133例儿童社区获得性坏死性肺炎的临床特征及病原谱  

Clinical characteristics and pathogen profile of 133 cases of community-acquired necrotizing pneumonia in children

作　　者：李婉莹 贾婉玉 付书琴[1] 宋春兰 成怡冰 LI Wanying;JIA Wanyu;FU Shuqin;SONG Chunlan;CHENG Yibing(Children's Hospital Affiliated to Zhengzhou University,He'nan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou,He'nan 450000,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院郑州儿童医院,河南郑州450000

出　　处：《中国热带医学》2024年第9期1123-1128,共6页China Tropical Medicine

基　　金：河南省医学科技攻关计划省部级共建项目(No.SB201903028);河南省医学科技攻关联合共建项目(No.LHGJ20220734)。

摘　　要：目的探讨2023年河南省儿童医院儿童社区获得性坏死性肺炎(necrotizing pneumonia,NP)的临床特征及病原谱分布,为临床诊治该病提供依据。方法回顾性分析2023年河南省儿童医院住院NP患儿的临床资料,并与非NP组患儿进行对比,总结其临床症状、病原学特点、实验室指标及影像学改变、治疗及预后情况。结果133例NP患儿,男64例,女69例,中位年龄7岁;61例非NP组患儿,男38例,女23例,中位年龄6岁。NP组患儿出现胸痛、呼吸困难、精神反应差、拒食/脱水征、肺外并发症比例均较非NP组升高(P<0.05)。NP患儿住院天数18 d,发热持续时间12 d,外周血白细胞计数11.44×10^(9)/L,C反应蛋白37.44 mg/L,降钙素原0.207 ng/mL,红细胞沉降率40 mm/h,D二聚体1.99μg/mL,乳酸脱氢酶455 U/L,血清铁蛋白233.8μg/L,以上指标较非NP组均升高(P<0.05)。NP组患儿胸部增强CT检查坏死病灶出现在病程第(17.47±6.56)天,部分合并胸腔积液、胸膜增厚、支气管狭窄或扩张、肺不张、肺栓塞等,伴随不同程度的肺功能受损;支气管镜下黏膜充血水肿,部分可见黏膜糜烂坏死、痰栓阻塞、米汤样分泌物等改变。NP组患儿129例(97.0%)检出病原体,阳性病原体前5位依次为肺炎支原体、肺炎链球菌、腺病毒、鼻病毒、乙型流感病毒。单一病原感染76例(57.1%),混合感染53例(39.8%),混合感染患儿外周血白细胞计数、精神反应差、拒食/脱水征、肺外并发症及应用丙种球蛋白比例高于非混合感染组(P<0.05)。经抗感染、对症支持治疗后预后良好,个别遗留呼吸系统后遗症。结论NP患儿病程长,感染指标高,易出现肺内外并发症、肺功能损害,胸部增强CT扫描及支气管镜检查有助于及早识别NP。2023年NP感染病原以耐药肺炎支原体为主,部分患儿多种病原混合感染,积极治疗后一般预后良好。Objective To investigate the clinical data of pediatric community-acquired necrotizing pneumonia(NP)in 2023,summarizing its clinical characteristics and pathogen profile distribution.Methods The clinical data of hospitalized children with NP in 2023 at Henan Children's Hospital were retrospectively analyzed.Comparisons were made with those in the non-NP group to summarize the clinical symptoms,pathogenetic features,laboratory indices and imaging changes,treatment,and prognosis.Results Among the 133 NP cases,there were 64 males and 69 females,with a median age of 7 years.In the non-NP group,there were 61 cases,including 38 males and 23 females,with a median age of 6.The NP group showed significantly higher proportions of chest pain,dyspnea,poor mental response,refusal of food/dehydration signs,and extrapulmonary complications compared to the non-NP group(P<0.05).The hospitalization duration of NP children was 18 days,with a fever duration of 12 days.They had a peripheral blood leukocyte count of 11.44×10^(9)/L,C-reactive protein of 37.44 mg/L,procalcitonin of 0.207 ng/mL,blood sedimentation of 40 mm/h,D-dimer of 1.99μg/mL,lactate dehydrogenase of 455 U/L,and serum ferritin of 233.8μg/L,all significantly higher compared to the non-NP group(P<0.05).Enhanced chest CT in the NP group revealed necrotic foci on the(17.47±6.56)day of the disease,with some cases complicated by pleural effusion,pleural thickening,bronchial stenosis or dilatation,pulmonary atelectasis,pulmonary embolism,etc.,accompanied by different degrees of impaired lung function.Bronchoscopy revealed mucosal congestion and edema,with some showing mucosal erosion and necrosis,phlegm thrombus obstruction,and rice soup-like secretions.Pathogens were detected in 129(97.0%)children in the NP group,with the top five infectious agents being Mycoplasma pneumoniae,Streptococcus pneumoniae,adenovirus,rhinovirus,and influenza B virus.There were 76 cases(57.1%)of single pathogen infection,and 53 cases(39.8%)of mixed infection.The mixed infection group had highe

关 键 词：坏死性肺炎 儿童 肺炎支原体 肺炎链球菌 混合感染 

分 类 号：R563[医药卫生—呼吸系统]