天津医药

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417 例肺炎支原体肺炎肺外并发症临床分析

陈晓颖1,董汉权2,郭伟2,任立歆2,徐勇胜2,万莉雅2,宁静3   

  1. 1. 天津市儿童医院呼吸科
    2. 天津市儿童医院
    3. 儿童医院内科
  • 收稿日期:2013-01-29 修回日期:2013-04-26 出版日期:2013-07-15 发布日期:2013-07-15
  • 通讯作者: 陈晓颖

Clinical Analysis of 417 Cases of Mycoplasma Pneumoniae Pneumonia Complicated by Extrapulmonary Complications

CHENXiao-Ying ,DONG Hanquan ,GUO Wei ,REN Lixin ,XU Yongsheng ,WAN Liya ,NING Jing   

  1. Tianjin Children’ s Hospital， Tianjin 300074, China
  • Received:2013-01-29 Revised:2013-04-26 Published:2013-07-15 Online:2013-07-15
  • Contact: CHENXiao-Ying

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摘要：

【摘要】 目的 探讨肺炎支原体（MP）肺炎患者肺外并发症的分布特点及临床诊断、治疗方法。方法  收集经血MP-IgM检测阳性，确诊为支原体肺炎的1 100例患儿的临床资料，统计417例肺外并发症患者（并发症组）的分布临床特点及MP-DNA检出率，并与683例无并发症组相关资料进行比较；分析4年间各种并发症的发生情况；比较行纤维支气管镜（纤支镜）灌洗术和未手术患者的相关资料。结果  并发症组血MP-DNA检出率、住院时间均高于无并发症组，肺外并发症以肝功能损害、皮疹、胃肠道反应多见，但较轻；脑炎、肾炎、心肌炎少见、但严重而隐匿；致命的噬血细胞性淋巴组织增生症（HLH）亦可见。纤支镜灌洗术有利于病情恢复。结论  MP肺炎肺外并发症发生率高且凶险，需要临床仔细的观察和检查，动态监测化验指标及综合治疗。 

关键词: 肺炎支原体, 肺炎., 诊断, 治疗, 肺外并发症, 噬血细胞性淋巴组织增生综合征

Abstract: [Abstract]  Objective   To investigate the distribution, clinical diagnosis and treatment methods of the extrapulmonary complications in children with mycoplasma pneumoniae (MP).  Methods   The clinical data of 1 100 patients confirmed the diagnosis of mycoplasma pneumonia and with the positive serum MP-IgM test were collected in this study. The distribution and clinical characteristics and MP-DNA detection rates were compared between 417 patients with extrapulmonary complications and 683 cases without complications. The occurrence of various complications in a four-year period was analyzed.Clinical data were compared between fiberoptic bronchoscopy lavage group and non-surgical group.  Results  The MP-DNA detection rate and the length of hospital stay were higher in patients with pulmonary complications than those of patients without complications. The most common types of extrapulmonary complications were liver damage, skin rashes and gastrointestinal reactions , but less severe. Encephalitis, nephritis and myocarditis were rare complications, but severe and occult. The fatal hemophagocytic lymphohistiocytosis (HLH) was also visible in patients. Bronchoscopy lavage was conducive to the recovery of the disease.   Conclusion  MP pneumonia showed high incidence and risks of extrapulmonary complications, which required careful clinical observation and inspection, the dynamic monitoring laboratory markers and comprehensive treatment as well.

Key words: Mycoplasma pneumoniae, pneumonia, diagnosis, therapy, pulmonary complications, hemophagocytic lymphohistiocytosis