儿童支原体肺炎的临床表现和实验室检查及影像学特点分析

摘要

目的：了解儿童支原体肺炎（MPP）的临床表现、实验室检查及影像学特点。方法选取2013年6—12月入住本院的0~14岁肺炎儿童，按照肺炎支原体（ MP）病原学检测结果分为 MPP 和非 MPP 组，进行回顾性分析。且分年龄段〔≤3岁（婴幼儿）和>3岁两个年龄段〕比较 MPP 和非 MPP 组肺炎患儿的临床表现、实验室指标和影像学改变。结果（1）婴幼儿肺炎患儿 MPP 组院前病程及发热时间长于非 MPP 组，差异有统计学意义（ p <0.05）；而>3岁肺炎患儿两组间比较差异均无统计学意义（p >0.05）。（2）所有病例均有咳嗽，MPP 组夜间咳嗽症状评分高于非 MPP 组，肺部湿啰音发生率低于非 MPP 组，差异均有统计学意义（p <0.05）。>3岁肺炎患儿 MPP 组急性期喘息发生率高于非 MPP 组，差异有统计学意义（p <0.05），但婴幼儿肺炎患儿两组间比较差异无统计学意义（p >0.05）。（3）所有病例均有肺部异常 X 线征，婴幼儿 MPP 均表现为小叶性肺炎，但>3岁肺炎患儿 MPP 组较非MPP 组更多表现为大叶性肺炎，更多病例出现肺外表现，差异均有统计学意义（p <0.05）。（4）两个年龄段 MPP 病例比较，婴幼儿组更多伴有肺部湿啰音；>3岁组胸部正位片更多表现为大叶性肺炎、胸腔积液，C 反应蛋白（CRP）水平也更高，差异均有统计学意义（p <0.05）。（5）MPP 组各症状缓解时间、住院时间长于非 MPP 组，出院后6个月再发喘息或慢性咳嗽的发生率更高，差异均有统计学意义（ p <0.05）。结论与非 MPP 儿童比较，MPP 病例咳嗽更严重，肺部体征更轻微，胸部 X 线表现更多样化，症状恢复时间更长，恢复期更多病例出现慢性咳嗽或反复喘息。婴幼儿肺炎患儿的两组比较，MPP 组院前病程及发热时间更长；>3岁肺炎患儿中 MPP 组较非 MPP 组更多存在喘息、大叶性肺炎 X 线征及肺外表现。儿童肺炎病例应及早进行 MP 病原体检测及胸部 X 线摄片，早诊断早治疗是改善 MPP预后的关键。%[ AbstraCt] ObjeCtive To learn clinical manifestations,laboratory variables and imaging features in children with mycoplasma pneumoniae pneumonia. Methods Children with pneumonia aged 0 _ 14 hospitalizd in our hospital between June and December,2013 were chosen as our research subjects. They were divided into MPP group and non _ MPP group according to the pathogenic test results of mycoplasma pneumoniae( MP)and analyzed retrospectively. The clinical manifestations,laboratory variables and imaging features of both groups were compared in two different age groups:infants( ≤3 years old) group and older children( > 3 years old)group. Results (1)Among the infants,MPP group had longer course and duration of fever than non _ MPP group did before admission,with significant difference(p < 0. 05),but there were no statistical differences between those two groups in the older children( p > 0. 05). (2) All patients coughed. Compared with those in non _ MPP group,in MPP group cough symptom scores during night were higher but the incidence of moist rales of lung was lower,all with significant difference(p < 0. 05). In the older children group,the asthmatic proportion during acute period in MPP group was higher than that in non _ MPP group with significant difference(p < 0. 05),but the difference in infants group was not significant (p > 0. 05). (3)All patients had the abnormal X _ ray signs in lung. MPP patients in infants all showed lobular pneumonia, but MPP in older children group showed more lobar pneumonia than non _ MPP group did,and more cases appeared extra _pulmonary manifestations. All differences were significant(p < 0. 05). (4)The comparison between MPP cases in the two age groups indicated that infants accompanied more by lung moist rales,however chest X _ ray in old children group showed more lobar pneumonia and pleural effusion,and C _ reactive protein(CRP)values were higher;the differences were all significant (p < 0. 05). (5) The children with MPP showed longer duration of symptoms and hospital stay than non _ MPP group. The proportion of recurrent wheezing and chronic cough in MPP group were higher than that in non _ MPP group 6 months after discharge;all were significant(p < 0. 05). ConClusion Children with MPP usually have the following manifestations:more severe cough,fewer lung signs,various chest X _ ray,longer recovery time and more recurrent wheezing and chronic cough during recovery. Infants with MPP usually have a longer period of courses and fever before admission;older children with MPP appear more wheezing,lobar pneumonia with X _ ray signs and extra _ pulmonary manifestations than children with other pneumonia. We should carry out the mycoplasma microbiological tests and chest flims test as early as possible during the acute stage. The early diagnosis and treatment are the keys to improve the prognosis of MPP.