摘要
目的探讨肺炎支原体相关性噬血细胞综合征(MP-HPS)的临床特点、诊断、治疗及转归。方法回顾性分析2013年6月1日至2018年12月31日深圳市儿童医院收治的MP-HPS患儿的临床资料。结果 11例MP-HPS患儿的中位年龄为3岁3个月(7个月至9岁7个月),<3岁5例,男6例、女5例。均有发热,咳嗽8例,腹泻3例,精神差1例;均有肝大,脾大6例。均表现为不同程度地血细胞减少、血清铁蛋白升高(≥500μg·L-1)和乳酸脱氢酶不同程度地升高;骨髓象提示均有噬血细胞现象;肝功能异常8例,高甘油三酯9例,低纤维蛋白原血症6例,NK细胞活性降低8例;11例均经MP-IgM和/或MP-DNA检查证实MP感染,合并细菌和真菌感染各2例,未检测到其他病毒感染。胸部X线和CT显示,11例均有肺炎表现,合并胸腔积液7例,合并纵膈气肿和颈胸部皮下气肿1例。7例行支气管镜检查,塑形性支气管炎2例。治疗和预后:均予大环内酯类联合其他抗生素治疗,使用糖皮质激素和丙种球蛋白各10例、环孢素4例,环孢素+依托泊苷1例;7例入住PICU,其中气管插管5例;好转出院9例,死亡2例。结论 MP-HPS应早期明确诊断,积极治疗,及时阻断细胞因子风暴,以改善患儿的预后。
Objective To investigate the clinical characteristics,diagnosis,treatment and prognosis of mycoplasma pneumoniae⁃associated hemophagocytic syndrome(MP⁃HPS).Methods The clinical data of MP⁃HPS children admitted to Shenzhen Children's Hospital between June 1,2013 and December 31,2018 were retrospectively analyzed.Results The median age of 11 patients with MP⁃HPS was 3 years and 3 months.There were 5 cases aged younger than 3 years,6 males and 5 females.Clinical manifestations included fever in 11 cases,cough in 8 cases,diarrhea in 3 cases,and poor mental health in 1 case.All patients had large liver,and large spleen was found in 6 cases.Laboratory examination results showed all of 11 patients had different degrees of hemocytopenia,elevated serum ferritin(≥500μg·L-1)and lactate dehydrogenase.Bone marrow images suggested hemophagocytosis in 11 cases.There were 8 cases of abnormal liver function,9 cases of high triglyceride,6 cases of low fibrinogenemia,and 8 cases of decreased NK cell activity.MP infection was confirmed by MP⁃IgM MP⁃DNA tests in all 11 cases with 2 cases of combined bacterial infections and 2 cases of fungal infections.No other viral infections were detected.Imaging examination(chest X⁃ray and chest CT)results showed all of 11 cases presented pneumonia,7 cases were complicated with pleural effusion,and 1 case was complicated with mediastinal emphysema and subcutaneous emphysema of the neck and chest.Seven cases underwent bronchoscopy and 2 cases had plastic bronchitis.Macrolides were combined with other antibiotics.Glucocorticoid and gamma globulin were used in 10 patients,immunosuppressant(cyclosporin)was used in 4 patients,and cyclosporin+etoposide was used in 1 patient.Among the 7 patients admitted to PICU,5 were intubated.Nine cases were discharged after improvement and 2 cases died.Conclusion MP⁃HPS should be diagnosed early and treated actively.Cytokine storm should be blocked in time to improve the prognosis of children.
作者
谷加丽
卢志威
王文建
郑跃杰
李晶
邵艳冰
GU Jia-li;LU Zhi-wei;WANG Wen-jian;ZHENG Yue-jie;LI Jing;SHAO Yan-bing(Shenzhen Children's Hospital,Shenzhen 518026,China)
出处
《中国循证儿科杂志》
CSCD
北大核心
2020年第3期229-232,共4页
Chinese Journal of Evidence Based Pediatrics
关键词
肺炎支原体
噬血细胞综合征
儿童
治疗
Mycoplasma pneumoniae
Hemophagocytic syndrome
Child
Therapy
