儿童重症肺炎支原体肺炎合并病毒感染的临床特征

Clinical characteristics of severe Mycoplasma pneumoniae pneumonia combined with viral infection in children

    摘要
  • 摘要:
    目的 探讨重症肺炎支原体肺炎（SMPP）合并病毒感染的发病特点及病原学特征。
    方法 回顾性收集2021年7月－2022年6月于济宁医学院附属医院就诊行支气管镜肺泡灌洗治疗的SMPP病例784例的临床资料，采用多重反转录聚合酶链反应检测11种呼吸道病原体联合血清支原体抗体滴度检测，按是否混合病毒感染分为单一肺炎支原体（MP）感染组和MP混合病毒感染组，分析患儿的临床表现、体格检查、实验室检查、影像学资料及纤维支气管镜下表现。
    结果 5岁以上儿童为SMPP的高发人群。单一MP感染者638例（81.38%），合并病毒感染者146例（18.62%），合并病毒感染前两位为腺病毒74例（占病毒感染者50.68%）、呼吸道合胞病毒（RSV）67例（45.89%）。MP合并病毒感染组年龄为（69.34±34.26）月，小于单一MP感染组（P=0.005），而住院时间、发热时间、合并肺气肿占比分别为7.00（6.00，9.00）d、（7.17±4.33）d、4.11%（6/146），长（高）于单一MP感染组（P＜0.05）；合并RSV感染患儿乳酸脱氢酶水平为345.00（293.00，425.00）U/L，高于合并腺病毒感染者（P=0.044）。
    结论 腺病毒、RSV是SMPP常合并感染的病毒。在实验室指标、纤维支气管镜下表现方面，单一MP感染组、混合病毒感染组及MP混合腺病毒组、MP混合RSV组发病特点均相似。MP合并病毒感染组年龄更小，住院时间更长，发热时间更长，合并肺气肿更多；合并RSV感染患儿乳酸脱氢酶水平高于合并腺病毒感染者。

     

    Abstract:
    OBJECTIVE  To investigate the epidemiological and etiological characteristics of severe Mycoplasma pneumoniae pneumonia (SMPP) complicated with viral infection.
    METHODS  A retrospective collection of clinical data from 784 SMPP cases treated with bronchoalveolar lavage via bronchoscopy at the Affiliated Hospital of Jining Medical University from Jul. 2021 to Jun. 2022 was conducted. Multiplex reverse transcription polymerase chain reaction was used to detect 11 respiratory pathogens, which was combined with serum Mycoplasma antibody titer testing. The cases were divided into a single M. pneumoniae (MP) infection group and an MP mixed viral infection group based on the presence or absence of mixed viral infection. The clinical manifestations, physical examinations, laboratory tests, imaging data and fiberoptic bronchoscopy findings of the children were analyzed.
    RESULTS Children over 5 years old were the high-risk group for SMPP. There were 638 cases (81.38%) for single MP infection and 146 cases (18.62%) for mixed viral infection. The top two viruses in mixed infections were adenovirus in 74 cases (50.68% of viral infectioned cases) and respiratory syncytial virus (RSV) in 67 cases (45.89%). The age of the MP mixed viral infection group was (69.34±34.26) months, which was younger than that of the single MP infection group (P=0.005). However, the length of hospital stay, fever duration and proportion of emphysema were 7.00 (6.00, 9.00) days, (7.17±4.33) days and 4.11% (6/146), respectively, which were longer (higher) than those in the single MP infection group (P＜0.05). The lactate dehydrogenase level in children with mixed RSV infection was 345.00 (293.00, 425.00) U/L, which was higher than that in children with mixed adenovirus infection (P=0.044).
    CONCLUSIONS  Adenovirus and RSV are commonly co-infected viruses in SMPP. In terms of laboratory indicators and fiberoptic bronchoscopy findings, the disease characteristics are similar among the single MP infection group, mixed viral infection group, MP mixed adenovirus group and MP mixed RSV group. The children in MP mixed viral infection group are younger, with longer hospital stays and fever durations and a higher incidence of emphysema. The lactate dehydrogenase level in children with mixed RSV infection is higher than that in children with mixed adenovirus infection.

     

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