儿童肺炎衣原体肺炎10例临床特征分析  

Clinical features of Chlamydia pneumoniae pneumonia in 10 children

作　　者：温潇慧 李惠民[1] 张晓艳[1] 刘辉[1] 唐晓蕾[1] 吴小会 徐玮涵 赵顺英[1] 杨海明[1] Wen Xiaohui;Li Huimin;Zhang Xiaoyan;Liu Hui;Tang Xiaolei;Wu Xiaohui;Xu Weihan;Zhao Shunying;Yang Haiming(Department No.2 of Respiratory Medicine,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院呼吸中心临床部二病区,北京100045

出　　处：《中华儿科杂志》2025年第4期362-366,共5页Chinese Journal of Pediatrics

基　　金：国家呼吸系统疾病临床医学研究中心“呼吸专项”(HX2X-20210401)。

摘　　要：目的总结儿童肺炎衣原体肺炎的临床特点。方法病例系列研究,回顾性收集2019年1月至2024年8月于首都医科大学附属北京儿童医院呼吸中心临床部二病区诊治的10例肺炎衣原体肺炎患儿的临床资料,包括一般情况、临床表现、肺部影像学、实验室检查及治疗情况等资料,总结其临床特征及预后。结果10例患儿中男7例、女3例。起病年龄11.2(10.3,13.1)岁。病程17(7,23)d。10例患儿中咳嗽9例,湿性咳嗽7例,发热6例(均为中、高热),胸痛4例,皮疹及咯血各1例。10例患儿肺部CT可见团状高密度影7例,均伴支气管充气征,周围有晕轮征,其中6例分布于胸膜下;余3例为斑片实变影。肺栓塞2例。10例患儿中双肺受累3例,单侧肺受累7例。血白细胞计数10.21(7.45,11.64)×10^(9)/L,中性粒细胞占比0.69(0.63,0.71)。7例患儿血C反应蛋白升高,为33(16,77)mg/L。3例患儿D二聚体轻度升高(分别为0.393、0.396、0.739 mg/L)。6例患儿血清肺炎衣原体IgM抗体阳性。6例患儿行支气管或肺泡灌洗液二代测序,均提示肺炎衣原体核酸阳性,其中2例血清IgM抗体及支气管灌洗液核酸检测均为阳性。10例患儿中,5例单用阿奇霉素抗感染治疗,其中1例加用糖皮质激素;4例阿奇霉素效果欠佳(3例更换多西环素、1例更换为米诺环素抗感染),其中2例加用糖皮质激素;1例病程长,先后予阿奇霉素、多西环素抗感染治疗后病情迁延,改莫西沙星联合糖皮质激素治疗。10例患儿均治愈。结论儿童肺炎衣原体肺炎主要见于大龄儿童,除咳嗽、发热外,可有胸痛表现,肺部影像学可见胸膜下团状高密度影伴晕轮征,可合并肺栓塞。儿童肺炎支原体肺炎诊断可借助核酸检测和(或)血清学抗体检测,部分需加用糖皮质激素治疗。Objective To summarize the clinical features of Chlamydia pneumoniae pneumonia(CPP)in children.Methods Case series study.Clinical data of 10 children with CPP hospitalized in Department No.2 of Respiratory Medicine of Beijing Children′s Hospital,Capital Medical University from January 2019 to August 2024 were retrospectively collected,including general information,clinical manifestations,chest imaging,laboratory examination and treatment.The clinical features and prognosis were summarized.Results Among the 10 children with CPP,7 were male and 3 were female.The age of onset was 11.2(10.3,13.1)years.The course were 17(7,23)days.Cough occurred in 9 cases with wet cough in 7 cases,while moderate and high fever occurred in 6 cases.Besides,chest pain occurred in 4 cases,rash and hemoptysis occurred in 1 case respectively.High density mass shadow was found in 7 cases chest CT imaging,accompanied by air bronchogram sign,surrounded by halo sign,6 cases of which were distributed under the pleura,while patchy consolidation in the remaining 3 cases.Pulmonary embolism was present in 2 cases.Among the 10 children with CPP,bilateral lung involvement was found in 3 cases and unilateral lung involvement in 7 cases.The white blood cell count was 10.21(7.45,11.64)×10^(9)/L and the proportion of neutrophils was 0.69(0.63,0.71).C-reactive protein increased in 7 cases,with the level of 33(16,77)mg/L.D-dimer increased slightly in 3 cases(0.393,0.396,0.739 mg/L).Serum Chlamydia pneumoniae-IgM antibody test was positive in 6 cases.Chlamydia pneumoniae nucleic acid test by bronchoalveolar lavage fluid(BALF)next-generation sequencing was positive in 6 cases.Both serum IgM antibody and BALF nucleic acid tests were positive in 2 cases.Among the 10 children with CPP,azithromycin alone was used in 5 cases,while glucocorticoid was added in 1 case.Due to poor response to azithromycin in 4 cases,doxycycline was replaced in 3 cases and minocycline was replaced in 1 case,while glucocorticoid was added in 2 cases.Moxifloxacin combined with glucoc

关 键 词：衣原体 肺炎 诊断 治疗 

分 类 号：R725.6[医药卫生—儿科]