Percutaneous thoracic duct intervention to treat plastic bronchitis related to Fontan palliation[J]. Pediatr Pulmonol,2017,52(2):97-101.
[30]王来成王惠丽赵瑜.经支气管镜注射布地奈德治疗儿童肺炎支原体大叶性肺炎[J].中国实用药物,2016,11(9):168-170.
[31]常光妮,张晗,尚云晓.盐酸氨溴索经纤维支气管镜灌洗治疗儿童难治性肺炎支原体肺炎的疗效观察[J].国际儿科学杂志,2018,8(45):1-3.
[32]曹鑫,代丽.支气管镜肺泡灌洗联合局部用药在难治性肺炎支原体肺炎中的应用效果[J].广西医科大学学报,2018,31(5):721-723.
[33] Eberlein M,Parekh K,Hansdottir S,et al. Plastic bronchitis complicating primary graft dysfunction after lung transplantation[J]. Ann Thorac Surg,2014,98(5):1849.
[34]孟晨.重症支原体肺炎的支气管镜下表现和治疗[J].中华儿科杂志,2010,48(12):954-956.
[35]孟晨,于华凤,倪彩云,等.应用球囊扩张气道成形术治疗儿童支原体肺炎肺不张的探讨[J].中华儿科杂志,2010,48(4):301-304.
[2]韩晓华,路素坤,李书秀,等.肺炎支原体23SrRNA基因突变及其所致肺炎的临床分析[J].中国医科大学学报,2016,40(2):162-165.
[3]姚慧生,张睿,刘立云,等.肺炎支原体耐药基因检测与难治性肺炎支原体肺炎的相关性分析[J].国际儿科学杂志,2016,43(6):492-496.
[4] Ishiguro N,Koseki N,Kaiho M,et al. Therapeutic efficacy of azithromycin, clarithromycin,minocycline and tosufloxacin againstmacrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients[J]. PLo S One,2017,12(3):e0173635.
[5] Kawai Y,Miyashita N,Kubo M,et al. Therapeutic efficacy of macrolides,minocycline,and tosufloxacin against macrolide-resistant mycoplasma pneumoniae pneumonia in pediatric patients[J]. PLoS One,2013,57(5):2252-2258.
[6]赵悦彤,尚云晓.肺炎支原体肺炎常见远期并发症的研究进展[J].国际儿科学杂志,2019,1(46):36-39.
[7]中华医学会儿科学分会呼吸学组.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中国实用儿科杂志,2015,30(17):1304-1308.
[8] Korean Centers for Disease Control and Prevention,Korea National Institute of Health. Korean Antimicrobial Resistance Monitoring System annual report[J]. Chungbuk:The Centers,2011.
[9] Cardinale F,Chironna M,Dumke R,et al. Macrolide.resistant mycoplasma pneumoniae in paedatric pneumonia[J]. Eur Respir J,2011,37(6):1522-1524.
[10] Youn YS,Lee SC,Rhim JW,et al. Early additional immune modulators for mycoplasma pneumoniae pneumonia in aliIdron:An observation study[J]. Infect Chemother,2014,46(4):239-247.
[11] Shan LS,Liu X,Kang XY,et al. Effects of methylprednisolone or immunoglobulin when added to standard treatment with intravenous azithromycin for refractory mycoplasma pneumoniae pneumonia in children[J]. World J Pediatr,2017,13(4):321-327.
[12] You SY,Jwa HJ,Yang EA,et al. Effects of methylprednisolone pulse therapy on refractory mycoplasma pneumoniae pneumonia in children[J]. Allergy Asthma Immunol Res,2014,6(1):22-26.
[13]史晓云,栾海丽,张晗,等.儿童难治性肺炎支原体肺炎的支气管镜下特征及支气管肺泡灌洗液中炎症因子水平的研究[J].国际儿科学杂志,2017,12(44):867-871.
[14]郑茂,陈瑶,符佳.难治性肺炎支原体肺炎患儿的早期临床特征及相关细胞因子水平变化[J].中国医药,2017,10(12):1499-1502.
[15]徐凤琴,张琪,毕良学.支气管肺泡灌洗液肺炎支原体核酸联合血清特异性IgM检测对儿童肺炎支原体感染的诊断价值[J]. 2018,1(23):35-37.
[16]张晗,尚云晓,王植嘉,等. 1415例支气管镜下异常改变患儿的镜下病因分析[J].中国小儿急救医学,2015,10(22):704-709.
[17]周淼,钟礼立.难治性肺炎支原体肺炎诊疗分析[J].浙江临床医学,2018,11(20):1815-1817.
[18]李秀文,王运铎,张毅华.肺泡灌洗液、纤支镜刷出物及痰病原菌培养对下呼吸道感染的诊断价值[J].中国实验诊断学,2018,22(12):2091-1094.
[19]栾海丽,张晗,尚云晓.儿童肺炎支原体肺炎肺泡灌洗液中T细胞亚群及细胞因子检测的意义[J].中国小儿急救医学,2017,11(24):850-854.
[20]张新星,陈正荣,顾文婧,等.难治性肺炎支原体肺炎患儿肺泡灌洗液中sB7-H3及细胞因子表达[J].临床儿科杂志,2016,8(34):561-565.
[21]任晓婷,姜静,郭晓焕,等.电子纤维支气管镜对儿童难治性肺炎支原体肺炎的临床疗效研究[J].河北医学,2018,4(24):640-643.
[22]杨男,单丽沈,张晗,等.儿童难治性肺炎支原体肺炎的特点分析及激素治疗的疗效观察[J].国际儿科学杂志,2017,12(44):882-886.
[23]石颖玉,华山,魏文,等.纤维支气管镜联合甲泼尼龙琥珀酸钠治疗难治性支原体肺炎的临床疗效观察[J].安徽医药,2017,21(9):1699-1701.
[24]王菲,张晗,王植嘉,等.难治性肺炎支原体肺炎支气管镜肺泡灌洗术治疗时机研究[J].中国实用儿科杂志,2015,30(11):855-858.
[25]余洁明,刘海英,刘瑜,等.纤维支气管镜肺泡灌洗术不同治疗时机对难治性肺炎支原体肺炎治疗效果的影响[J].海南医学,2017,4(28):584-585.
[26]白鹏,高岳.支气管镜术在儿童难治性肺炎支原体肺炎诊治中的应用效果探讨[J].中外医疗,2018,37(7):97-99.
[27]何馨,徐波,姚志刚,等.支气管镜下刷检对儿童难治性肺炎支原体肺炎的临床价值探讨[J].临床和实验医学杂志,2017,21(17):2308-2311.
[28] AGarcia-Henriquez N,Toloza EM,Khalil F,et al. Extensive plastic bronchitis:etiology of a rare condition[J]. J Thorac Dis,2016,8(6):961-965.
[29] B DePopas EM,Veress LA,Ahmed F,et al. Percutaneous thoracic duct intervention to treat plastic bronchitis related to Fontan palliation[J]. Pediatr Pulmonol,2017,52(2):97-101.
[30]王来成王惠丽赵瑜.经支气管镜注射布地奈德治疗儿童肺炎支原体大叶性肺炎[J].中国实用药物,2016,11(9):168-170.
[31]常光妮,张晗,尚云晓.盐酸氨溴索经纤维支气管镜灌洗治疗儿童难治性肺炎支原体肺炎的疗效观察[J].国际儿科学杂志,2018,8(45):1-3.
[32]曹鑫,代丽.支气管镜肺泡灌洗联合局部用药在难治性肺炎支原体肺炎中的应用效果[J].广西医科大学学报,2018,31(5):721-723.
[33] Eberlein M,Parekh K,Hansdottir S,et al. Plastic bronchitis complicating primary graft dysfunction after lung transplantation[J]. Ann Thorac Surg,2014,98(5):1849.
[34]孟晨.重症支原体肺炎的支气管镜下表现和治疗[J].中华儿科杂志,2010,48(12):954-956.
[35]孟晨,于华凤,倪彩云,等.应用球囊扩张气道成形术治疗儿童支原体肺炎肺不张的探讨[J].中华儿科杂志,2010,48(4):301-304.