难治性肺炎支原体肺炎并发血栓形成1例分析

摘要

Objective To investigate clinical features, diagnosis, and treatment of refractory Mycoplasma pneumoniae pneumonia (MPP) combined with thrombosis. Methods One case with refractory MPP associated with thrombosis was retrospectively analyzed with literature review. Results The patient presented with respiratory symptom at the onset, while melosalgia and decreased respiratory sound in left lung were occurred during anti-infection therapy. Thereafter, thrombosis of lower extremity veins and pulmonary embolism were confirmed by a series of examinations. Serum anti-phospholipid antibody was positive. Finally, the patient was treated with a combination of anticoagulation and immunosuppressive therapies. Conclusions The mechanism of refractory MPP combined with thrombosis may be associated with excessive inflammatory response and endothelial cells injury. The thrombosis complication should be suspected in patient of Mycoplasma pneumonia infection with positive anti-phospholipid antibody and low concentration of protein C and immunosuppressive therapy should be implemented promptly.%目的：探讨难治性肺炎支原体肺炎合并血栓形成的临床特点和诊断、治疗要点。方法回顾性分析1例难治性肺炎支原体肺炎合并下肢静脉血栓形成以及肺栓塞的病例资料。结果患儿以呼吸道症状起病，在抗感染治疗的过程中出现下肢肿痛和左肺呼吸音减低，经检查明确下肢静脉血栓形成和肺栓塞，伴抗心磷脂抗体阳性，经甲基泼尼松龙、丙种球蛋白抑制炎症反应，低分子肝素、华法林抗凝，阿司匹林抗凝的综合治疗，患儿症状、体征明显好转。结论难治性肺炎支原体肺炎合并血栓形成可能与过度炎症反应和内皮损伤有关。临床上对于难治性肺炎支原体肺炎合并有抗磷脂抗体阳性和蛋白C浓度降低的患儿，需要警惕合并血栓形成的可能性，应尽早使用糖皮质激素和丙种球蛋白治疗。