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目的探讨肺炎支原体(MP)抗体IgM(MP-IgM)高滴度阳性的临床意义。方法2005年6月-2008年8月本院儿科共确诊MP感染患儿267例,均以呼吸道感染为主要症状,MP-IgM均阳性,其中63例MP-IgM呈高滴度阳性(即滴度≥1∶1 280),详细记录其临床资料并进行总结。结果1.MP-IgM高滴度阳性63例中,肺炎45例,急性支气管炎12例,急性上呼吸道感染6例。2.患儿以发热、咳嗽为主要表现,其中发热59例,刺激性剧烈咳嗽45例,39例肺部可闻及细湿啰音。3.心血管系统受累21例,肝功能受损35例,消化系统症状22例,皮疹7例,肾功能损伤3例,神经系统受累1例。4.胸部X线改变多种多样,45例患儿肺部异常,其中表现为肺纹理增粗模糊、小斑片状阴影15例,大片密度增高影或云絮状影12例,肺纹理增多、网结状阴影8例,大叶性肺炎6例,肺门增大4例。并胸腔积液3例,肺不张2例。5.均予阿奇霉素抗感染治疗[10 mg/(kg.d),连用5 d为1个疗程,停药4 d后,根据病情予下1个疗程治疗,每例患儿分别予1～4个疗程治疗]。治疗后发热持续时间平均6.6 d,咳嗽消失时间平均11.7 d,肺部啰音消失时间平均7.5 d。治疗后每周复查胸片,38例治疗2～3周病变基本吸收。结论MP-IgM高滴度阳性的MP感染患儿,临床症状较为严重,超过90%患儿表现为下呼吸道感染,大多为肺炎;胸片的好转时间明显落后于临床症状的改善,提示要及时复查胸片,不要因为临床症状的改善而盲目停止治疗。
Objective To investigate the clinical significance of high titer positive IgM (MP-IgM) antibody of Mycoplasma pneumoniae (MP). Methods From June 2005 to August 2008, a total of 267 children with MP infection were diagnosed in our pediatric department. All the patients were infected with respiratory tract infection. MP-IgM was positive, of which 63 were positive for MP-IgM Degree ≥1: 280 280), a detailed record of its clinical data and to summarize. Among 63 cases with high titer of MP-IgM, 45 cases were pneumonia, 12 cases were acute bronchitis and 6 cases were acute upper respiratory tract infection. 2. Children with fever, cough as the main performance, of which 59 cases of fever, irritation, severe cough 45 cases, 39 cases of lungs can be heard and fine wet rales. Cardiovascular system involvement in 21 cases, impaired liver function in 35 cases, digestive system symptoms in 22 cases, rash in 7 cases, 3 cases of renal dysfunction, nervous system involvement in 1 case. The chest X-ray changes a variety of 45 cases of children with abnormal lungs, which showed the thickening of the lungs fuzzy, small patchy shadow in 15 cases, large density or cloudy flocculus in 12 cases, increased lung markings , Net knot shadow in 8 cases, lobar pneumonia in 6 cases, hilar enlargement in 4 cases. And pleural effusion in 3 cases, 2 cases of atelectasis. 5 were azithromycin anti-infection treatment [10 mg / (kg.d), once every 5 d for a course of treatment, withdrawal 4 d, according to the disease to be given a course of treatment, each child were given 1 to 4 A course of treatment]. After treatment, the mean duration of fever was 6.6 days, the duration of cough disappearance was 11.7 days, and the pulmonary rales disappeared for an average of 7.5 days. Chest radiography weekly review after treatment, 38 cases of 2 to 3 weeks treatment of basic absorption. Conclusions Children with MP-IgM high titer positive MP infection have severe clinical symptoms. More than 90% of children with MP-IgM infection have lower respiratory tract infection, mostly pneumonia. The improvement time of the chest radiograph lags behind the improvement of clinical symptoms, suggesting promptly Check the chest, do not blindly stop treatment because of the improvement of clinical symptoms.