临床医学论著

儿童肺炎支原体肺炎的临床特征及其发病机制探讨

  • 曲艳杰 ,
  • 高淑青 ,
  • 孙红匣 ,
  • 王冬梅 ,
  • 董春凤 ,
  • 王佩霞
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  • 包头市第四医院,内蒙古包头 014030

收稿日期: 2021-07-06

  网络出版日期: 2023-01-09

Clinical features and pathogenesis of mycoplasma pneumoniae pneumonia in children

  • QU Yanjie ,
  • GAO Shuqing ,
  • Sun Hongxia ,
  • WANG Dongmei ,
  • DONG Chunfeng ,
  • WANG Peixia
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  • Baotou Fourth Hospital, Baotou 014030,China

Received date: 2021-07-06

  Online published: 2023-01-09

摘要

目的: 观察儿童肺炎支原体肺炎的临床特征,探讨社区获得性呼吸窘迫综合征毒素(CARDS TX)及血清IL-1β的表达等因素在肺炎支原体肺炎发病中的作用。方法: 选取本院2019年1月—2020年1月住院的社区获得性肺炎患儿120例为研究对象,分为重症支原体肺炎组(SMPP)(30例)、非重症支原体肺炎组(NSMPP)(50例)及非支原体肺炎组 (NMPP)(40例);所有研究对象检测支气管灌洗液CARDS TX水平及外周静脉血IL-1β、血生化、炎症指标、凝血功能等。结果: (1)CARDS TX和IL-1β:SMPP组明显高于NSMPP组,NSMPP组均高于NMPP组,差异均有统计学意义(P<0.05);(2)乳酸脱氢酶(LDH):SMPP组明显高于NSMPP和NMPP组,差异均有统计学意义(P<0.05);(3)炎性指标:C反应蛋白(CRP)和铁蛋白SMPP组明显高于NMPP组;降钙素原(PCT)NMPP组高于SMPP和NSMPP组,差异均有统计学意义(P<0.05);(4)凝血指标:凝血酶原时间(PT)、PT活动度(PT%)、部分凝血酶原时间(APTT)在SMPP组明显短于NSMPP组,又短于NMPP组;纤维蛋白原(FIB)SMPP组高于NSMPP,又高于NMPP组;D-二聚体(D-Di)SMPP组高于NSMPP、NMPP组,差异均有统计学意义(P<0.05)。结论: (1)CARDS TX可导致呼吸道损伤,同时诱导炎症因子IL-1β的产生增加,临床上可以通过CARDS TX的检测对支原体肺炎进行诊断,为进一步有针对性的治疗提供理论依据;(2)支原体感染后存在较严重的机体炎症反应,为抗炎治疗提供有力证据;(3)支原体感染时存在高凝血功能异常,是导致支原体感染出现血栓的原因,是引起支原体感染难治和重症的影响因素。

本文引用格式

曲艳杰 , 高淑青 , 孙红匣 , 王冬梅 , 董春凤 , 王佩霞 . 儿童肺炎支原体肺炎的临床特征及其发病机制探讨[J]. 包头医学院学报, 2022 , 38(10) : 64 -69 . DOI: 10.16833/j.cnki.jbmc.2022.10.013

Abstract

Objective: To observe the clinical characteristics of mycoplasma pneumoniae pneumonia in children, and to explore the role of community acquired respiratory distress syndrome toxin (CARDS TX) and serum IL-1β expression in the pathogenesis of mycoplasma pneumoniae pneumonia. Methods: A total of 120 children with community-acquired pneumonia hospitalized in our hospital from 2019 to 2020 were selected as the research objects and divided into severe mycoplasma pneumonia group (SMPP, 30 cases), non-severe mycoplasma pneumonia group (NSMPP, 50 cases) and non-mycoplasma pneumonia group (NMPP, 40 cases). All subjects underwent bronchial lavage fluid CARDS TX levels and peripheral venous blood IL-1β, blood biochemistry, inflammatory markers, coagulation function test. Results: (1) The levels of CARDS TX and IL-1β in SMPP group were higher than those in NSMPP group, and those in NSMPP group were higher than those in NMPP group, the differences were statistically significant (P<0.05). (2) The level of lactate dehydrogenase (LDH) in SMPP group was higher than that in NSMPP and NMPP groups, and the differences were statistically significant (P<0.05). (3) The levels of C-reactive protein (CRP) and ferritin in SMPP group were higher than those in NMPP group, and the level of procalcitonin (PCT) in NMPP group was higher than those in SMPP and NSMPP groups, the differences were statistically significant (P<0.05). (4) Prothrombin time (PT), PT activity (PT%) and partial prothrombin time (APTT) in SMPP group were shorter than those in NSMPP group and NMPP group; the fibrinogen (FIB) in SMPP group was higher than that in NSMPP group and higher than that in NMPP group; the D-dimer (D-Di) in SMPP group was higher than that in NSMPP and NMPP groups, and the differences were statistically significant (P<0.05). Conclusion: (1) CARDS TX can lead to respiratory tract injury, and increase the production of inflammatory cytokines IL-1β. Clinically, mycoplasma pneumonia can be diagnosed by CARDS TX detection, which provides a theoretical basis for further targeted treatment. (2) Severe inflammatory reaction after mycoplasma infection provides strong evidence for anti-inflammatory treatment. (3) High coagulation dysfunction in mycoplasma infection is the cause of thrombosis in mycoplasma infection, which is the influencing factor of refractory and severe mycoplasma infection.

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