冷凝集素介导贫血的成人重症支原体肺炎2例并文献复习  

2 cases report and review of adults severe mycoplasma pneumonia with anemia causing by cold agglutinin

作　　者：谭星宇[1] 公丕花[1] 董霄松[1] 韩芳[1] 高占成[1] 

机构地区：[1]北京大学人民医院呼吸与危重症医学科,北京100044

出　　处：《中国临床医生杂志》2013年第9期22-25,共4页Chinese Journal For Clinicians

摘　　要：目的总结成人冷凝集素介导溶血性贫血的重症支原体肺炎病例的特点。方法报道2例成人冷凝集素介导溶血性贫血的重症支原体肺炎病例。结果病例1男,28岁,咳嗽、咳痰16天,发热14天,贫血,巩膜黄染,双肺可闻及细小湿啰音,胸片示双下肺多发小结节,右下肺和右中叶片状阴影,伴树芽征,入院时静脉抽血几秒后就出现红细胞自凝现象,50℃温浴后解凝,肺炎支原体抗体1∶20480,抗人球蛋白综合试验阳性。莫西沙星、阿奇霉素加强的松30mg口服,治疗好转。病例2女,18岁,发热伴咳嗽、咳痰2周,1周前患者出现右侧胸痛,偶有腹泻,贫血貌,胸片示右肺下叶大片实变影,右侧中量胸腔积液,右下肺呼吸音减弱,未闻及干湿啰音。静脉抽血时均发现有红细胞自凝现象,肺炎支原体抗体1∶1280。环介导等温扩增技术检测出支原体,抗人球蛋白综合试验阳性,胸水为渗出液ADA 44.1U/L,予阿奇霉素、甲泼尼龙40mg,1日1次,低分子肝素抗凝好转。结论 2例人冷凝集素介导溶血性贫血的重症支原体肺炎患者都是青年,发热超过2周,静脉抽血有红细胞自凝现象,贫血,抗人球蛋白综合试验阳性,肺炎支原体抗体很高,影像学表现不特异,仅用大环内酯类和氟喹诺酮类药物效果不佳,最后需加以糖皮质激素,必要时抗凝治疗。Objective To investigate the characteristic of adults severe mycoplasma pneumonia with anemia causing by cold agglutinin.Method Adults severe mycoplasma pneumonia with anemia causing by cold agglutinin.Result Case 1,male,28 y,cough phlegm 16 days,fever 14 days,anemia,icteric sclera,little moist rales.The chest radiograph shows multiple small nodules under double lung,patchy shadows in the right lower lung and right middle,and tree-in-bud sign.Red blood cell of venous blood coagulation after a few seconds and solution after 50℃ warm bath.Mycoplasma pneumonia antibody 1∶ 20480.Coomb’s test was positive.Moxifloxacin,azithromycin and prednisone 30mg were treated.Case 2,female,18 y,with anemia,fever and cough 2 weeks,right-sided chest pain,1 weeks occasionally diarrhea.The chest radiograph showed patchy shadows in right lower lobe and right pleural effusion.The breath sounds of right lower lung decreased,without rale.Venous blood were found to have self coagulation phenomenon of red blood cells.Mycoplasma pneumoniae antibody was 1： 1280.Loop mediated isothermal amplification detection mycoplasma.Coomb’s test was positive.Pleural effusion were exudative with ADA 44.1U / L.Azithromycin,methylprednisolone 40mg and low molecular weight heparin were treated.Conclusion Two cases were young people with fever more than 2 weeks,venous blood red blood cells condensatiog,anemia,Coombs’test positive,high mycoplasma pneumoniae antibody,nonspecific imaging findings.Only macrolide antibiotics and fluoroquinolone drugs had ineffective.It need treatment with glucocorticoid and anticoagulant when necessary.

关 键 词：成人 重症 冷凝集素 支原体肺炎 

分 类 号：R375.2[医药卫生—病原生物学]