摘要
目的了解海南地区儿童社区获得性肺炎支原体(Mp)肺炎的临床和流行病学特征,并分析甲泼尼龙辅助治疗的疗效。方法纳入2021年10月至2022年9月在海南省妇女儿童医学中心住院治疗的社区获得性肺炎患儿,采集其痰液或者鼻咽拭子,采用多重荧光定量聚合酶链反应毛细电泳片段分析技术检测呼吸道病原体。通过电子病历收集Mp肺炎病例的临床资料,分析临床特征、流行特征、疾病严重程度、合并检出其他呼吸道病原体情况,以及联合与未使用低剂量甲泼尼龙(每日1次,每次1~2 mg/kg)患儿的临床特点和转归。统计学分析采用非参数秩和检验。结果共有3032例因社区获得性肺炎住院的儿童病例接受了呼吸道病原体检测,Mp阳性检出率为25.46%(772/3032),Mp全年流行,5月至9月检出率高,达47.06%~64.84%。Mp肺炎患儿年龄为5.4(2.9,7.6)岁,同时检出其他呼吸道病原体者446例(57.77%),84.84%(655/772)有发热,热程为6(2,7)d,其中75.57%(495/655)的患儿为高热(热峰>39℃);98.96%(764/772)有咳嗽。重症Mp肺炎病例有100例(12.95%),多见于5岁以下儿童[67.00%(67/100)],30.00%(30/100)伴喘息,17.00%(17/100)伴肺不张,4.00%(4/100)伴胸腔积液。与未使用甲泼尼龙的患儿比较,联合甲泼尼龙治疗的患儿临床发热症状能更快改善[1.0(0,1.0)d比6.0(4.0,7.0)d],差异有统计学意义(Z=-15.82,P<0.001)。早期糖皮质激素治疗患儿9例,延迟糖皮质激素治疗患儿411例,两者发热症状改善时间差异无统计学意义[0.5(0,1.0)d比1.0(0,1.0)d;Z=-0.71,P=0.479]。结论Mp是引起海南地区5岁以上儿童社区获得性肺炎的常见病原体,临床多伴有高热症状,重症病例多见于5岁以下儿童,存在喘息、肺不张、胸腔积液等表现。低剂量甲泼尼龙联合抗菌药物治疗可显著缩短Mp患儿临床发热时间。Mp肺炎多合并其他多种病原体检出,但应区分定植或感染。
Objective To investigate the clinical and epidemiological characteristics of community-acquired Mycoplasma pneumoniae(Mp)pneumonia in children in Hainan region,as well as the efficacy of low-dose methylprednisolone adjuvant therapy.MethodsChildren with community-acquired pneumonia(CAP)in Hainan Women and Children′s Medical Center from October 2021 to September 2022 were enrolled.Sputum or nasopharyngeal swabs were collected and respiratory pathogens were detected by multiplex fluorescence quantitative polymerase chain reaction capillary electrophoresis fragment analysis.The clinical features,epidemiological characteristics,severity of disease and detection of combined pathogens of the children were analyzed.The clinical characteristics and outcomes of children with and without low-dose methylprednisolone(once a day,1 to 2 mg/kg each time)adjuvant therapy were analyzed.Statistical analysis was performed using the nonparametric rank-sum test.ResultsA total of 3032 children who were hospitalized with CAP underwent testing for respiratory pathogens.The positive detection rate of Mp was 25.46%(772/3032),and Mp was prevalent throughout the year,with a high detection rate of 47.06%to 64.84%from May to September.Among the children with Mp pneumonia,the age was 5.4(2.9,7.6)years,446 cases(57.77%)were detected with other respiratory pathogens,84.84%(655/772)had fever with a duration of 6(2,7)days,75.57%of the children had high fever(the peak temperature was more than 39℃),and 98.96%(764/772)had cough.There were 100 cases(12.95%)developed severe Mp pneumonia,mostly in children under five years of age(67.00%(67/100)),30.00%(30/100)with wheezing,17.00%(17/100)with pulmonary atelectasis,and 4.00%(4/100)with pleural effusion.Comparison with children who did not use methylprednisolone,children treated with methylprednisolone achieved clinical resolution of fever faster(1.0(0,1.0)d vs 6.0(4.0,7.0)d),and the difference was statistically significant(Z=-15.82,P<0.001).There were nine children with early methylprednisolone treatment and 411 children with delayed methylprednisolone treatment,and there was no significant difference in time to clinical resolution of fever between early and delayed methylprednisolone treatment(0.5(0,1.0)d vs 1.0(0,1.0)d;Z=-0.71,P=0.479).ConclusionsMp is a common pathogen causing CAP in children older than five years in Hainan region,which is mostly accompanied by clinical symptoms of high fever.Severe cases are mostly seen in children younger than five years,with the presence of wheezing,pulmonary atelectasis,pleural effusion.Low-dose methylprednisolone combined with antimicrobial treatment can significantly shorten the clinical fever time in children with Mp.Mp pneumonia is often associated with the detection of various other pathogens,but infection should be distinguished from colonization.
作者
吴守业
曾玫
周琼花
林道炯
魏仲秋
Wu Shouye;Zeng Mei;Zhou Qionghua;Lin Daojiong;Wei Zhongqiu(Department of Infectious Diseases,Hainan Women and Children′s Medical Center,Haikou 571103,China;Department of Infectious Diseases,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China)
出处
《中华传染病杂志》
CSCD
北大核心
2024年第11期647-655,共9页
Chinese Journal of Infectious Diseases
关键词
肺炎支原体
儿童
社区获得性肺炎
甲泼尼龙治疗
Mycoplasma pneumoniae
Children
Community-acquired pneumonia
Methylprednisolone therapy
