儿童难治性肺炎支原体肺炎的临床和实验室特征

Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children.

作者信息

Wang Meijuan, Wang Yuqing, Yan Yongdong, Zhu Canhong, Huang Li, Shao Xuejun, Xu Jun, Zhu Hong, Sun Xiangle, Ji Wei, Chen Zhengrong

机构信息

Department of Respiratory Disease, Soochow University Affiliated Children's Hospital, Jingde Road No. 303, Suzhou, Jiangsu Province, 215003, P.R. China.

Department of Molecular Clinical Laboratory, Soochow University Affiliated Children's Hospital, Suzhou, P.R. China.

出版信息

Int J Infect Dis. 2014 Dec;29:18-23. doi: 10.1016/j.ijid.2014.07.020. Epub 2014 Oct 22.

DOI:10.1016/j.ijid.2014.07.020

PMID:25449230

Abstract

OBJECTIVES

The purpose of this study was to explore the clinical and laboratory characteristics of children with refractory Mycoplasma pneumoniae pneumonia (RMPP).

METHODS

Seventy-six children with RMPP and 26 children with non-refractory M. pneumoniae pneumonia (NRMPP), confirmed by both serology and fluorescent quantitation PCR in bronchoalveolar lavage fluid (BALF), were evaluated retrospectively.

RESULTS

Compared to those with NRMPP, children with RMPP were older (66.6±39.0 vs. 48.4±35.4 months, p=0.038) and had a longer duration of fever (12.7±2.6 vs. 7.5±1.8 days) and hospital stay (12.1±3.2 vs. 7.4±2.9 days). Children with RMPP presented neutrophil infiltration both in serum and BALF, as well as severe pulmonary lesions with pleural effusion. Children with RMPP had a significantly higher M. pneumoniae DNA load in BALF compared to NRMPP patients, and the M. pneumoniae load in BALF was significantly correlated with neutrophils and inversely correlated with macrophages for both the NRMPP and RMPP groups. The serum concentrations of tumor necrosis factor alpha (median 114.5 pg/ml, range 49.1-897.9 pg/ml) and interferon gamma (median 376.9 pg/ml, range 221.4-1997.6 pg/ml) were significantly higher in children with RMPP compared to children with NRMPP.

CONCLUSIONS

This study indicates that a direct microbe effect and the subsequent induced excessive host immune response contribute in part to the progression of RMPP.

摘要

目的

本研究旨在探讨难治性肺炎支原体肺炎（RMPP）患儿的临床及实验室特征。

方法

回顾性评估76例经血清学及支气管肺泡灌洗液（BALF）荧光定量PCR确诊的RMPP患儿和26例非难治性肺炎支原体肺炎（NRMPP）患儿。

结果

与NRMPP患儿相比，RMPP患儿年龄更大（66.6±39.0 vs. 48.4±35.4个月，p = 0.038），发热持续时间更长（12.7±2.6 vs. 7.5±1.8天），住院时间更长（12.1±3.2 vs. 7.4±2.9天）。RMPP患儿血清及BALF中均出现中性粒细胞浸润，并有严重的肺部病变伴胸腔积液。与NRMPP患儿相比，RMPP患儿BALF中肺炎支原体DNA载量显著更高，且NRMPP组和RMPP组BALF中肺炎支原体载量均与中性粒细胞显著相关，与巨噬细胞呈负相关。RMPP患儿血清肿瘤坏死因子α（中位数114.5 pg/ml，范围49.1 - 897.9 pg/ml）和干扰素γ（中位数376.9 pg/ml，范围221.4 - 1997.6 pg/ml）浓度显著高于NRMPP患儿。