论文部分内容阅读
目的对昆明地区175例小儿肺炎衣原体(CPn)感染患儿临床特点进行分析。方法应用间接免疫荧光法(IFA),对小儿急性下呼吸道感染(ALRI)住院患儿进行肺炎衣原体血清IgM抗体检测,对其中资料齐全的175例Cpn阳性病例年龄分布特点、临床特征进行回顾性分析。结果 ~1岁、~3岁、~6岁、>6岁年龄组分别占阳性病例的6.9%、21.1%、39.4%、32.6%,随年龄增长CPn感染呈上升趋势,~6岁以上儿童占阳性病例的72%。男女儿童阳性率无性别差异。CPn感染临床无特异表现,咳嗽伴发热者多见,多为低-中度发热,热程多为7~14d,少数患儿可持续14d以上,急性呼吸道症状早期以干咳为主要表现;肺部体征出现较晚,但仍可闻及干、湿性啰音,有大叶实变者可有肺部实变体征;胸部X线改变多样,可表现为支气管肺炎、肺门炎变、节段性肺炎、大叶性肺炎等;部分患儿白细胞总数及中性粒细胞百分比升高、CRP增高。CPn混合MP、LP1感染27例,多伴肺外器官、系统的损害,尤以肝功能、心肌损害为多见,病程亦较长。肺外并发症31例,为化脓性扁桃腺炎、过敏性紫癜、心肌炎、急性肾小球肾炎、麻疹等。大环内酯类抗菌药物治疗有效。结论 CPn病原体感染以年长儿多见,可伴混合感染及肺外并发症,病原学监测对儿童CPn感染诊治、减少临床盲目经验用药有重要的作用。
Objective To analyze the clinical features of 175 children with Chlamydia pneumoniae (CPn) infection in Kunming area. Methods The indirect immunofluorescence assay (IFA) was used to detect the serum IgM antibody of Chlamydia pneumoniae in hospitalized children with acute lower respiratory tract infection (ALRI). The age distribution characteristics and clinical features of 175 Cpn positive cases with complete data were analyzed retrospectively . Results ~ 1 year old, ~ 3 years old, ~ 6 years old,> 6 years old group accounted for 6.9%, 21.1%, 39.4%, 32.6% of positive cases respectively. CPn infection increased with age, 72% of positive cases. The positive rate of boys and girls had no gender difference. Clinical manifestations of CPN infection were nonspecific. Cough with fever was more common, mostly with low-moderate fever, with fever ranged from 7 to 14 days, and a few children survived for more than 14 days. Early onset of acute respiratory symptoms mainly manifested as dry cough. Signs appear later, but still can be heard and dry and wet rales, solidified large lobe may have signs of lung consolidation; chest X-ray changes in diverse, can be manifested as bronchial pneumonia, hilar inflammation, segmental Pneumonia, lobar pneumonia, etc .; some children with leukocytes and the percentage of neutrophils increased CRP increased. CPn mixed MP, LP1 infection in 27 cases, many with extrapulmonary organs and system damage, especially liver function, myocardial damage is more common, longer duration. 31 cases of extrapulmonary complications, suppurative tonsillitis, allergic purpura, myocarditis, acute glomerulonephritis, measles and so on. Macrolide antibiotic treatment is effective. Conclusion CPn pathogen infection is more common in older children, with mixed infection and extrapulmonary complications. Etiological monitoring plays an important role in the diagnosis and treatment of children’s CPN infection and the reduction of clinical blind experience.