Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou, 310052, China.
World J Pediatr. 2018 Aug;14(4):344-349. doi: 10.1007/s12519-018-0162-6. Epub 2018 Jun 11.
To investigate the clinical features of necrotizing pneumonia (NP) caused by refractory Mycoplasma pneumoniae pneumonia (RMPP).
A retrospective observational study was carried out in patients with NP caused by RMPP who were admitted to our hospital from January 2008 to December 2015, and the clinical manifestations, laboratory data, imaging performances, hospital courses and outcomes were analyzed.
Twenty-five patients with NP caused by RMPP were collected, with a median age of 5.1 (4.0-7.9) years. The mean duration of fever and hospital stay was 21.0 ± 8.9 and 19.9 ± 9.9 days, respectively. The levels of lactate dehydrogenase (LDH), C-reactive protein, interleukin (IL)-6, IL-10 and interferon-gamma were elevated. Meanwhile, the pleural fluid cell count, LDH and protein were also increased. 80.0% of the patients had pleural effusion; and a high incidence of lobar atelectasis and pulmonary consolidation was found the patients. The mean duration from the onset of symptoms to the discovery of necrotic lesions was 21.0 ± 6.9 days. 80.0% of the patients were administrated corticosteroids, and bronchoalveolar lavage was extracted separately from all patients. Of the 20 patients who presented with pleural effusion, 11 underwent thoracocentesis alone and 2 underwent chest drainage. All patients received prolonged courses of antibiotics (32.2 ± 8.7 days). All patients were dischaged home and recovered without surgical intervention; and chest lesions were resolved or only minimal residual fibrotic changes were residual within 3.0 (2.0-6.0) months.
Necrotizing pneumonia caused by RMPP is severe, however, self-limiting and reversible. Good outcomes can be achieved with appropriate management.
探讨难治性肺炎支原体肺炎（RMPP）所致坏死性肺炎（NP）的临床特征。
对 2008 年 1 月至 2015 年 12 月我院收治的 NP 患儿进行回顾性观察性研究，分析其临床表现、实验室数据、影像学表现、住院过程和结局。
共收集 25 例 RMPP 所致 NP 患儿，中位年龄 5.1（4.0-7.9）岁。发热和住院时间的平均时间分别为 21.0±8.9 和 19.9±9.9 天。乳酸脱氢酶（LDH）、C 反应蛋白、白细胞介素（IL）-6、IL-10 和干扰素-γ水平升高。同时胸腔液细胞计数、LDH 和蛋白也增加。80.0%的患者有胸腔积液；肺不张和肺实变的发生率较高。从症状出现到发现坏死病变的平均时间为 21.0±6.9 天。80.0%的患者接受了皮质激素治疗，所有患者均单独进行了支气管肺泡灌洗。20 例有胸腔积液的患者中，11 例单独进行了胸腔穿刺，2 例进行了胸腔引流。所有患者均接受了长时间的抗生素治疗（32.2±8.7 天）。所有患者均出院回家，无需手术干预即可康复；胸部病变在 3.0（2.0-6.0）个月内得到解决或仅残留最小的纤维性残留。
RMPP 所致 NP 严重，但具有自限性和可逆转性。适当的治疗可以获得良好的结局。
