难治性肺炎支原体肺炎并发颅内静脉窦血栓二例  

Two cases of intractable mycoplasma pneumoniae pneumonia complicated with intracranial venous sinus thrombosis

作　　者：李隽 史艳平[1] 边国强 陈涛 张金虎[1] 梁蓬勃[1] 薛斌 田纪凤 吉慧 刘小乖[2] Li Jun;Shi Yanping;Bian Guoqiang;Chen Tao;Zhang Jinhu;Liang Pengbo;Xue Bin;Tian Jifeng;Ji Hui;Liu Xiaoguai(Department of Integrated Traditional Chinese Medicine&Western Medicine,Xi′an Children′s Hospital,Shaanxi Province,Xi′an 710003,China;Xi′an Children′s Hospital,Shaanxi Province,Xi′an 710003,China)

机构地区：[1]陕西省西安市儿童医院中西医结合科,710003 [2]陕西省西安市儿童医院感染三科,710003

出　　处：《中国综合临床》2021年第4期360-367,共8页Clinical Medicine of China

基　　金：西安市科技计划项目(2019114613YX001SF034(8));西安市卫生科研人才项目(J201902035);西安市中医药科研项目(SZ1201915);西安市卫生健康委员会科研项目(2020yb31)。

摘　　要：肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)并发颅内静脉窦血栓(cerebral venous sinus thrombosis,CVST)很罕见。我们回顾性分析2例2018年12月至2019年4月在西安市儿童医院住院治疗的难治性MPP(refractory mycoplasma pneumoniae pneumonia,RMPP)并发CVST病例的临床资料并查询相关文献,分析其临床诊疗特点,讨论RMPP并发CVST的诊断及治疗措施。2例均为6岁女童,以发热、咳嗽为主要症状,查体患侧肺呼吸音减低,双肺可闻及痰湿鸣音,肺炎支原体(mycoplasma pneumoniae,MP)抗体及RNA均阳性,胸部CT均提示大叶性肺炎并大量胸腔积液,大环内酯类抗生素抗感染治疗后效果欠佳,病程中均有头痛症状,血清D-二聚体显著升高,头颅MRI提示CVST,其中1例有下肢疼痛症状,血管B超提示右下肢动脉栓塞。经抗感染、手术取栓、抗凝及对症等治疗后,2例均病情好转出院。对于MPP患儿尤其是RMPP患儿有颅外血栓和/或有神经系统症状的表现,并伴有血清D-二聚体升高时,需考虑CVST的发生可能,应及时行头颅MRI检查明确并积极治疗,可减少或者避免后遗症的发生。血栓形成可能与MP感染导致的过度炎症反应及血管内皮损伤有关。Mycoplasma pneumoniae pneumonia(MPP)complicated with cerebral venous sinus thrombosis(CVST)is rare.We retrospectively analyzed the clinical data of two patients with refractory mycoplasma pneumoniae pneumonia(RMPP)complicated with CVST who were hospitalized in Xi′an children′s Hospital from December 2018 to April 2019,inquired the relevant literature,analyzed the clinical diagnosis and treatment characteristics,and discussed the diagnosis and treatment measures of RMPP complicated with CVST.Two cases were 6-year-old girls with fever and cough as the main symptoms.After physical examination,the respiratory sounds of the affected lung decreased,and the sounds of phlegm and dampness could be heard in both lungs.Mycoplasma pneumoniae(MP)antibody and RNA were positive.Chest CT showed lobar pneumonia with a large number of pleural effusion.The effect of macrolide antibiotics anti infection treatment was not good.Headache symptoms occurred during the course of the disease,and serum D-dimer increased significantly.Brain MRI showed CVST,including 1 case with lower extremity pain,and B-ultrasound showed right lower extremity arterial embolism.After anti infection,thrombectomy,anticoagulation and symptomatic treatment,2 cases were discharged.When children with MPP,especially those with RMPP,have extracranial thrombosis and/or neurological symptoms,accompanied by elevated serum D-dimer,the possibility of CVST should be considered,and brain MRI examination should be performed in time to confirm and actively treat,which can reduce or avoid the occurrence of sequelae.Thrombosis may be related to excessive inflammatory reaction and vascular endothelial injury caused by MP infection.

关 键 词：难治性肺炎支原体肺炎 颅内静脉窦血栓 儿童 

分 类 号：R725.6[医药卫生—儿科] R743[医药卫生—临床医学]