儿童重症肺炎支原体肺炎的支气管镜镜下特征分析  

Bronchoscopic characteristics of severe mycoplasma pneumoniae pneumonia in children

作　　者：李丹丹 李攀[1] 刘新锋[1] 郎艳美 马铮 石艳玺 张艳平 Li Dandan;Li Pan;Liu Xinfeng;Lang Yanmei;Ma Zheng;Shi Yanxi;Zhang Yanping(Department ofⅣRespiratory,Hebei Children's Hospital,Hebei,Shijiazhuang 053000,China;Neonatal Intensive Care Unit,the Seventh Medical Center of PLA General Hospital,Faculty of Pediatrics,the Chinese PLA General Hospital,Beijing 100700,China)

机构地区：[1]河北省儿童医院呼吸四科,河北石家庄053000 [2]解放军总医院儿科医学部,解放军总医院第七医学中心,新生儿重症监护病房,北京100700

出　　处：《发育医学电子杂志》2023年第5期352-358,共7页Journal of Developmental Medicine (Electronic Version)

基　　金：河北省医学科学研究课题计划(20211652)。

摘　　要：目的探讨儿童重症肺炎支原体性肺炎(severe mycoplasma pneumoniae pneumonia,SMPP)的支气管镜镜下特征,为临床诊治提供参考。方法选取2020年1月至2021年12月于河北省儿童医院呼吸科住院的SMPP且行支气管镜检查及肺泡灌洗术的168例患儿为研究对象,按照年龄分为婴幼儿组(≤3岁)58例和儿童组(3~≤14岁)110例。比较两组患儿的临床症状、影像学资料,并分析支气管镜镜下特征性改变、临床预后等。统计学方法采用t检验、χ^(2)检验或Fisher确切概率法。结果儿童组与婴幼儿组的发热天数分别为(7.75±2.79)与(5.78±1.77)d、最高体温分别为(39.40±1.15)与(37.91±0.39)℃,儿童组均高于婴幼儿组(χ^(2)值分别为-5.609、-12.323,P值均<0.001);而出现咳痰[30.0%(33/110)与100%(58/58)]、喘息[15.5%(17/110)与77.6%(45/58)]、呼吸困难[10.9%(12/110)与25.9%(15/58)]及呕吐[6.4%(7/110)与41.4%(24/58)]的比例,儿童组低于婴幼儿组,差异均有统计学意义(χ^(2)值分别为74.954、62.959、6.295、30.944,P值均<0.05)。CT结果显示,实变大片影及坏死影像仅发生在儿童组,婴幼儿组与儿童组出现小斑片影[72.4%(42/58)与18.2%(20/110)]、磨玻璃样改变[65.5%(38/58)与27.3%(30/110)]等影像学变化,婴幼儿组明显高于儿童组,差异均有统计学意义(χ^(2)值分别为47.967、23.055,P值均<0.001)。儿童组与婴幼儿组支气管镜镜下黏膜糜烂坏死[46.4%(51/110)与3.4%(2/58)]及黏液栓阻塞[45.5%(50/110)与20.7%(12/58)],儿童组明显高于婴幼儿组(χ^(2)值分别为32.388、10.002,P值均<0.05),结节性突起及塑形形成仅见于儿童组。婴幼儿组未进行介入治疗,儿童组18.2%(20/110)患儿进行了介入治疗。结论儿童不同年龄段SMPP的支气管镜镜下特征有诸多不同,儿童组多表现为黏膜糜烂坏死、结节性突起、黏液栓阻塞及塑形形成,婴幼儿组常见絮状分泌物,可作为指导临床诊疗及进行预后评估的参考依据。Objective To investigate the bronchoscopic characteristics of severe mycoplasma pneumoniae pneumonia(SMPP)in children,and to provide reference for clinical diagnosis and treatment.Method A total of 168 children with SMPP who were hospitalized in the Department of Respiratory,Hebei Children's Hospital from January 2020 to December 2021 and underwent bronchoscopy and alveolar lavage were selected as the study objects,and they were divided into the infant group(≤3 years old,n=58),and the children group(3-≤14 years old,n=110)according to the age.The clinical symptoms and imaging data of the two groups were compared,and the characteristic changes under bronchoscopy and clinical prognosis were analyzed.The statistical methods performed by t-test,χ^(2) test or Fisher exact probability method.Result The fever days in the children group and the infant group were(7.75±2.79)vs(5.78±1.77)days,and the maximum body temperature was(39.40±1.15)vs(37.91±0.39)℃,respectively,which were higher in the children group than those in the infant group(χ^(2) value was-5.609 and-12.323,all P<0.001).In addition,sputum[30.0%(33/110)vs 100%(58/58)],wheezing[15.5%(17/110)vs 77.6%(45/58)],dyspnea[10.9%(12/110)vs 25.9%(15/58)]and vomiting[6.4%(7/110)vs 41.4%(15/58)],the above data in the children group were significantly lower than those in the infant group(χ^(2)value was 74.954,62.959,6.295,30.944,all P<0.05).The results of CT showed that the bulk of solid lesions and necrotic images only occurred in the children group;small spots[72.4%(42/58)vs 18.2%(20/110)]and ground glass changes[65.5%(38/58)vs 27.3%(30/110)]in the infant group were significantly higher than those in the child group with statistical significance(χ^(2)value 47.967,23.055,all P<0.001).Bronchoscopic mucosal erosion and necrosis[46.4%(51/110)vs 3.4%(2/58)]and mucous embolus obstruction[45.5%(50/110)vs 20.7%(12/58)]were significantly higher in the children group than those in the infant group(χ^(2)value was 32.388,10.002,all P<0.05),nodular protrusion and shape for

关 键 词：儿童 重症肺炎支原体肺炎 支气管镜 镜下特征 肺泡灌洗术 

分 类 号：R725.6[医药卫生—儿科]