肺炎支原体相关肺脓肿4例  

Four cases of lung abscess related to Mycoplasma pneumoniae infection

作　　者：韩青[1] 史彧[1] 梁慧[1] 唐文伟[1] 赵德育[1] 

机构地区：[1]南京医科大学附属南京儿童医院呼吸科,210008

出　　处：《中华实用儿科临床杂志》2013年第10期760-763,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨小儿肺炎支原体（MP）相关肺脓肿的临床特点。方法回顾性分析2000年1月至2011年6月南京医科大学附属南京儿童医院MP相关肺脓肿4例患儿的病史、临床特点、病原学、肺CT及相关辅助检查等结果。结果4例患儿中，男女各2例，年龄3～6岁，均急性起病，剧烈咳嗽，痰少。3例人院时弛张高热，3例肺部有固定中小水泡音。4例血清MP-IgM均≥1：160、痰荧光半定量（FQ）-MPDNA均阳性；3例血wBc、多形核白细胞（PMN）、CRP、ESR增高，3例支气管肺泡灌洗液FQ—MPDNA阳性、血及胸水FQ—MPDNA阳性各1例，1例痰培养见卡他布兰汉菌；4例入院时影像学检查均提示肺间实质病变，病程5～20d出现多个大小不等囊状影、液平囊状影、厚壁空洞等组织坏死影像。3例纤维支气管镜下见支气管黏膜充血水肿、黏膜下散在小结节，病变部位支气管黏痰堵塞。4例均在入院3～5d后体温恢复正常，咳嗽减轻，肺部体征逐渐好转。应用大环内酯类抗生素3—4周后复查胸片示肺炎大部分吸收。随访6—18个月均吸收良好，1例留有左上肺局限肺不张。结论MP相关肺脓肿临床较少见，该症持续高热，血WBC、PMN、CRP及ESR明显增高，影像学示大片高密度影，一般剂量红霉素等疗效欠佳。及时予足量大环内酯类抗生素，必要时联用GC、丙种球蛋白，可改善病情，预后较好。Objective To investigate the clinical characteristics of pediatric Mycoplasma pneumoniae （MP） complicated with lung abscess. Methods Data of 4 cases suffering from pulmonary abscess associated with MP from Jan. 2000 to dun. 2011, including manifestations, imaging, laboratory examinations and therapies, were collected and analyzed. Related literatures were reviewed. Results Two female and 2 male cases were included in this study. The age ranged from 3 to 6 years old, and all patients had a history of acute onset, severe cough and little sputum. Three cases had remittent fever, and 3 cases had fixed small and medium-sized blisters sound in the lung. The levels of MP antibody M （MP-IgM） in the serum were higher than 1 ： 160 and sputum fluorescence quantitative-mycoplasma pneumonia （ FQ-MP DNA） tests were positive in 4 patients. The white blood cells （ WBC）, polymorphonuclear leukocyte （ PMN）, C-reactive protein （CRP） ,erythrocyte sedimentation rate （ESR） in 3 cases were significantly higher than the normal level ,and the FQ-MP DNA tests in the bronchoalveolar lavage fluid （BALF） were positive in 3 cases. The FQ-MP DNA in both blood and chest water were positive in 1 case. Cultures of sputum, blood, chest water, BALF and procalcitionin tests were negative, except for 1 case with positive sputum culture of Brauhamellacatarrhalis. The imaging examinations on admission of 4 cases strongly suggested that the interstitial and parenchymal lung disease and subsequently appeared the different sized cystic shadow,liquid flat cystic shadow,thickened wall empty tissue image during the course of 5 to 20 days. All cases were sequentially treated with azithromycin after full erythromycin,3 cases received intravenous glu- cocorticoid, 1 case received intravenous gamma globulin. The bronchial mucosal hyperemia and edema, submucosal scat- tered small nodules ,pathological changes of bronchial sticky phlegm jam were observed in 3 cases by flexible bronchos- copy. After 3 to 5 days of admission, all pa

关 键 词：肺炎支原体 坏死性肺炎 肺脓肿 儿童 

分 类 号：R725.6[医药卫生—儿科]