婴幼儿肺炎支原体肺炎327例临床分析(1)
[摘要] 目的 探讨婴幼儿肺炎支原体肺炎(MPP)的临床表现，提高诊治水平。方法 回顾分析2014年1月—2016年6月期间住院治疗的327例婴幼儿MPP的临床表现、肺外表现、影像学改变、外周血白细胞数及C-反应蛋白(CRP)、治疗及预后。 结果 婴幼儿MPP占小儿社区获得性肺炎(CAP)的5.77%，1岁以上者多见，临床表现以发热、咳嗽为主，70.95%有喘息，53.52%有气促，30.89%有湿啰音，59.94%有哮鸣音，11.31%伴有肺外表现，以神经及消化系统等单个肺外表现为主，外周血白细胞数(85.93%)及CRP(90.52%)呈正常或轻度增高，X线胸片多为单侧右肺中下肺改变，并呈点状或斑片状浸润影(31.19%)及间质性改变(49.85%)，全部患者经间断口服阿奇霉素3～4个疗程后病情痊愈。 结论 婴幼儿MPP临床表现独特，常伴有肺外表现，间断口服阿奇霉素治疗安全、效果满意。
[关键词] 肺炎支原体肺炎；婴幼儿；临床表现
[中图分类号] R722 [文献标识码] A [文章编号] 1674-0742(2016)11(c)-0095-04
[Abstract] Objective To investigate the infants with Mycoplasma pneumoniae pneumonia (MPP) clinical manifestations， diagnosis and treatment to improve. Methods A retrospective analysis of January 2014 to June 2016 the clinical manifestations of 327 cases hospitalized infants during the MPP， extrapulmonary manifestations， imaging changes， WBC count and C- reactive protein (CRP)， treatment and prognosis. Results Infant MPP children accounted for community-acquired pneumonia (CAP) of 5.77%， 1 year old were more common clinical manifestations were fever， cough mainly， 70.95% had wheezing， shortness of breath 53.52%， 30.89% had auscultation ， 59.94% had wheezing， 11.31% with pulmonary manifestations， nerve and digestive single extrapulmonary manifestations mainly WBC (85.93%) and CRP (90.52%) were normal or slightly elevated， X-ray mostly unilateral right lung lower lung changes and spotty or patchy infiltrates (31.19%) and interstitial changes (49.85%)， all patients with intermittent oral azithromycin for 3 to 4 courses after the disease cured. Conclusion Unique infant MPP clinical manifestations， often accompanied by extrapulmonary manifestations， intermittent oral azithromycin safe， satisfactory results.
[Key words] Mycoplasma pneumonia；Infant；Clinical manifestations
肺炎支原體(Mycoplasma pneumoniae，MP)是儿童社区获得性肺炎(Community acquired pneumonia CAP)的重要病原之一，肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia，MPP)在非流行年间约占小儿CAP的10%～20%，流行年份则高达30%以上。MP感染见于各个年龄组小儿，且其发病年龄有低龄化趋势，尤其是学龄前期和学龄期儿童MPP发生率较高，但婴幼儿MPP也占有一定的比例，应该引起重视[1]。为探讨婴幼儿MPP的临床特点，对2014年1月—2016年6月期间在该院儿科住院治疗的327例婴幼儿MPP患者的病例资料，现报道如下。
1 资料与方法
1.1 一般资料
2014年1月—2016年6月期间在该院儿科住院治疗的CAP的患者5669例，确诊为MPP的患者808例(14.25%)，其中婴幼儿MPP的患者327例(5.77%)。327例婴幼儿MPP的患者中男168例(51.38%)，女159例(48.62%)；1～6个月19例，6个月～1岁50例，1～2岁146例，2～3岁112例；MPP的诊断：①具有肺炎的症状、体征及影像学表现；②采用颗粒凝集法(PA)测定血清MP-IgM抗体滴度，MP-IgM抗体滴度≥1：160。
1.2 辅助检查
全部患儿均进行血、尿、粪3大常规、C-反应蛋白(CRP)、血生化全套、血清MP-IgM抗体滴度、痰细菌培养及X线胸片等检查；选择性进行肌钙蛋白、肌红蛋白、心肌酶谱、心电图、心脏彩超、B超、胸部CT、颅脑CT、脑电图、脑脊液常规+生化+培养、呼吸道九联谱等检查。 (吴国媛 卓俊瑞)
[关键词] 肺炎支原体肺炎；婴幼儿；临床表现
[中图分类号] R722 [文献标识码] A [文章编号] 1674-0742(2016)11(c)-0095-04
[Abstract] Objective To investigate the infants with Mycoplasma pneumoniae pneumonia (MPP) clinical manifestations， diagnosis and treatment to improve. Methods A retrospective analysis of January 2014 to June 2016 the clinical manifestations of 327 cases hospitalized infants during the MPP， extrapulmonary manifestations， imaging changes， WBC count and C- reactive protein (CRP)， treatment and prognosis. Results Infant MPP children accounted for community-acquired pneumonia (CAP) of 5.77%， 1 year old were more common clinical manifestations were fever， cough mainly， 70.95% had wheezing， shortness of breath 53.52%， 30.89% had auscultation ， 59.94% had wheezing， 11.31% with pulmonary manifestations， nerve and digestive single extrapulmonary manifestations mainly WBC (85.93%) and CRP (90.52%) were normal or slightly elevated， X-ray mostly unilateral right lung lower lung changes and spotty or patchy infiltrates (31.19%) and interstitial changes (49.85%)， all patients with intermittent oral azithromycin for 3 to 4 courses after the disease cured. Conclusion Unique infant MPP clinical manifestations， often accompanied by extrapulmonary manifestations， intermittent oral azithromycin safe， satisfactory results.
[Key words] Mycoplasma pneumonia；Infant；Clinical manifestations
肺炎支原體(Mycoplasma pneumoniae，MP)是儿童社区获得性肺炎(Community acquired pneumonia CAP)的重要病原之一，肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia，MPP)在非流行年间约占小儿CAP的10%～20%，流行年份则高达30%以上。MP感染见于各个年龄组小儿，且其发病年龄有低龄化趋势，尤其是学龄前期和学龄期儿童MPP发生率较高，但婴幼儿MPP也占有一定的比例，应该引起重视[1]。为探讨婴幼儿MPP的临床特点，对2014年1月—2016年6月期间在该院儿科住院治疗的327例婴幼儿MPP患者的病例资料，现报道如下。
1 资料与方法
1.1 一般资料
2014年1月—2016年6月期间在该院儿科住院治疗的CAP的患者5669例，确诊为MPP的患者808例(14.25%)，其中婴幼儿MPP的患者327例(5.77%)。327例婴幼儿MPP的患者中男168例(51.38%)，女159例(48.62%)；1～6个月19例，6个月～1岁50例，1～2岁146例，2～3岁112例；MPP的诊断：①具有肺炎的症状、体征及影像学表现；②采用颗粒凝集法(PA)测定血清MP-IgM抗体滴度，MP-IgM抗体滴度≥1：160。
1.2 辅助检查
全部患儿均进行血、尿、粪3大常规、C-反应蛋白(CRP)、血生化全套、血清MP-IgM抗体滴度、痰细菌培养及X线胸片等检查；选择性进行肌钙蛋白、肌红蛋白、心肌酶谱、心电图、心脏彩超、B超、胸部CT、颅脑CT、脑电图、脑脊液常规+生化+培养、呼吸道九联谱等检查。 (吴国媛 卓俊瑞)