Necrotizing pneumonia caused by refractory Mycoplasma pneumonia pneumonia in children
Necrotizing pneumonia caused by refractory Mycoplasma pneumonia pneumonia in children
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DOI：
10.1007/s12519-018-0162-6
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发表时间：
2018-08-01
影响因子：
8.7
通讯作者：
Zhang, Yuan-Yuan
中科院分区：
文献类型：
--
作者：
Wang, Xia;Zhong, Li-Jia;Zhang, Yuan-Yuan
背景 探讨难治性肺炎支原体肺炎（RMPP）所致坏死性肺炎（NP）的临床特点。方法对我院2008年1月至2015年12月收治的难治性肺炎支原体肺炎（RMPP）所致坏死性肺炎（NP）患者进行回顾性观察，了解其临床表现、实验室资料、影像学表现、住院病程及治疗情况。 结果 纳入RMPP所致NP患者25例，中位年龄5.1（4.0~7.9）岁。平均发病时间和住院时间分别为 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的水平升高。同时，胸水细胞计数、LDH、蛋白也升高。 80.0%的患者有胸腔积液；患者肺叶不张和肺实变发生率较高。从出现症状到发现坏死病灶的平均持续时间为21.0+/-6.9天。 80.0%的患者使用皮质类固醇，所有患者均单独抽取支气管肺泡灌洗液。 20 例出现胸腔积液的患者中，11 例仅接受胸腔穿刺术，2 例接受胸腔引流术。所有患者均接受长期抗生素疗程（32.2 +/- 8.7 天）。所有患者均出院回家，无需手术干预即可康复； 3.0（2.0-6.0）个月内胸部病灶消退或仅残留微小纤维化改变。结论 RMPP引起的坏死性肺炎病情严重，但具有自限性、可逆性。通过适当的管理可以取得良好的结果。
Background To investigate the clinical features of necrotizing pneumonia (NP) caused by refractory Mycoplasma pneumoniae pneumonia (RMPP).Methods 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.Results 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 offever and hospital stay was 21.0 +/- 8.9 and 19.9 +/- 9.9days, 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 alsoincreased. 80.0% of the patients had pleural effusion; and a high incidence of lobar atelectasis and pulmonary consolidation was found the patients. The meanduration from the onset of symptoms to the discovery of necrotic lesions was 21.0 +/- 6.9days. 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 +/- 8.7days). 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.Conclusions Necrotizing pneumonia caused by RMPP is severe, however, self-limiting and reversible. Good outcomes can be achieved with appropriate management.