目的 探讨儿童难治性肺炎支原体肺炎(RMPP)中医证型特点.方法 以81例RMPP住院患儿为研究对象,观察临床表现,进行中医辨证分型,统计分析各证型实验室指标特点.结果 81例患儿临床表现均有发热、咳嗽及肺部影像学异常,合并胸腔积液33例,肺不张12例,坏死性肺炎2例;63例患儿出现肺外合并症.中医证型分布:痰热壅肺证46例,肺脾气虚证15例,风热犯肺证12例,风寒袭肺证6例,阴虚肺热证2例.实验室指标中,白细胞(WBC)在正常范围,血沉(ESR)增快,C反应蛋白(CRP)、乳酸脱氢酶(LDH)、D-二聚体(D-dimer)显著升高.风寒袭肺组病程最短,年龄最大;肺脾气虚组病程最长;肺脾气虚组CRP、LDH均低于风热犯肺及痰热壅肺组.结论 儿童RMPP肺内外并发症常见,中医证型以痰热壅肺证为主,其次为肺脾气虚证;瘀血是贯穿儿童RMPP的重要病理因素;部分证型间病程、发病年龄、实验室指标有差异.%Objective:To explore the characteristics of TCM syndromes of RMPP in children.Methods:81 cases of RMPP hospitalized children were taken as the research object,and the clinical manifestations were observed;the TCM syndrome differentiation was carried out,and the characteristics of each syndrome type laboratory index were statistically analyzed.Results:The clinical manifestations of all 81 patients included fever,cough and abnormal imaging results,while pleural effusion was seen in 33 cases,atelectasis in 12 cases,necrotizing pneumonia in 2 cases.Extra-pulmonary complication occurred in 63 cases.The distribution of TCM syndromes was as follows:46 cases of phlegm-heat obstructing lung syndrome,15 cases of lung spleen Qi deficiency syndrome,12 cases of wind-heat attacking lung syndrome,6 cases of wind-cold attacking lung syndrome,2 cases of Yin deficiency and lung heat syndrome.Laboratory test showed that WBC was normal;ESR increased;CRP,LDH and Ddimer significantly increased.The course of the wind-cold attacking lung group was the shortest,the age the biggest.The course of the lung-spleen Qi deficiency group was the longest.CRP and LDH of the lung-spleen Qi deficiency group were lower than those of the wind-heat attacking lung and the phlegm-heat obstructing lung group.Conclusion:Children with RMPP often have pulmonary and extra-pulmonary complications.The patients of phlegm-heat obstructing lung are the most,and then followed by the lung-spleen Qi deficiency group.Blood stasis is the crucial pathological factor in RMPP.There are differences in duration,age of patient and laboratory tests in some groups.
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