儿童肺炎支原体细支气管炎临床特征分析  

Clinical analysis of Mycoplasma pneumoniae bronchiolitis in children

作　　者：黄坤玲[1] 路素坤[1] 孙玲[2] 牛波[1] 曹丽洁[1] 及立立[1] 帅金凤[1] 刘建华[1] Huang Kunling;Lu Sukun;Sun Ling;Niu Bo;Cao Lijie;Ji Lili;Shuai Jinfeng;Liu Jianhua(Department of Respiratory 2,Hebei Children′s Hospital,Shijiazhuang 050031,China;Medical Office,Hebei Children′s Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院呼吸二科,石家庄050031 [2]河北省儿童医院医务处,石家庄050031

出　　处：《中华实用儿科临床杂志》2022年第12期909-913,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：河北省医学科学研究课题计划(20210084)。

摘　　要：目的:探讨肺炎支原体(MP)细支气管炎的临床特征,为临床防治提供参考。方法:回顾性研究。收集2019年1月至2020年1月在河北省儿童医院呼吸二科住院确诊为MP细支气管炎患儿的临床资料并进行分析,随访观察预后。结果:共纳入67例患儿。其中男39例,女28例;年龄5(1~14)岁。患儿均有咳嗽,其中63例(94.0%)发热,49例(77.8%)高热(≥39.0 ℃),总热程中位数为8(1~27) d;10例(14.9%)喘息;5例(7.5%)呼吸困难;3例(4.5%)低氧血症;58例(86.6%)肺部可闻及湿啰音;10例(14.9%)有喘鸣音。48例(71.6%)有家族过敏史或个人过敏史。外周血白细胞计数为(8.6±2.6)×10^(9)/L;C-反应蛋白中位数为9.1(0.5~55.6) mg/L,其中≥30 mg/L者7例(10.4%);乳酸脱氢酶中位数为278(181~590) U/L。胸部高分辨CT均表现为树芽征、小叶中心结节;双侧病变45例(67.2%),38例(56.7%)累及≥3个肺叶;22例(32.8%)并少量肺实变;19例(28.4%)并少量胸腔积液。35例(52.2%)患儿支气管镜下特点:71.4%(25/35例)表现为白色絮状、条索状分泌物;17.1%(6/35例)表现为黏液栓堵塞管腔;10.9%(4/35例)表现为结节样凸起合并肉芽组织增生。67例患儿均予阿奇霉素序贯治疗,42例(62.7%)患儿加用小剂量激素,首次应用时间为病程第(10.62±2.71)天,应用中位疗程为14(2~42) d。67例随访0.5年,其中61例(91.0%)患儿肺部几乎完全恢复,6例(9.0%)遗留闭塞性细支气管炎(BO)后遗症。 结论:MP细支气管炎多发生于具有家族过敏史或个人过敏史的婴幼儿及学龄前期儿童,以发热、咳嗽为主要临床表现,严重者可出现呼吸困难、低氧血症;肺部体征以湿啰音为主,部分有喘鸣音。支气管镜下表现以白色絮状、条索状分泌物为主。经积极治疗,多数患儿预后良好,部分患儿可遗留BO后遗症。Objective To explore the clinical characteristics of Mycoplasma pneumoniae(MP)bronchiolitis to provide references for clinical prevention and treatment.Methods From January 2019 to January 2020,the clinical data of children diagnosed with MP bronchiolitis in the Department of Respiratory 2 of Hebei Children′s Hospital were retrospectively collected and analyzed,and the patients were followed up to observe the prognosis.Results Among the 67 children,there were 39 boys and 28 girls,with age of 5(1-14)years.All the children had cough,63 cases(94.0%)had fever,49 cases(77.8%)had high fever(≥39.0℃),and the median total fever course was 8(1-27)d;10 cases(14.9%)had wheezing;5 cases(7.5%)had dyspnea;3 cases(4.5%)had hypoxemia;wet rales were heard in 58 cases(86.6%)and wheezing in 10 cases(14.9%).Forty-eight patients(71.6%)had family allergy history or personal allergy history.The average value of peripheral blood white blood cells was(8.6±2.6)×10^(9)/L;the me-dian of C reactive protein was 9.1(0.5-55.6)mg/L,of which 7 cases(10.4%)were≥30 mg/L;the median of lactate dehydrogenase was 278(181-590)U/L.Tree bud sign and central lobular nodules were the main findings of high-resolution CT of the chest.Among them,45 cases(67.2%)had bilateral lesions,38 cases(56.7%)involved≥3 lung lobes,and 22 cases(32.8%)had a little lung consolidation,19 cases(28.4%)had a small amount of pleural effusion.The bronchoscopic features of 35 children(52.2%):71.4%(25/35 cases)showed white flocculent and cord-like secretions,17.1%(6/35 cases)displayed mucus plugs blocking the lumen,and 10.9%(4/35 cases)showed no-dular protrusions and granulation tissue hyperplasia.All children were treated with Azithromycin sequentially;42 children(62.7%)were treated with low-dose hormones,and the average initiation time was on day(10.62±2.71)and the median course was 14(2-42)d.Sixty-seven cases were followed up for half a year,of which 61 cases(91.0%)had almost complete lung recovery,and 6 cases(9.0%)developed bronchiolitis obliterans(BO).Conclusions MP

关 键 词：儿童 肺炎支原体 细支气管炎 临床特征 

分 类 号：R725.6[医药卫生—儿科]