存在肺外表现的成人肺炎支原体肺炎临床特征及误诊分析  

Clinical Characteristics and Misdiagnosis of Adult Mycoplasmal Pneumonia with Extrapulmonary Manifestations

作　　者：熊鑫[1] 刘领[1] 周荣荣 薛兵[1] XIONG Xin;LIU Ling;ZHOU Rongrong;XUE Bing(Department of Respiratory and Critical Care Medicine,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院呼吸与危重症医学科,北京100022

出　　处：《临床误诊误治》2024年第10期6-10,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析存在肺外表现的成人肺炎支原体肺炎(AMP)患者的临床特征及误诊情况。方法回顾性分析2022年1月至2023年6月经肺炎支原体DNA检测阳性的AMP 60例临床资料,根据是否存在肺外表现分为无肺外表现组(n=29)和存在肺外表现组(n=31)。比较2组凝血功能、生化指标、院外病程、住院时间、误诊占比、误诊时间。结果60例AMP中存在肺外表现31例(51.67%),常见肺外表现有乏力18例(30.00%),关节肌肉痛16例(26.67%),头痛、纳差、腹泻各7例(11.67%),嗜睡4例(6.67%),皮疹3例(5.00%),恶心2例(3.33%),腰痛、黑便各1例(1.67%)。存在肺外表现组C反应蛋白、天冬氨酸转氨酶、乳酸脱氢酶、α-羟丁酸脱氢酶、纤维蛋白原水平均高于无肺外表现组(P<0.05)。存在肺外表现组住院时间以及误诊时间均长于无肺外表现组(P<0.05)。2组院外病程比较差异无统计学意义(P>0.05)。存在肺外表现组误诊占比高于无肺外表现组(P<0.05)。结论AMP存在较高的肺外表现发生率。存在肺外表现的AMP炎症反应程度更高,住院时间更长,误诊占比更高,临床应注意对这部分人群生化指标、凝血功能的监测,及时发现病情变化,避免误诊漏诊发生,延误治疗。Objective To analyze the clinical characteristics and misdiagnosis of adult mycoplasmal pneumonia(AMP)with extrapulmonary manifestations.Methods The clinical data of 60 adult patients with AMP and positive DNA detection of mycoplasma pneumoniae from January 2022 to June 2023 were retrospectively analyzed,and were divided into presence of extrapulmonary manifestation group(n=29)and absence of extrapulmonary manifestation group(n=31)according to presence or absence of extrapulmonary manifestations.Blood coagulation function,biochemical indexes,out-of-hospital course of disease,length of hospital stay,proportion of misdiagnosis and duration of misdiagnosis were compared between the two groups.Results Among the 60 patients with AMP,31 patients(51.67%)had extrapulmonary manifestations,and the common extrapulmonary manifestations included fatigue in 18(30.00%)patients,joint muscle pain in 16(26.67%)patients,headache in 7(11.67%)patients,poor appetite in 7(11.67%)patients,diarrhea in 7(11.67%)patients,drowsiness in 4(6.67%)patients,rash in 3(5.00%)patients,nausea in 2(3.33%)patients.lumbago in 1(1.67%)patient,and black stool in 1(1.67%)patient.The average levels of C-reactive protein,aspartate aminotransferase,lactate dehydrogenase,α-hydroxybutyrate dehydrogenase and fibrinogen in the presence of extrapulmonary manifestation group were higher than those in the absence of extrapulmonary manifestation group(P<0.05).The length of hospital stay and duration of misdiagnosis in the presence of extrapulmonary manifestation group were longer than those in the absence of extrapulmonary manifestation group(P<0.05).There was no significant difference in the out-of-hospital course of disease between the two groups(P>0.05).The proportion of misdiagnosis in the presence of extrapulmonary manifestation group was higher than that in the absence of extrapulmonary manifestation group(P<0.05).Conclusion MPP in adults has a high incidence of extrapulmonary manifestations.AMP with extrapulmonary manifestations has a higher degree of inflam

关 键 词：肺炎 支原体 肺外表现 成人 误诊 C反应蛋白 天冬氨酸转氨酶 乳酸脱氢酶 纤维蛋白原 

分 类 号：R563.1[医药卫生—呼吸系统]