儿童肺炎支原体细支气管炎临床特点及预后研究  

Clinical features and prognosis of Mycoplasma pneumoniae bronchiolitis in children

作　　者：温潇慧 徐慧[1] 唐晓蕾[1] 刘辉[1] 杨海明[1] 申月琳[1] 刘金荣[1] 李惠民[1] 赵顺英[1] WEN Xiao-hui;XU Hui;TANG Xiao-lei(No.2 Department of Respiratory Diseases,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院呼吸二科,北京100045

出　　处：《中国实用儿科杂志》2020年第12期963-967,共5页Chinese Journal of Practical Pediatrics

基　　金：北京市科技重大专项资助项目(Z181100001918003)。

摘　　要：目的探讨儿童肺炎支原体细支气管炎的临床特点及预后,提高对该病的认识。方法对首都医科大学附属北京儿童医院呼吸二科病房2017年3月至2020年3月诊断的71例肺炎支原体细支气管炎患儿病例资料进行回顾性分析。结果 (1)71例患儿起病中位年龄6.6岁,均有咳嗽表现;97.2%(69/71)有发热,中位热峰39.4℃;36.6%(26/71)有喘息;39.4%(28/71)有低氧血症;81.7%(58/71)有过敏背景。(2)中位白细胞7.6×109/L,78.9%(56/71)C反应蛋白升高(15 mg/L)。仅40.8%(29/71)胸片提示网状结节影,71例肺部高分辨率CT(HRCT)均可见小叶中心结节、树芽征,35.2%(25/71)为弥漫性细支气管炎,38.0%(27/71)合并少量肺实变或者肺不张。8.5%(6/71)电子支气管镜检查可见广泛黏稠分泌物。(3)均予阿奇霉素治疗;98.6%(70/71)应用甲泼尼龙,单日最大量为1~6 mg/(kg·d),首次应用时间中位病程为第10天,中位疗程为14 d。随访2.5~6.0个月,8.5%(6/71)发生闭塞性细支气管炎(BO)病情均为轻度;余91.5%(65/71)痊愈。(4)遗留BO患儿喘息、低氧血症、弥漫性细支气管炎的发生率明显高于未遗留BO者,P值分别为0.041、0.006和0.033。结论肺炎支原体细支气管炎患儿多数有过敏背景。肺部HRCT表现为弥漫性病变,有喘息和低氧血症者,发生BO的可能性大。Objective To summarize the clinical features and prognosis of Mycoplasma pneumoniae bronchiolitis in children and improve the understanding about the disease.Methods Seventy-one children with Mycoplasma pneumoniae bronchiolitis"were recruited from Beijing Children’ s Hospital,who received treatment from March 2017 to March 2020.The clinical data of these childrenwere retrospectively analyzed.Results(1)The median onset age of the 71 childrenvas 6.6 years.Fever(69/71,97.2%) and cough(97/97,100%)were the common symptoms,while wheezing(26/71,36.6%) and hypoxemia(28/71,39.4%)often occurred in some severe cases.Atopic background was positive in 58 patients(58/71,81.7%).(2) The median WBC count in blood was 7.6×10^9/L.The level of CRP increased in 56 patients(56/71,78.9%) and the median level was 15 mg/L.Reticulonodular infiltrate in chest X-ray was found in 29 patients(29/71,40.8%).Centrilobular nodules and tree-in-bud pattern were the common chest HRCT features,and diffuse bronchiolitis was found in 25 patients(25/71,35.2%),while a little lung consolidation and atelectasis was also found in 27 patients(27/71,38.0%).Electronic bronchoscopy lavage was conducted in 71 patients and diffuse and sick secretion was found in 6.(3)All patients were treated with azithromycin.Seventy patients(70/71,98.6%) were treated with systemic methylprednisolone.The maximum dose of methylprednisolone ranged from 1 mg/(kg·d)to 6 mg/(kg·d),and the median initiation time was on Day 10 and the median course was 14 days.All patients were followed up for 2.5 to 6 months;6 patients(6/71,8.5%) developed mild bronchiolitis obliterans,while the other 65 patients(65/71,91.5%)were cured.(4)The proportion of wheezing,hypoxemia and diffuse bronchiolitis in patients who developed BO was higher than that in patients who didn’t develop BO,and P value was 0.041,0.006 and 0.033,respectively.Conclusion The children with Mycoplasma pneumoniae bronchiolitis often have atopic background.The lung HRCT shows diffuse lesion in lung,and the children who have w

关 键 词：肺炎支原体 细支气管炎 闭塞性细支气管炎 

分 类 号：R72[医药卫生—儿科]