中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2015年
1期
59-64
,共6页
肺炎,支原体%儿童%疾病特征
肺炎,支原體%兒童%疾病特徵
폐염,지원체%인동%질병특정
Pneumonia,mycoplasma%Child%Disease attributes
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。
目的：瞭解兒童支原體肺炎（MPP）的臨床錶現、實驗室檢查及影像學特點。方法選取2013年6—12月入住本院的0~14歲肺炎兒童，按照肺炎支原體（ MP）病原學檢測結果分為 MPP 和非 MPP 組，進行迴顧性分析。且分年齡段〔≤3歲（嬰幼兒）和>3歲兩箇年齡段〕比較 MPP 和非 MPP 組肺炎患兒的臨床錶現、實驗室指標和影像學改變。結果（1）嬰幼兒肺炎患兒 MPP 組院前病程及髮熱時間長于非 MPP 組，差異有統計學意義（ p <0.05）；而>3歲肺炎患兒兩組間比較差異均無統計學意義（p >0.05）。（2）所有病例均有咳嗽，MPP 組夜間咳嗽癥狀評分高于非 MPP 組，肺部濕啰音髮生率低于非 MPP 組，差異均有統計學意義（p <0.05）。>3歲肺炎患兒 MPP 組急性期喘息髮生率高于非 MPP 組，差異有統計學意義（p <0.05），但嬰幼兒肺炎患兒兩組間比較差異無統計學意義（p >0.05）。（3）所有病例均有肺部異常 X 線徵，嬰幼兒 MPP 均錶現為小葉性肺炎，但>3歲肺炎患兒 MPP 組較非MPP 組更多錶現為大葉性肺炎，更多病例齣現肺外錶現，差異均有統計學意義（p <0.05）。（4）兩箇年齡段 MPP 病例比較，嬰幼兒組更多伴有肺部濕啰音；>3歲組胸部正位片更多錶現為大葉性肺炎、胸腔積液，C 反應蛋白（CRP）水平也更高，差異均有統計學意義（p <0.05）。（5）MPP 組各癥狀緩解時間、住院時間長于非 MPP 組，齣院後6箇月再髮喘息或慢性咳嗽的髮生率更高，差異均有統計學意義（ p <0.05）。結論與非 MPP 兒童比較，MPP 病例咳嗽更嚴重，肺部體徵更輕微，胸部 X 線錶現更多樣化，癥狀恢複時間更長，恢複期更多病例齣現慢性咳嗽或反複喘息。嬰幼兒肺炎患兒的兩組比較，MPP 組院前病程及髮熱時間更長；>3歲肺炎患兒中 MPP 組較非 MPP 組更多存在喘息、大葉性肺炎 X 線徵及肺外錶現。兒童肺炎病例應及早進行 MP 病原體檢測及胸部 X 線攝片，早診斷早治療是改善 MPP預後的關鍵。
목적：료해인동지원체폐염（MPP）적림상표현、실험실검사급영상학특점。방법선취2013년6—12월입주본원적0~14세폐염인동，안조폐염지원체（ MP）병원학검측결과분위 MPP 화비 MPP 조，진행회고성분석。차분년령단〔≤3세（영유인）화>3세량개년령단〕비교 MPP 화비 MPP 조폐염환인적림상표현、실험실지표화영상학개변。결과（1）영유인폐염환인 MPP 조원전병정급발열시간장우비 MPP 조，차이유통계학의의（ p <0.05）；이>3세폐염환인량조간비교차이균무통계학의의（p >0.05）。（2）소유병례균유해수，MPP 조야간해수증상평분고우비 MPP 조，폐부습라음발생솔저우비 MPP 조，차이균유통계학의의（p <0.05）。>3세폐염환인 MPP 조급성기천식발생솔고우비 MPP 조，차이유통계학의의（p <0.05），단영유인폐염환인량조간비교차이무통계학의의（p >0.05）。（3）소유병례균유폐부이상 X 선정，영유인 MPP 균표현위소협성폐염，단>3세폐염환인 MPP 조교비MPP 조경다표현위대협성폐염，경다병례출현폐외표현，차이균유통계학의의（p <0.05）。（4）량개년령단 MPP 병례비교，영유인조경다반유폐부습라음；>3세조흉부정위편경다표현위대협성폐염、흉강적액，C 반응단백（CRP）수평야경고，차이균유통계학의의（p <0.05）。（5）MPP 조각증상완해시간、주원시간장우비 MPP 조，출원후6개월재발천식혹만성해수적발생솔경고，차이균유통계학의의（ p <0.05）。결론여비 MPP 인동비교，MPP 병례해수경엄중，폐부체정경경미，흉부 X 선표현경다양화，증상회복시간경장，회복기경다병례출현만성해수혹반복천식。영유인폐염환인적량조비교，MPP 조원전병정급발열시간경장；>3세폐염환인중 MPP 조교비 MPP 조경다존재천식、대협성폐염 X 선정급폐외표현。인동폐염병례응급조진행 MP 병원체검측급흉부 X 선섭편，조진단조치료시개선 MPP예후적관건。
[ 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 <br> 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.
