儿童肺炎支原体肺炎合并肺血栓栓塞临床特征及利伐沙班治疗经验  

Clinical characteristics and therapeutic experience with rivaroxaban in children with Mycoplasma pneumoniae pneumonia associated with pulmonary thromboembolism

作　　者：张晶 刘奉琴 陈星 郭春艳 杨娟 梁燕 王珂 Zhang Jing;Liu Fengqin;Chen Xing;Guo Chunyan;Yang Juan;Liang Yan;Wang Ke(Department of Pediatric Respiratory,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院小儿呼吸科,济南250021

出　　处：《中华儿科杂志》2025年第4期373-378,共6页Chinese Journal of Pediatrics

基　　金：山东省自然科学基金面上项目(ZR2021MH315)。

摘　　要：目的探讨儿童肺炎支原体肺炎(MPP)合并肺血栓栓塞(PTE)临床特征,总结利伐沙班的疗效及安全性。方法病例系列研究。以2020年1月至2024年6月在山东第一医科大学附属省立医院小儿呼吸科收治的36例MPP合并PTE患儿为研究对象,收集其临床资料和随访情况,分析患儿临床转归及利伐沙班抗凝治疗效果。采用Mann-Whitney非参数秩和检验比较接受利伐沙班治疗前后凝血指标的差异。结果36例患儿中男27例、女9例,发病年龄(7.8±2.8)岁,PTE确诊于MPP发病后(17±6)d,低危PTE 34例(94%),13例(36%)同时合并其他部位栓塞。所有患儿均以持续发热和咳嗽起病,病程中出现气促33例(92%)、胸痛12例(33%)、咯血6例(17%)和呼吸困难5例(14%)。36例患儿经CT肺动脉造影均显示肺动脉受累。D二聚体5.1(4.2,12.2)mg/L,≥4.0 mg/L的29例(81%)。总抗凝时间3.1(2.5,4.2)个月。所有患儿接受利伐沙班序贯胃肠内抗凝治疗时间2.7(2.2,3.8)个月。35例完成抗凝治疗3个月随访,30例(83%)肺动脉血栓吸收。34例获得最终结局随访信息,其中33例受累部位血栓吸收,1例部分吸收,无死亡、血栓复发或进展、大出血事件、慢性血栓栓塞性肺动脉高压的发生,利伐沙班相关不良事件有咯血2例、肝酶升高4例。利伐沙班治疗后,D二聚体水平低于PTE治疗前[0.3(0.2,0.5)比5.1(4.2,12.2)mg/L,Z=-7.12,P<0.05],凝血酶原时间水平长于PTE治疗前[13.6(12.4,14.9)比13.0(11.8,13.6)s,Z=2.34,P<0.05]。结论MPP病程中出现气促、胸痛、咯血、呼吸困难等新临床症状或原疾病加重,D二聚体水平升高时需警惕PTE发生的可能。利伐沙班抗凝治疗效果好,安全性较高。Objective To evaluate the efficacy and safety of rivaroxaban and investigate the clinical features of Mycoplasma pneumoniae pneumonia(MPP)associated with pulmonary thromboembolism(PTE)in children.Methods A case series study was conducted on 36 children,diagnosed with MPP associated with PTE and hospitalized in our institution from January 2020 to June 2024 of Department of Pediatric Respiratory,Shandong Provincial Hospital Affiliated to Shandong First Medical University.Clinical data and follow-up information were collected to analyze their clinical characteristics,outcomes,and adverse events to rivaroxaban.Comparison of coagulation indices before and after treatment with rivaroxaban using the Mann-Whitney rank sum test.Results Among the 36 children,there were 27 males and 9 females,and the age of onset was(7.8±2.8)years.PTE was diagnosed(17±6)days after the onset of MPP.Thirty-four cases(94%)were classified as low-risk PTE,and 13 cases(36%)had thromboembolism of multiple anatomic sites.All patients presented with cough and fever,manifesting as shortness of breath in 33 cases(92%),chest pain in 12 case(33%),hemoptysis in 6 case(17%)and dyspnea in 5 cases(14%).Pulmonary artery involvement was demonstrated by CT pulmonary angiography in all 36 children.The D-dimer level was 5.1(4.2,12.2)mg/L.D-dimer levels were 5.1(4.2,12.2)mg/L,of which 29 cases(81%)were≥4.0 mg/L.The total duration of anticoagulation 3.1(2.5,4.2)months.All children received rivaroxaban for 2.7(2.2,3.8)months.Of the 36 children,35 cases were followed up after 3 months of anticoagulant therapy,and 30 cases(83%)showed pulmonary artery thrombus absorption.Finally,follow-up outcome data were available for 34 cases,of which 33 showed complete resolution of thrombus in the affected areas,and 1 showed partial resolution.There were no cases of death,thrombus recurrence or progression,major bleeding events occurred or chronic thromboembolic pulmonary hypertension.Adverse events included hemoptysis in 2 cases and elevated liver enzymes in 4 cases.After t

关 键 词：肺栓塞 支原体 肺炎 抗凝药 利伐沙班 儿童 

分 类 号：R725.6[医药卫生—儿科]