小儿嗜肺军团菌肺炎合并肺炎支原体感染的临床特征分析

摘要

目的 探讨小儿嗜肺军团菌肺炎合并肺炎支原体感染的临床特征.方法 采用间接免疫荧光法对62例嗜肺军团菌肺炎患儿的血清肺炎支原体特异性抗体IgM进行检测,根据是否合并肺炎支原体感染分为研究组(n=30)与对照组(n=32).比较两组患儿入院时相关辅助检查结果和临床体征症状.结果 两组患儿性别、年龄比较差异无统计学意义(P>0.05),但研究组城镇患儿比例及住院天数均高于对照组(P<0.05);研究组WBC<4×109/L发生率与对照组比较,差异无统计学意义(P>0.05),但研究组ALT异常、AST异常、肌酸激酶同工酶>10 U/L、心电图ST-T段改变及心动过速、C反应蛋白>8.0 mg/L、WBC>20×109/L、胸片检查胸腔积液及大片斑片影发生率均高于对照组(P<0.05);研究组腹痛及咳嗽发生率与对照组比较,差异无统计学意义(P>0.05),但研究组肝脏增大、颈部淋巴结肿大、心率加快、肺部阳性体征、热程≥5 d、热峰≥40.0℃、发热发生率均高于对照组(P<0.05).结论 小儿嗜肺军团菌肺炎合并肺炎支原体感染患儿临床症状及不良体征明显加重,且多合并肺外器官损伤.%Objective To investigate the clinical characteristics of children with Legionella pneumophila pneumonia complicated with Mycoplasma pneumoniae infection.Methods Sixty-two children with Legionella pneumophila pneumonia were detected by indirect immunofluorescence assay for the specific antibody M of serum Mycoplasma pneumoniae,and they were divided into study group(n=30) and control group(n=32) depending on whether they were complicated with Mycoplasma pneumoniae infection.The auxiliary examination results on admission and the clinical signs and symptoms of the children were compared between the two groups.Results There was no significant difference in gender or age between the two groups(P>0.05),but the study group had higher proportion of urban children and more hospital stay compared with the control group(P<0.05).There was no statistically significant difference in the incidence rate of WBC less than 4×109/L between the study group and the control group (P>0.05),but the study group had abnormal ALT and AST,and obtained higher incidence rates of creatinine kinase-MB(CK-MB) more than 10 U/L,ECG ST-T segment changes and tachycardia,C-reactive protein(CRP) more than 8.0 mg/L,WBC less than 20×109/L,and pleural effusion and large patchy shadow revealed by chest X-ray compared to the control group(P<0.05).There was no significant difference in the incidence rate of abdominal pain or cough between the study group and the control group(P>0.05),but the study group had higher incidence rates of hepatomegaly,cervical lymphedema,tachycardia,positive pulmonary signs,duration of fever more than or equal to 5 days,the highest temperature of fever more than or equal to 40.0℃,and fever compared to the control group(P<0.05).Conclusion Children with Legionella pneumophila complicated with Mycoplasma pneumoniae infection have obviously severer clinical symptoms and adverse signs,and most of them are complicated with extrapulmonary organ injury.