成人肺炎支原体感染临床特征分析  

Clinincal characteristics of Mycoplasma pneumonia in adults

作　　者：王春婷 徐军[1] 朱华栋[1] 于学忠[1] WANG Chun-ting;XU Jun;ZHU Hua-dong;YU Xue-zhong(Department of Emergency Medicine,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院急诊科,北京100730

出　　处：《中国急救医学》2018年第9期761-763,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的 提高临床医生对成人肺炎支原体感染肺内、肺外表现的认识，探讨初始抗生素选择对临床的影响。方法 收集2010-01~2017-12北京协和医院收治的29例成人肺炎支原体感染患者，根据初始抗生素选择分为莫西沙星组（12例）、阿奇霉素组（17例），比较两种抗生素的临床疗效。结果 除个别患者外，绝大多数患者有发热、咳嗽的肺内表现，7例（24.1%）患者出现肺外表现，其中溶血性贫血4例（其中3例有冷凝素病），分泌性中耳炎1例，反应性关节炎1例，心肌炎1例。初始选择莫西沙星组患者获得临床稳定时间短于阿奇霉素组［（3.6±3.3）d vs. （8.2±3.5）d , P=0.002］。初始选择阿奇霉素的17例患者中，有14例在应用阿奇霉素1~10 d［平均（4.0±2.6）d］后更改为莫西沙星，更换药物后平均（3.4±2.4）d体温降至正常。结论 肺炎支原体感染不仅仅局限于肺内表现，当患者同时伴有溶血性贫血、关节炎、分泌性中耳炎、心肌炎等肺外表现时需高度警惕肺炎支原体感染。莫西沙星治疗肺炎支原体感染更易获得临床稳定。Objective To emphasize extrapulmonary symptoms on Mycoplasma pneumonia in adults and evaluate clinical efficacy of primary antibiotic. Methods 29 cases with diagnosis of mycoplasma pneumonia from Peking Union Medical College hospital during 2010 - 2017 were analyzed. Of which, 12 patients treated with Moxifloxacin （Moxifloxacin group） and 17 patients treated with Azithromycin （Azithromycin group） initially. Results Almost patients presented with fever and cough, and extrapulmonary symptoms including hemolytic anemia, tympanitis, arthritis, myocarditis occurred in 7 patients （24. 1% ）. Compared with Azithromycin group, Moxifloxacin group was easier access to clinical stability [ （3.6±3.3） d vs. （8.2 ± 3.5 ） d, P = 0. 002 ]. 14 patients in Azithromycin group changed antibiotic to Moxifloxacin later because of persistent fever. And then the temperature of 14 patients got back to normal in （ 3. 4± 2.4 ） d after changing antibiotic. Conclusion Mycoplasma pneumonia not only present within pulmonary, but also ocurr extrapulmonary symptoms. When patients with community acquired pneumonia along with hemolytic anemia, tympanitis, arthritis, myocarditis etc, Mycoplasma pneumonia infection should be highly considered. Moxifloxacin is easier access to clinical stability.

关 键 词：肺炎支原体 成人 肺外表现 莫西沙星 阿奇霉素 

分 类 号：R725.631[医药卫生—儿科]