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目的探讨难治性肺炎支原体肺炎(RMPP)患儿的临床特点。方法 150例肺炎支原体肺炎(MPP)患儿,其中60例采用大环内酯类药物治疗>5 d,影像学与临床仍表现恶化,将其归入RMPP组,其余90例归入MPP组。比较两组患儿实验室数据、胸部影像学表现、纤维支气管表现。结果两组患儿单核细胞与外周血中性粒细胞绝对值、淋巴细胞绝对值比较差异有统计学意义(P<0.05);RMPP组C反应蛋白(CRP)、乳酸脱氢酶(LDH)、血浆纤维蛋白原(Fib)、D-二聚体(D-dimer)指标显著高于MPP组,差异具有统计学意义(P<0.05)。RMPP组患儿支气管镜下有黏液分泌物阻塞,部分患儿出现坏死物阻塞、黏膜糜烂。患儿肺部有大片高密度实变影,伴有胸腔积液。MPP组患儿镜下可见部分水肿、黏膜粗糙、黏膜分泌物,无通气不良或阻塞表现,无坏死物阻塞与黏膜糜烂。胸片表现斑片状、云絮状阴影或大片密度增高影。结论 RMPP疾病发生与过强的黏液高分泌、混合感染、高凝状态、免疫炎性反应有关。
Objective To investigate the clinical features of children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods A total of 150 children with Mycoplasma pneumoniae pneumonia (MPP), 60 of whom were treated with macrolides for more than 5 days, were found to be worsened in both imaging and clinical manifestations. They were classified as RMPP and the remaining 90 as MPP. The laboratory data, chest radiographic findings and fibrobronchial manifestations were compared between the two groups. Results The absolute value of neutrophil and the absolute value of lymphocytes in monocytes and peripheral blood in two groups were significantly different (P <0.05). The levels of C-reactive protein (CRP), lactate dehydrogenase (LDH) , Fibrinogen (Fib) and D-dimer were significantly higher than those in MPP group (P <0.05). Bronchoscopy in children with RMPP group blocked mucus secretions, some children with necrosis obstruction, mucosal erosion. Children with large areas of high-density solid photocoagulation, with pleural effusion. MPP group of patients with microscopic edema can be seen under the microscope, mucosal rough, mucosal secretions, no signs of poor ventilation or obstruction, no necrosis obstruction and mucosal erosion. Chest radiograph patchy, cloud-like shadow or large density of shadow. Conclusion The occurrence of RMPP is associated with excessive mucus hypersecretion, mixed infection, hypercoagulable state and immune-inflammatory reaction.