Lan Yinle, Li Shuxian, Yang Dehua, Zhou Junfen, Wang Yingshuo, Wang Jianhua, Xu Yingchun, Chen Zhimin
Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang.
Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China.
Medicine (Baltimore). 2020 May;99(19):e19987. doi: 10.1097/MD.0000000000019987.
This study aimed to investigate the inner linkage and mechanism of Mycoplasma pneumoniae (MP) infection and Kawasaki disease (KD), as well as the risk factors of outcome in this cohort of patients.A retrospective study was performed in 210 patients diagnosed with KD complicated with community acquired pneumonia (CAP) in Children's Hospital, Zhejiang University School of Medicine from January 2014 to December 2017. They were divided into two groups based on MP infection: MP infection group (n = 97) and non-MP infection group (n = 113). We compared the variables of these two groups based on medical records.The MP infection group had higher ESR than the non-MP infection group. During hospitalization, the non-MP infection group had higher levels of WBC during hospital, LDH, PCT, and lower HB when compared to the MP infection group. No differences were found in the hs-CRP level, N%, PLT, ALT, CKMB, and cytokine levels (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) between MP and non-MP infection group. Likewise, no difference was found in fever duration or hospital stays between them. Totally 19 patients in the infection group had CAA with a rate of 19.59%; and 27 (23.89%) patients had CAA in the non-MP infection group. Unfortunately, no difference was found in CAA rate between the two groups.MP infection may occur simultaneously in children with Kawasaki disease. KD patients with MP infection tended to occur in older population. MP infection may not increase the risk of CAA, which still needs further large-scaled studies to confirm. Clinicians should be alert to KD patients with high level of ESR. MP should be screened and early treatment with macrolides should be given timely.
本研究旨在探讨肺炎支原体（MP）感染与川崎病（KD）的内在联系及机制，以及该队列患者预后的危险因素。对2014年1月至2017年12月在浙江大学医学院附属儿童医院诊断为KD合并社区获得性肺炎（CAP）的210例患者进行回顾性研究。根据MP感染情况将他们分为两组：MP感染组（n = 97）和非MP感染组（n = 113）。我们根据病历比较了两组的变量。MP感染组的血沉（ESR）高于非MP感染组。住院期间，与MP感染组相比，非MP感染组的白细胞（WBC）、乳酸脱氢酶（LDH）、降钙素原（PCT）水平较高，血红蛋白（HB）较低。MP感染组和非MP感染组之间的超敏C反应蛋白（hs-CRP）水平、中性粒细胞百分比（N%）、血小板（PLT）、谷丙转氨酶（ALT）、肌酸激酶同工酶（CKMB）和细胞因子水平（白细胞介素-2、白细胞介素-4、白细胞介素-6、白细胞介素-10、肿瘤坏死因子-α和干扰素-γ）无差异。同样，两组之间的发热持续时间或住院时间也无差异。感染组共有19例患者发生冠状动脉瘤（CAA），发生率为19.59%；非MP感染组有27例（23.89%）患者发生CAA。遗憾的是，两组之间的CAA发生率无差异。MP感染可能在川崎病患儿中同时发生。合并MP感染的KD患者往往年龄较大。MP感染可能不会增加CAA的风险，这仍需要进一步的大规模研究来证实。临床医生应警惕ESR水平高的KD患者。应筛查MP并及时给予大环内酯类药物早期治疗。
