摘要
目的观察不同年龄段儿童肺炎支原体肺炎(MPP)的临床表现,为精确医疗提供参考。方法选取2019年1月至2021年12月西安市儿童医院治疗的MPP患儿216例。其中,男117例,女99例。将其按年龄分为学龄组(>6岁、75例)、学龄前组(3~6岁、72例)及婴幼儿组(<3岁、69例)。收集并比较三组患儿的一般资料、临床症状、并发症、实验室检查指标、影像学及支气管镜下表现、疗效和转归。结果学龄组、学龄前组及婴幼儿组患儿干咳[45例(60.00%)、34例(47.22%)、18例(26.08%)]、喘息[13例(17.33%)、19例(26.39%)、41例(59.42%)]、并发胸腔积液[26例(34.67%)、20例(27.78%)、11例(15.94%)]、肺坏死[12例(16.00%)、3例(4.17%)、0例(0)]、肺部影像学(斑片影[12例(16.00%)、22例(30.56%)、46例(66.67%)]、磨玻璃影[11例(14.67%)、18例(25.00%)、40例(57.97%)]、实变影[58例(77.33%)、42例(58.33%)、8例(11.59%)])、发热时间[(9.58±4.85)d、(9.48±4.89)d、(6.58±3.64)d]、咳嗽缓解时间[9(8,12)d、9(8,11)d、8(7,11)d]比较,差异均有统计学意义(χ^(2)=16.94、31.10、6.59、15.53、41.51、33.40、65.12,F=11.97,H=6.05,均P<0.05);三组发热、呼吸困难、并发肺不张、转归情况比较,差异均无统计学意义(χ^(2)=0.21、0.27、0.61、1.74,均P>0.05)。三组患儿外周血中性粒细胞百分比[(63.91±10.96)%、(58.26±13.79)%、(50.98±13.79)%]、血小板计数[(305.01±96.13)×109/L、(324.91±108.05)×109/L、(342.41±120.50)×109/L]、红细胞沉降率[(47.07±26.46)mm/h、(48.29±26.33)mm/h、(38.16±18.23)mm/h]、肌酐[(39.10±7.02)μmol/L、(31.50±5.43)μmol/L、(25.85±4.57)μmol/L]、谷丙转氨酶[14(11,21)U/L、12(9,20)U/L、15(11,19)U/L]、肌酸激酶同工酶[17(14,21)U/L、20(16,24)U/L、23(19,27)U/L]及乳酸脱氢酶[260.0(224.5,343.5)U/L、294.5(252.0,379.3)U/L、317.0(266.5,384.5)U/L]水平比较,差异均有统计学意义(F=37.07、4.91、3.55、167.22,H=7.54、57.34、33.58,均P<0.05),三组患儿外周血白细胞计数、C反应蛋白及降钙素原水平比较差异均无统计学意义(H=1.09、2.49、2.21,均P>0.05)。三组患儿支气管镜镜检均可见黏膜充血水肿(χ^(2)=0.51,P>0.05);淋巴滤泡[43例(57.33%)、28例(38.89%)、18例(26.09%)]、纵行皱襞[58例(77.33%)、34例(47.22%)、10例(14.49%)]、黏液栓[46例(61.33%)、32例(44.44%)、6例(8.70%)]及塑型[16例(21.33%)、5例(6.94%)、0例(0.00%)]的检出则随着年龄增长,呈上升趋势,且三组间的差异均有统计学意义(χ^(2)=14.72、56.94、43.30、19.58,均P<0.05)。结论不同年龄段MPP患儿临床特征有所不同,婴幼儿喘息症状更为多见,易出现多器官功能损害,肺部影像学以散在斑片影、磨玻璃影为主;而年长儿多以干咳为主要表现,其肺部影像学以大片实变为主;支气管镜检可见特征性的淋巴滤泡、纵行皱襞、黏液栓及塑型,发热及咳嗽缓解时间更长。
ObjectiveTo investigate the clinical characteristics of Mycoplasma pneumonia infection in children of different ages,and to provide a basis for precise treatment.MethodsA total of 216 children with Mycoplasma pneumonia infection who were admitted to the Xi'an Children's Hospital from January 2019 to December 2021 were included in this study.These children consisted of 117 males and 99 females.These children were divided into school-age group(>6 years old,n=75),preschool group(3-6 years old,n=72)and infant and toddler group(<3 years old,n=69)according to age.Data on general demographics,clinical manifestations,complications,laboratory indicators,imaging findings,and bronchoscopic results,as well as treatment efficacy and outcomes,were collected and compared among the three groups.ResultsThere were statistically significant differences among the school-age,preschool,and infant and toddler groups in terms of dry cough[45(60.00%),34(47.22%),18(26.08%)],wheezing[13(17.33%),19(26.39%),41(59.42%)],concurrent pleural effusion[26(34.67%),20(27.78%),11(15.94%)],pulmonary necrosis[12(16.00%),3(4.17%),0(0)],pulmonary imaging findings(patchy shadows[12(16.00%),22(30.56%),46(66.67%)],ground-glass opacities[11(14.67%),18(25.00%),40(57.97%)],consolidation shadows[58(77.33%),42(58.33%),8(11.59%)]),fever duration[(9.58±4.85)days,(9.48±4.89)days,(6.58±3.64)days],and cough relief time[9(8,12)days,9(8,11)days,8(7,11)days](χ^(2)=16.94,31.10,6.59,15.53,41.51,33.40,65.12,F=11.97,H=6.05,all P<0.05).However,there were no statistically significant differences in fever,dyspnea,concurrent atelectasis,or prognosis(χ^(2)=0.21,0.27,0.61,1.74,all P>0.05).The percentage of neutrophils[(63.91±10.96)%,(58.26±13.79)%,(50.98±13.79)%],platelet count[(305.01±96.13)×109/L,(324.91±108.05)×109/L,(342.41±120.50)×109/L],erythrocyte sedimentation rate[(47.07±26.46)mm/h,(48.29±26.33)mm/h,(38.16±18.23)mm/h],creatinine[(39.10±7.02)µmol/L,(31.50±5.43)µmol/L,(25.85±4.57)µmol/L],alanine aminotransferase[14(11,21)U/L,12(9,20)U/L,15(11,19)U/L],creatine kinase isoenzyme[17(14,21)U/L,20(16,24)U/L,23(19,27)U/L],and lactate dehydrogenase[260.0(224.5,343.5)U/L,294.5(252.0,379.3)U/L,317.0(266.5,384.5)U/L]levels in the peripheral blood differed significantly among the school-age,preschool,and infant and toddler groups(F=37.07,4.91,3.55,167.22,H=7.54,57.34,33.58,all P<0.05).However,there were no statistically significant differences in peripheral blood white blood cell count,C-reactive protein,or procalcitonin levels(H=1.09,2.49,2.21,all P>0.05).The bronchoscopic examinations revealed mucosal congestion and edema in all three groups(χ^(2)=0.51,P>0.05).However,the detection of lymphoid follicles[43(57.33%),28(38.89%),18(26.09%)],longitudinal folds[58(77.33%),34(47.22%),10(14.49%)],mucus plugs[46(61.33%),32(44.44%),6(8.70%)],and airway shaping[16(21.33%),5(6.94%),0(0.00%)]increased with age,showing statistically significant differences among the three groups(χ^(2)=14.72,56.94,43.30,19.58,all P<0.05).ConclusionsThe clinical characteristics of children with Mycoplasma pneumonia infection vary among children of different ages.In infants and young children,wheezing symptoms are more common,and they are prone to multiple organ dysfunction.Lung imaging primarily shows scattered patchy shadows and ground-glass opacities.In contrast,older children mainly present with dry cough,and lung imaging typically reveals large areas of consolidation.Bronchoscopic examinations reveal characteristic findings such as lymphoid follicles,longitudinal folds,mucus plugs,and airway shaping,with longer durations of fever and cough relief.
作者
武楠
任思洋
张雯
陈伟超
Wu Nan;Ren Siyang;Zhang Wen;Chen Weichao(Second Department of Respiratory Medicine,Xi'an Children's Hospital,Xi'an 710003,Shaanxi Province,China)
出处
《中国基层医药》
2025年第7期975-980,共6页
Chinese Journal of Primary Medicine and Pharmacy
基金
陕西省西安市卫健委一般研究项目(2020yb29)
西安市儿童医院院级课题一般项目(2022F02)。
关键词
肺炎支原体
肺炎
感染
胸腔积液
发热
粒细胞
血小板
C反应蛋白质
儿童
Mycoplasma pneumoniae
Pneumonia
Infection
Pleural effusion
Fever
Granulocytes
Blood platelets
C-reactive protein
Child
