肺炎支原体肺炎患儿肺泡灌洗液病菌量与临床特征相关性研究  

Relationship between bronchoalveolar lavage mycoplasma load and clinical characteristics in children with Mycoplasma pneumoniae pneumonia

作　　者：成云改[1] 李淑娴[1] 李雪静[1] 陈颖[1] 陈志敏[1] 

机构地区：[1]浙江大学医学院附属儿童医院呼吸科,杭州310003

出　　处：《中华儿科杂志》2013年第10期736-740,共5页Chinese Journal of Pediatrics

基　　金：国家自然科学基金（81070004,81000765,30872798）

摘　　要：目的评价肺炎支原体肺炎患儿肺泡灌洗液病菌量与临床特征的相关性。方法应用荧光实时定量PCR对77例肺炎支原体肺炎患儿肺泡灌洗液进行肺炎支原体DNA定量检测，并根据其基因拷贝数分为低菌量组（〈10’／ml，14例），中等菌量组（103-103／ml，22例）和高菌量组（〉103／ml，41例），比较不同组患儿的临床症状及主要实验室与影像学结果。结果与低菌量组（7d）及中等菌量组（10d）相比，高菌量组患儿（12d）总热程更长，高热患儿（50．0％、68．2％、87．8％）更多，使用大环内酯类热退时间（4d、8d、10d）也更长，热程≥10d者分别为35．7％，50％和73．2％（P均〈0．05）。三组患儿C反应蛋白（mg／L）（1．0、11．5、34）比较差异有统计学意义（P=0．004）。高菌量组患儿影像学表现为大片肺实变／不张影者58．5％，明显多于中等菌量组（22．7％）和低菌量组（14．3％）（P=0．002）。低菌量组未见双侧胸腔积液或大量胸腔积液，中等菌量组和高菌量组分别为13．6％和24．4％（P=0．033）。高菌量组不同年龄患儿临床症状、主要实验室与影像学结果比较差异无统计学意义（P均〉0．05）。结论肺炎支原体肺炎儿童肺泡灌洗液病菌量与临床特征有一定的相姜巾}．高萧骨鲴帛IJ病情再为严雷．Objective Mycoplasma pneumoniae （MP） is an important pathogen for community- acquired pneumonia in children. MP infection was considered to be self-limited, but many severe refractory MP pneumonia cases have been reported in recent years. The reason for variation in severity of MP pneumonia remains unclear. MP virulence including drug-resistance and host immunologic function are important influencing factors. The present study aimed to clarify relationship between local MP load and severity of MP pneumonia. Method MP DNA was quantitatively detected by fluorescent real-time PCR in bronchoalveolar lavage fluid （BALF） from 77 children with MP pneumonia. They were classified into groups of low MP load （ 〈 103/ml, n = 14）, moderate MP load（ 103 - 106/ml, n = 22） and high MP load（ 〉 106/ml, n =41 ）. Clinical symptoms, main laboratory and imaging results of children among the three groups were compared. Result When compared with low load group and moderate load group, high load group had longer fever duration （7 d, 10 d vs. 12 d）, longer time to normalization of temperature with macrolide administration（4 d, 8 d vs. 10 d） , more patients with high fever（50. 0% ,68.2% vs. 87.8% ） and longer duration of fever than 10 d （35.7%, 50. 0% vs. 73.2% ）. Statistically significant difference existed in CRP among the three groups（ 1.0 mg/L, 11.5 mg/L, 34 mg/L）. Large field of consolidation or atelectasis were found in 58.5% of high load patients, much higher than 22. 7% in moderate load and 14. 3% in low load patients. Bilateral or massive pleural effusion was not found in low load group, while in moderate load and high load group, they were 13.6% and 24. 4%. However, no significant difference was found in symptoms and main laboratory and imaging results among different age groups in high load patients. Conclusion There is a close relationship between MP load in BALF and clinical characteristics in children with MP pneumonia. Those with high MP load have a more severe process.

关 键 词：肺炎支原体 肺炎 儿童 

分 类 号：R725.6[医药卫生—儿科]