摘要
目的探讨儿童肺炎支原体细支气管炎的临床特点及预后,提高对该病的认识。方法对首都医科大学附属北京儿童医院呼吸二科病房2017年3月至2020年3月诊断的71例肺炎支原体细支气管炎患儿病例资料进行回顾性分析。结果 (1)71例患儿起病中位年龄6.6岁,均有咳嗽表现;97.2%(69/71)有发热,中位热峰39.4℃;36.6%(26/71)有喘息;39.4%(28/71)有低氧血症;81.7%(58/71)有过敏背景。(2)中位白细胞7.6×109/L,78.9%(56/71)C反应蛋白升高(15 mg/L)。仅40.8%(29/71)胸片提示网状结节影,71例肺部高分辨率CT(HRCT)均可见小叶中心结节、树芽征,35.2%(25/71)为弥漫性细支气管炎,38.0%(27/71)合并少量肺实变或者肺不张。8.5%(6/71)电子支气管镜检查可见广泛黏稠分泌物。(3)均予阿奇霉素治疗;98.6%(70/71)应用甲泼尼龙,单日最大量为1~6 mg/(kg·d),首次应用时间中位病程为第10天,中位疗程为14 d。随访2.5~6.0个月,8.5%(6/71)发生闭塞性细支气管炎(BO)病情均为轻度;余91.5%(65/71)痊愈。(4)遗留BO患儿喘息、低氧血症、弥漫性细支气管炎的发生率明显高于未遗留BO者,P值分别为0.041、0.006和0.033。结论肺炎支原体细支气管炎患儿多数有过敏背景。肺部HRCT表现为弥漫性病变,有喘息和低氧血症者,发生BO的可能性大。
Objective To summarize the clinical features and prognosis of Mycoplasma pneumoniae bronchiolitis in children and improve the understanding about the disease.Methods Seventy-one children with Mycoplasma pneumoniae bronchiolitis"were recruited from Beijing Children’ s Hospital,who received treatment from March 2017 to March 2020.The clinical data of these childrenwere retrospectively analyzed.Results(1)The median onset age of the 71 childrenvas 6.6 years.Fever(69/71,97.2%) and cough(97/97,100%)were the common symptoms,while wheezing(26/71,36.6%) and hypoxemia(28/71,39.4%)often occurred in some severe cases.Atopic background was positive in 58 patients(58/71,81.7%).(2) The median WBC count in blood was 7.6×10^9/L.The level of CRP increased in 56 patients(56/71,78.9%) and the median level was 15 mg/L.Reticulonodular infiltrate in chest X-ray was found in 29 patients(29/71,40.8%).Centrilobular nodules and tree-in-bud pattern were the common chest HRCT features,and diffuse bronchiolitis was found in 25 patients(25/71,35.2%),while a little lung consolidation and atelectasis was also found in 27 patients(27/71,38.0%).Electronic bronchoscopy lavage was conducted in 71 patients and diffuse and sick secretion was found in 6.(3)All patients were treated with azithromycin.Seventy patients(70/71,98.6%) were treated with systemic methylprednisolone.The maximum dose of methylprednisolone ranged from 1 mg/(kg·d)to 6 mg/(kg·d),and the median initiation time was on Day 10 and the median course was 14 days.All patients were followed up for 2.5 to 6 months;6 patients(6/71,8.5%) developed mild bronchiolitis obliterans,while the other 65 patients(65/71,91.5%)were cured.(4)The proportion of wheezing,hypoxemia and diffuse bronchiolitis in patients who developed BO was higher than that in patients who didn’t develop BO,and P value was 0.041,0.006 and 0.033,respectively.Conclusion The children with Mycoplasma pneumoniae bronchiolitis often have atopic background.The lung HRCT shows diffuse lesion in lung,and the children who have wheezing and hypoxemia are more likely to develop BO.
作者
温潇慧
徐慧
唐晓蕾
刘辉
杨海明
申月琳
刘金荣
李惠民
赵顺英
WEN Xiao-hui;XU Hui;TANG Xiao-lei(No.2 Department of Respiratory Diseases,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)
出处
《中国实用儿科杂志》
CSCD
北大核心
2020年第12期963-967,共5页
Chinese Journal of Practical Pediatrics
基金
北京市科技重大专项资助项目(Z181100001918003)。
作者简介
通讯作者:赵顺英,电子信箱:zhaoshunying2001@163.com。
