CAJ | 학술논문

目的探讨迁延与非迁延性肺炎支原体肺炎患儿气道黏膜损害的形态学特点,以期为临床判断预后和制定综合治疗方案提供参考.方法回顾性收集2006年6月至2007年12月在首都医科大学附属北京儿童医院诊断为肺炎支原体肺炎,并于急性期行支气管镜检查的住院患儿为研究对象.依据迁延性肺炎定义分为迁延性肺炎支原体肺炎(迁延)组(病程≥1个月)和非迁延性肺炎支原体肺炎(非迁延)组(病程<1个月).分析两组临床表现、影像学特征、支气管镜所见气道黏膜损害以及治疗和预后情况.结果研究期间144例(男61例,女83例)肺炎支原体肺炎患儿进入分析,年龄2～15岁.迁延组36例,非迁延组108例.胸部X线检查显示所有患儿均有单侧或双侧的肺实变.迁延组伴肺不张或含气不良25/36例(69%), 非迁延组为48/108例(44%);迁延组伴胸腔积液或胸膜增厚14/36例(39%),非迁延组为24/108例(22%).两组均可见气道黏膜滤泡样增生、粗糙、充血、肿胀、纵行皱褶和黏液性分泌物增多等,但程度和范围以迁延组为著;气道黏膜滤泡样增生和黏液性分泌物增多发生率迁延组显著高于非迁延组(36/36例 vs 91/108例,35/36例 vs 89/108例;P均<0.05).支气管开口炎症性狭窄,黏液栓阻塞及段支气管通气不良发生率迁延组显著高于非迁延组(11/36例 vs 10/108例,18/36例 vs 22/108例、24/36例 vs 44/108例;P均＜0.05).气道黏膜糜烂(3例)、肉芽组织增生(1例)、管腔闭塞(4例)和塑型性支气管炎(4例)等表现仅见于迁延组.结论肺炎支原体肺炎患儿气道黏膜损害特征性表现为黏膜滤泡样增生及黏液性分泌物增多,其持续存在表明气道黏膜炎症为活动性,提示肺炎支原体感染或炎症反应控制不良;黏膜糜烂、肉芽组织增生、闭塞性支气管炎及塑型性支气管炎可能提示病程迁延不愈.
목적 탐토천연여비천연성폐염지원체폐염환인기도점막손해적형태학특점,이기위림상판단예후화제정종합치료방안제공삼고.방법 회고성수집2006년6월지2007년12월재수도의과대학부속북경인동의원진단위폐염지원체폐염,병우급성기행지기관경검사적주원환인위연구대상.의거천연성폐염정의분위천연성폐염지원체폐염(천연)조(병정≥1개월)화비천연성폐염지원체폐염(비천연)조(병정<1개월).분석량조림상표현、영상학특정、지기관경소견기도점막손해이급치료화예후정황.결과 연구기간144례(남61례,녀83례)폐염지원체폐염환인진입분석,년령2～15세.천연조36례,비천연조108례.흉부X선검사현시소유환인균유단측혹쌍측적폐실변.천연조반폐불장혹함기불량25/36례(69%), 비천연조위48/108례(44%);천연조반흉강적액혹흉막증후14/36례(39%),비천연조위24/108례(22%).량조균가견기도점막려포양증생、조조、충혈、종창、종행추습화점액성분비물증다등,단정도화범위이천연조위저;기도점막려포양증생화점액성분비물증다발생솔천연조현저고우비천연조(36/36례 vs 91/108례,35/36례 vs 89/108례;P균<0.05).지기관개구염증성협착,점액전조새급단지기관통기불량발생솔천연조현저고우비천연조(11/36례 vs 10/108례,18/36례 vs 22/108례、24/36례 vs 44/108례;P균＜0.05).기도점막미란(3례)、육아조직증생(1례)、관강폐새(4례)화소형성지기관염(4례)등표현부견우천연조.결론 폐염지원체폐염환인기도점막손해특정성표현위점막려포양증생급점액성분비물증다,기지속존재표명기도점막염증위활동성,제시폐염지원체감염혹염증반응공제불량;점막미란、육아조직증생、폐새성지기관염급소형성지기관염가능제시병정천연불유.
Objective To explore the morphologic features of the airway mucosal lesions in children with persisting and non-persisting mycoplasma pneumoniae pneumonia.Methods This study retrospectively reviewed the records of the children with mycoplasma pneumoniae pneumonia who had admitted to Beijing Children′s Hospital and received bronchoscopy from June 2006 to December 2007. According to the process of the disease, they were divided into two groups which were the persisting mycoplasma pneumoniae pneumonia group (the process≥1 month) and the non-persisting mycoplasma pneumoniae pneumonia group (the process<1 month). The data of the two groups such as clinical manifestations, roentgenographic findings, airway mucosal lesions seen through the bronchoscope, and the condition of the treatment and prognosis were analyzed. Results There were 144 children with mycoplasma pneumoniae pneumonia(61 boys and 83 girls) aged from 2 to 15 years with a median of 7.5 years included in the groups. The persisting mycoplasma pneumoniae pneumonia group included 36 cases, and non-persisting mycoplasma pneumoniae pneumonia group included 108 cases. The radiologic findings of all patients in this study presented lobar or sublobar consolidation bilaterally or unilaterally. Twenty-five of 36 cases ( 69%) in the persisting mycoplasma pneumoniae pneumonia group and 48/108 cases (44%) in the non-persisting mycoplasma pneumoniae pneumonia group were with segmental or lobar atelectasis.14/36 cases (39%) in the persisting mycoplasma pneumoniae pneumonia group and 24/108 cases (22%) in the non-persisting mycoplasma pneumoniae pneumonia group were with small or large pleural effusion. Under flexible bronchoscope, the most common mucosal lesions in both groups were bronchial mucosal follicle-like hyperplasia, roughness, hyperemia, edema, microtubule reductus, and increasing mucus secretion,but the degrees and ranges of these lesions in the two groups were different. Bronchial mucosal follicle-like hyperplasia and the increasing mucus secretion were more common in the persisting mycoplasma pneumoniae pneumonia group than in the non-persisting mycoplasma pneumoniae pneumonia group(36/36 cases vs 91/108 cases, 35/36 cases vs 89/108 cases, P<0.05). Meanwhile the lesions such as airway inflammatory stenosis, mucus plug blocking and segmental bronchi dysventilation were the more common changes in the persisting mycoplasma pneumoniae pneumonia group than those in the non-persisting mycoplasma pneumoniae pneumonia group(11/36 cases vs 10/108 cases, 18/36 cases vs 22/108 cases, 24/36 cases vs 44/108 cases, P＜0.05). However, the lesions such as mucosal erosions(3/36 cases), granulation proliferation(1/36 cases), plastic bronchitis(4/36 cases) and bronchial obliteration (4/36 cases)were existed only in the persisting mycoplasma pneumoniae pneumonia group. Conclusions The characteristic bronchoscopic findings of the airway mucosal lesions in children with mycoplasma pneumoniae pneumonia were bronchial mucosal follicle-like hyperplasia and increasing mucus secretion. These two lesions meant the airway inflammation was active, and the infection of mycoplasma pneumoniae was out of control. The lesions like mucosal erosions, granulation proliferation, plastic bronchitis or bronchial obliteration indicated the process of mycoplasma pneumoniae pneumonia may be delayed.