难治性肺炎支原体肺炎患儿并发塑型性支气管炎的影像学特征及T淋巴细胞亚群变化  

Imaging feature of plasmacytoid bronchiolitis and changes of T lymphocyte subsets in children with refractory Mycoplasma pneumoniae pneumonia

作　　者：郑春林 喻耀华 陈强 胡向荣 郑志东 ZHENG Chun-lin;YU Yao-hua;CHEN Qiang;HU Xiang-rong;ZHENG Zhi-dong(Putian First Hospital,Putian,Fujian 351100,China)

机构地区：[1]莆田市第一医院儿科,福建莆田351100 [2]莆田市第一医院麻醉科,福建莆田351100

出　　处：《中华医院感染学杂志》2025年第2期260-264,共5页Chinese Journal of Nosocomiology

基　　金：福建省自然科学基金联合资金新上项目(2023J011729)。

摘　　要：目的探讨难治性肺炎支原体肺炎(RMPP)患儿并发塑型性支气管炎(PB)的临床特征、影像学特征及T淋巴细胞亚群水平,为临床后续制定合理的治疗方案提供参考。方法回顾性分析2022年1月—2024年4月莆田市第一医院收治的102例RMPP患儿的临床资料,根据是否并发PB分为PB组33例和非PB组69例。比较两组患儿的临床特征、影像学特征及外周血检查结果。结果PB组与非PB组患儿热峰[(40.87±0.54)℃vs.(39.07±0.41)℃]、热程[(9.76±2.20)d vs.(8.05±1.34)d]及肺部啰音、呼吸困难、低氧血症、多次支气管镜介入占比比较有统计学差异(P<0.05)。PB组与非PB组患儿支气管黏液嵌塞征、累及胸膜病变、双肺实变、肺不张和胸腔积液占比比较有统计学差异(P<0.05),PB组占比分别为36.36%、15.15%、63.64%、24.24%和36.36%。PB组与非PB组患儿血清D-二聚体(D-D)、降钙素原(PCT)、C-反应蛋白(CRP)、肌酸激酶同工酶(CKMB)和乳酸脱氢酶(LDH)水平比较有统计学差异(P<0.05),且PB组患儿指标水平更高,分别为(6.01±3.19)μg/ml、(0.18±0.02)ng/ml、(46.15±14.04)mg/ml、(23.47±4.59)IU/L和(497.86±41.25)U/L。PB组与非PB组患儿T淋巴细胞亚群水平比较有统计学差异(P<0.05)。结论RMPP并发PB患儿的热峰高,热程及住院天数长,支气管镜介入次数多,多伴肺部啰音、呼吸困难及低氧血症,影像表现以支气管黏液嵌塞征、累及胸膜病变、双肺实变、肺不张、胸腔积液为主,且患儿多伴血清D-D、PCT、C RP、CK-MB、LDH水平异常升高及T淋巴细胞亚群异常紊乱,临床需根据上述表现,警惕RMPP患儿发生PB。OBJECTIVE To explore the clinical characteristics,imaging manifestations and T lymphocyte subsets of the refractory Mycoplasma pneumoniae pneumonia(RMPP)children with plasmacytoid bronchiolitis(PB)so as to provide bases for formulating reasonable treatment programs.METHODS The clinical data were collected from 102 children with RMPP who were treated in Putian First Hospital from Jan.2022 to Apr.2024 and were retrospectively analyzed.The children were divided into the PB group with 33 cases and the non-PB group with 69 cases according to the status of PB.The clinical features,imaging characteristics and peripheral blood test indexes were observed and compared between the two groups of children.RESULTS The fever peak was(40.87±0.54)℃in the PB group,(39.07±0.41)℃in the non-PB group;the duration of fever was(9.76±2.20)days in the PB group,(8.05±1.34)days in the non-PB group;there were significant differences in the proportions of children with lung rales,dyspnea,hypoxemia and repeated bronchoscopic intervention procedures between the PB group and the non-PB group(P<0.05).There were significant differences in the proportions of children with bronchial mucus embedded signs,involved pleural lesions,bilateral solid lung lesions,pulmonary atelectasis and pleural effusion between the PB group and the non-PB group(P<0.05);the proportions of the PB group were 36.36%,15.15%,63.64%,24.24%and 36.36%,respectively.There were significant differences in the levels of serum D-dimer(D-D),procalcitonin(PCT),C-reactive protein(CRP),creatine kinase isoenzyme-MB(CK-MB)and lactate dehydrogenase(LDH)between the PB group and the non-PB group(P<0.05);the levels of above indexes of the PB group were respectively(6.01±3.19)μg/ml,(0.18±0.02)ng/ml,(46.15±14.04)mg/ml,(23.47±4.59)IU/L and(497.86±41.25)U/L,higher than those of the non-PB group.There were significant differences in the levels of T lymphocyte subsets between the PB group and the non-PB group(P<0.05).CONCLUSIONS The RMPP children with PB are characterized by the high fev

关 键 词：难治性肺炎支原体肺炎 感染 塑型性支气管炎 临床特征 影像学特征 T淋巴细胞亚群 

分 类 号：R563.1[医药卫生—呼吸系统]