川崎病患儿肺炎支原体感染的临床特征分析

发布时间：2019-06-10 08:05

【摘要】：目的观察川崎病患儿肺炎支原体感染儿童的试验室检查数据及临床意义。方法回顾性分析2012年6月-2016年6月医院儿科确诊为川崎病的683例患儿,将30例肺炎支原体感染患儿列为观察组,未感染653例列为对照组,记录患儿临床资料及试验室检查结果、临床表现等进行分析;两组患者均于治疗前、后采空腹静脉血进行实验室检查,包括白细胞计数WBC、血小板计数PLT、红细胞沉降率ESR、超敏C-反应蛋白hs-CRP、血清降钙素PCT、血清免疫球蛋白、T细胞亚群等;应用全自动血培养仪及自动微生物鉴定仪分别进行细菌培养及鉴定;对两组患儿进行血清MP-IgM检测,使用血液抗凝法检测患儿血清中的肺炎支原体抗体;根据患儿超声心动图探查冠状动脉诊断冠状动脉损伤(CAL)。结果全体患儿送检血液样本共检出革兰阳性菌23株、革兰阴性菌48株、肺炎支原体30例以及肺炎衣原体3例,病原体分布;检测肺炎支原体感染率为4.4%;全体患儿治疗后复查WBC、PLT、ESR、Hs-CRP、PCT等实验室检测,治疗后WBC、PLT、Hs-CRP均较治疗前降低(P0.05),治疗后PCT较治疗前升高(P0.05),观察组与对照组在Hs-CRP及PCT方面差异有统计学意义(P0.05)。两组患儿在IgG、C3、CD8+与CD4+/CD8+差异有统计学意义(P0.05)。观察组CAD发生率为86.7%,对照组CAD发生率为42.9%。结论川崎病合并肺炎支原体感染的患儿增加了并发冠状动脉损伤(CAD)的概率,其体液免疫和细胞免疫较未并发感染MP的KD患儿更为紊乱,建议临床上加强重视,避免漏诊延误病情。
[Abstract]:Objective to observe the laboratory data and clinical significance of mycoplasma pneumoniae infection in children with Kawasaki disease. Methods from June 2012 to June 2016, 683 children with Kawasaki disease diagnosed by pediatrics in hospital were analyzed retrospectively. thirty children with mycoplasma pneumoniae infection were classified as observation group and 653 children without infection as control group. The clinical data, laboratory results and clinical manifestations of the children were recorded and analyzed. Fasting venous blood was collected before and after treatment in both groups for laboratory examination, including white blood cell count WBC, platelet count PLT, erythrocyte sedimentation rate ESR, sensitive C-reactive protein hs-CRP, serum calcitonin PCT, serum immunoglobulin. T cell subsets, etc. Bacterial culture and identification were carried out by automatic blood culture instrument and automatic microbial identification instrument, serum MP-IgM was detected in the two groups, and mycoplasma pneumoniae antibody in serum was detected by blood anticoagulant method. Diagnosis of coronary artery injury (CAL). According to echocardiography exploration of coronary artery in children Results 23 strains of Gram-positive bacteria, 48 strains of Gram-negative bacteria, 30 cases of Mycoplasma pneumoniae and 3 cases of Chlamydia pneumoniae were detected in all the children, and the infection rate of Mycoplasma pneumoniae was 4.4%. All the children were examined by WBC,PLT,ESR,Hs-CRP,PCT and other laboratory tests after treatment. The WBC,PLT,Hs-CRP after treatment was lower than that before treatment (P 0.05), and the PCT after treatment was higher than that before treatment (P 0.05). There were significant differences in Hs-CRP and PCT between the observation group and the control group (P 0.05). There was significant difference between IgG,C3,CD8 and CD4 / CD8 between the two groups (P 0.05). The incidence of CAD was 86.7% in the observation group and 42.9% in the control group. Conclusion the probability of (CAD) complicated with coronary artery injury in children with Kawasaki disease complicated with mycoplasma pneumoniae infection is increased, and their humoral immunity and cellular immunity are more disordered than those without MP infection. It is suggested that more attention should be paid to them in clinic. Avoid missed diagnosis and delay.
【作者单位】：华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)风湿免疫科;华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)重症医学科;南京鼓楼医院心血管内科;
【基金】：武汉市卫生局公共卫生科研基金资助项目(WG12B01)
【分类号】：R725.4

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