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 bacteria loads of bronchoalveolar lavage fluid and clinical characteristics in children with mycoplasma pneumoniae pneumonia

作　　者：王亚坤[1] 高文杰[1] 王伟[2] 杜习霞[3] 杜安[4] 王艳艳[1] 

机构地区：[1]河北省儿童医院小儿内科,石家庄050030 [2]河北省儿童医院护理部,石家庄050030 [3]河北省石家庄市妇产医院护理部,石家庄050000 [4]日本城西国际大学药房学院

出　　处：《检验医学与临床》2015年第10期1361-1363,1366,共4页Laboratory Medicine and Clinic

基　　金：河北省2014年度医学科学研究重点课题计划(ZD20140097)

摘　　要：目的研究肺炎支原体（MP）肺炎患儿肺泡灌洗液（BALF）中MP-DNA基因拷贝数和患儿病情严重程度的关系。方法选取河北省儿童医院2012年10月至2013年12月收治的82例MP肺炎患儿作为研究对象,行支气管镜下支气管肺泡灌洗（BAL）,采用荧光实时定量聚合酶链反应（FQ-PCR）对肺泡灌洗液中MP-DNA定量检测,并根据检测结果的基因拷贝数分为低菌量组（MP-DNA的拷贝数〈10^3/mL的患儿）,中等菌量组（MP-DNA的拷贝数为103~10^6/mL的患儿）和高菌量组（MP-DNA的拷贝数〉10^6/mL的患儿）。比较不同菌量组患儿的临床症状、实验室检查结果和影像学结果。结果高菌量组患儿总病程长,高热患儿和热程大于或等于7d的患儿数量均多于中、低菌量组,使用大环内酯类药物后退热时间也较其他两组更长,差异均具有统计学意义（P=0.027、P=0.025、P=0.029、P=0.003）。实验室检查中高菌量组C反应蛋白值升高明显,高于中低菌量组,差异有统计学意义（P=0.005）。影像学检查中高菌量组大片肺实变、肺不张者较、低菌量组多（P=0.002）。低菌量组未见双侧胸腔积液或大量胸腔积液患儿,中高菌量组此症状患儿较多,差异有统计学意义（P=0.033）。结论 MP肺炎患儿BALF病菌量和临床表现密切相关,高菌量组患儿病情更为严重。可能与患儿体内的肺炎支原体不易清除和存在较强的免疫反应有关,临床需延长抗菌药物治疗时间以及加强免疫治疗。Objective To study the relationship between mycoplasma pneumoniae（MP）-DNA gene copy number of bacteria loads of bronchoalveolar lavage fluid（BALF）and clinical characteristics in children with MP pneumonia.Methods A total of 82 children with MP pneumonia were recruited as objects from October 2012 to December 2013,bronchoscopic bronchoalveolar lavage（BAL）was perfomed,and real-time polymerase chain reaction（FQPCR）was used to detected MP-DNA in BALF.According to the results of MP-DNA detection,objects were divided into low MP load group（MP-DNA was less than 10^3/mL）,moderate MP load group（MP-DNA was 103-10^6/mL）and high MP load group（MP-DNA was more than 10^6/mL）.Clinical symptoms in three groups,laboratory test results and imaging results were compared.Results Children in the high MP load group had long course of disease,children with high fever and with fever process more than 7d in the high MP load group were more than other two groups,and the fever relieving time after using drugs in the high MP load group were longer than other two groups,the differences were statistical significant（P=0.027,P=0.025,P=0.029,P=0.003）.The C-reactive protein（CRP）level in the high MP load group was significant higher than the other two groups,the difference was statistical significant（P=0.005）.Imaging examination showed that the big range of consolidation and pulmonary atelectasis in the high MP load group were more than that in the low MP loads group（P=0.002）.There were no children with bilateral pleural effusion or pleural effusion in the low MP loads group,which was significant less than the other two groups（P=0.033）.Conclusion There is a close relationship between MP load in BALF and clinical characteristics in children with MP pneumoniae,children with high MP load had a more severe process.

关 键 词：肺炎支原体 肺泡灌洗液 儿童 

分 类 号：R734.204[医药卫生—肿瘤]