46例重症肺炎支原体肺炎合并胸腔积液患儿临床及预后分析  

Clinical characteristics and prognosis of severe Mycoplasma pneumoniae pneumonia with pleural effusion in 46 cases

作　　者：王崇杰[1] 骆学勤[1] 罗健[1] 罗征秀[1] 刘恩梅[1] 谢晓虹[1] WANG Chongjie;LUO Xueqin;LUO Jian;LUO Zhengxiu;LIU Enmei;XIE Xiaohong(Department of Respiratory Medicine,Children’s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院呼吸中心,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《临床儿科杂志》2020年第4期269-274,共6页Journal of Clinical Pediatrics

基　　金：重庆市科委社会事业与民生保障科技创新专项项目(No.cstc2017shmsA130036)。

摘　　要：目的分析重症肺炎支原体肺炎(SMPP)合并胸腔积液的临床特点及预后。方法回顾分析46例合并胸腔积液和53例无胸腔积液的SMPP患儿临床资料,并进行比较。结果与SMPP无胸腔积液组相比,SMPP合并胸腔积液组的男性、合并肺不张、肺外系统损害以及全身糖皮质激素使用比例均升高,住院天数、发热天数、阿奇霉素起效时间以及出院后肺部病变吸收时间均延长,C-反应蛋白、降钙素原、D-二聚体、乳酸脱氢酶水平均升高,白蛋白水平降低,差异均有统计学意义(P<0.05)。与少、中量胸腔积液组相比,大量胸腔积液组患儿的年龄较大,发热天数和住院天数明显延长,差异均有统计学意义(P<0.05)。胸水MP阳性患儿的年龄大于胸水MP阴性者,差异有统计学意义(P<0.05)。SMPP合并胸腔积液患儿内气道分泌状态评级>4级组的D-二聚体和LDH水平高于评级≤4级组,差异有统计学意义(P<0.05)。结论SMPP合并胸腔积液患儿热程更长、肺内外并发症发生率高、血清炎症指标和血生化指标均明显异常,单纯阿奇霉素起效时间和后期肺部病变吸收时间更长。急性期需尽早预测全身糖皮质激素应用的可能性,出院后需定期随访胸部影像。Objective To explore the clinical characteristics and prognosis of severe Mycoplasma pneumoniae pneumonia(SMPP)with pleural effusion.Methods The clinical data of SMPP with pleural effusion in 46 children and SMPP without pleural effusion in 53 children were retrospectively analyzed and compared.Results Compared with SMPP without pleural effusion group,male to female sex ratio and the proportions of pulmonary atelectasis,extrapulmonary system damage and systemic glucocorticoid use were significantly increased.The days of hospitalization,days of fever,the effective time of azithromycin and the absorption time of pulmonary lesions after discharge were all significantly prolonged.The levels of C-reactive protein,PCT,D-dimer and lactate dehydrogenase were significantly increased.The level of albumin was significantly decreased in SMPP with pleural effusion group.The differences were statistically significant(P<0.05).Compared with the low-medium volume of pleural effusion group,the children in the high volume of pleural effusion group were older and had significantly longer duration of fever and hospitalization,and differences were statistically significant(P<0.05).The age of children with MP positive hydrothorax was significantly higher than that of children with MP negative hydrothorax(P<0.05).The levels of D-dimer and LDH in children having intrinsic airway secretory status rating>4 were higher than those in children having intrinsic airway secretory status rating≤4(P<0.05)in SMPP children with pleural effusion.Conclusions Children with SMPP combined with pleural effusion have a longer duration of fever,a higher incidence of extrapulmonary and intrapulmonary complications,significantly abnormal serum inflammatory indicators and blood biochemical indicators,and later start time of effectiveness of azithromycin alone and a longer absorption time of pulmonary lesions.The possibility of systemic glucocorticoid application should be predicted as early as possible in the acute phase and regular follow-up of chest imagin

关 键 词：肺炎支原体肺炎 胸腔积液 随访 预后 儿童 

分 类 号：R725.6[医药卫生—儿科]