«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2025年01期

页码:

55-61

栏目:

论著

出版日期:

2025-02-25

文章信息/Info

Title:

Analysis of epidemiological and clinical characteristics of 465 pediatric cases of Mycoplasma pneumoniae pneumonia: a single-center retrospective study

作者:

吕奎林¹; 2; 陈 虹²

400037 重庆,陆军军医大学第二附属医院儿科¹
400016 重庆,重庆医科大学附属第一医院呼吸与危重症医学科²

Author(s):

Lyu Kuilin¹; 2;  Chen Hong².

¹Department of Pediatrics, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China; ²Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongq

关键词:

肺炎支原体;  肺炎;  儿童;  临床特征

Keywords:

Mycoplasma pneumoniae;  Pneumonia;  Children;  Clinical characteristics

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2025.01.009

摘要:

目的 分析儿童肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia, MPP)的流行病学变迁及重症化临床特征,探讨2023年后肺炎支原体(Mycoplasma pneumoniae, MP)感染高发趋势的潜在影响因素,为优化诊疗策略提供参考。方法 回顾性纳入我院2018年1月至2024年5月MPP住院患儿临床资料,分析人口统计学、流行病学、临床特征、及轻、重症肺炎的影像学、实验室指标、治疗差异。结果 2023年后MP-IgM检测阳性率显著升高,2023年10.61%,2024年1～5月18.12%,住院MPP占比达11.16%～13.73%。观察组患儿年龄中位数6岁,发热260例(86.38%)、高热144例(47.84%)、退热药使用254例(84.39%)高于对照组年龄中位数3岁、102例(62.20%)、40例(24.39%)、88例(53.65%)(P<0.05)。影像学显示,观察组多肺叶受累2～3肺叶144例(47.84% )、高密度病灶200例(66.45%)、肺实变86例(28.57%)较对照组16例(9.76%)、41例(25.00%)、10例(6.01%)常见(P<0.005)。观察组CRP(14.62±18.45)mg/L 、PCT(0.16±0.38)ng/ml、 激素使用214例(71.10%)、四环素类药物应用70例(23.26% )较对照组(9.82±13.38)mg/L、(0.10±0.14)ng/ml,63例(38.41%)、30例(18.30%)高。两组住院天数无差异,观察组胸片复查119例(39.05%)、炎症吸收延迟97例(32.23%)较对照组34例(20.73%)、25例(15.24%)增加(P<0.001)。结论 2023年后儿童MP感染呈重症化趋势,重症MPP以年长儿、高热、多肺叶受累及炎症标志物升高为特征。早期肺部影像学联合MP核酸及耐药基因检测对重症MPP鉴别有意义,四环素类药物及激素的合理使用需结合耐药监测及个体化分析。

Abstract:

Objective To analyze the epidemiological changes and clinical characteristics of severe Mycoplasma pneumoniae pneumonia(MPP)in children, and to explore potential factors influencing the rising trend of M. pneumoniae(MP)infections post-2023, providing insights for optimizing treatment strategies. Methods A retrospective review of clinical data from children hospitalized with MPP between January 2018 and May 2024 was conducted. Demographic, epidemiological, and clinical features were analyzed, along with differences in imaging, laboratory findings, and treatment between mild and severe cases. Results Post-2023, the positive rate of MP-IgM detection significantly increased, reaching 10.61% in 2023 and 18.12% from January to May 2024. Hospitalized MPP cases accounted for 11.16% to 13.73%. The median age of the observed group was 6 years, with higher incidences of fever(86.38%), high fever(47.84%), and antipyretic use(84.39%)compared to the control group(median age 3 years, 62.20%, 24.39%, and 53.65%, respectively; P<0.05). Imaging revealed that the observed group had more cases with multi-lobe involvement(47.84%), high-density lesions(66.45%), and lung consolidation(28.57%)compared to the control group(9.76%, 25.00%, and 6.01%, respectively; P<0.005). The observed group also had higher CRP(14.62±18.45 mg/L), PCT(0.16±0.38 ng/ml), steroid use(71.10%), and tetracycline use(23.26%)compared to the control group(9.82±13.38 mg/L, 0.10±0.14ng/ml, 38.41%, and 18.30%, respectively). Hospital stay duration did not differ, but the observed group had more chest X-ray re-examinations(39.05%)and delayed inflammation resolution(32.23%)compared to the control group(20.73% and 15.24%, respectively; P<0.001). Conclusion Post-2023, MP infections in children have shown a trend towards severity, characterized by older age, high fever, multi-lobe involvement, and elevated inflammatory markers. Early lung imaging combined with MP nucleic acid and drug resistance gene testing is valuable for identifying severe MPP. The rational use of tetracyclines and steroids should be guided by resistance monitoring and individualized analysis.

参考文献/References:

1 陆 权. 儿童社区获得性肺炎管理指南(试行)(上)[J]. 中华儿科杂志, 2007, 45(2): 1-21.
2 李昌崇, 尚云晓, 沈叙庄, 等. 儿童社区获得性肺炎管理指南(2013修订)(上)[J]. 中华儿科杂志, 2013, 51(10): 745-752.
3 中华医学会儿科学分会呼吸学组, 中华儿科杂志编辑委员会, 中国医药教育协会儿科专业委员会. 儿童社区获得性肺炎管理指南(2024修订)[J]. 中华儿科杂志, 2024, 62(10): 920-930.
4 Zhang LN, Cao L, Meng LH. Pathogenic changes of community-acquired pneumonia in a children’s hospital in Beijing, China before and after COVID-19 onset: A retrospective study[J]. World J Pediatr, 2022, 18(11): 746-752.
5 Yan C, Xue GH, Zhao HQ, et al. Current status of Mycoplasma pneumoniae infection in China[J]. World J Pediatr, 2024, 20(1): 1-4.
6 Waites KB, Xiao L, Liu Y, et al. Mycoplasma pneumoniae from the Respiratory Tract and Beyond[J]. Clin Microbiol Rev, 2017, 30(3): 747-809.
7 Meyer Sauteur PM, Unger WWJ, van Rossum AMC, et al. The art and science of diagnosing mycoplasma pneumoniae infection[J]. Pediatr Infect Dis J, 2018, 37(12): 1192-1198.
8 蒋晓慧, 卢 亮, 施 佳, 等. 2017年至2021年淮安地区肺炎支原体感染流行病学分析[J]. 临床肺科杂志, 2024, 29(3): 347-350, 356.
9 Kim K, Jung S, Kim M, et al. Global trends in the proportion of macrolide-resistant mycoplasma pneumoniae infections: A systematic review and Meta-analysis[J]. JAMA Netw Open, 2022, 5(7): e2220949.
10 李铭一, 沈袁恒, 陈 峰, 等. 2019-2023年急性呼吸道感染儿童肺炎支原体流行病学特征分析: 一项单中心回顾性研究[J]. 临床儿科杂志, 2024, 42(6): 485-490.
11 闫宣辰, 路 杰, 胡晓斌, 等. 甘肃省儿童肺炎支原体感染流行病学分析[J]. 中华全科医学, 2024, 22(7): 1090-1093.
12 Meyer Sauteur PM, Beeton ML. European society of clinical microbiology and infectious diseases(ESCMID)study group for Mycoplasma and chlamydia infections(ESGMAC), and the ESGMAC Mycoplasma pneumoniae Surveillance(MAPS)study group. Mycoplasma pneumoniae: delayed re-emergence after COVID-19 pandemic restrictions[J]. Lancet Microbe, 2024, 5(2): e100-e101.
13 王 亨, 徐玮涵, 刘金荣, 等. 儿童重症肺炎支原体肺炎的临床表型分析[J]. 中华儿科杂志, 2024, 62(7): 669-675.
14 Yang S, Lu S, Guo Y, et al. A comparative study of general and severe mycoplasma pneumoniae pneumonia in children[J]. BMC Infect Dis, 2024, 24(1): 449.
15 Li H, Li S, Yang H, et al. Resurgence of Mycoplasma pneumonia by macrolide-resistant epidemic clones in China[J]. Lancet Microbe, 2024, 5(6): e515.
16 国家卫生健康委员会, 陆 权, 陈慧中, 等. 儿童肺炎支原体肺炎诊疗指南(2023年版)[J]. 全科医学临床与教育, 2023, 21(3): 196-202.
17 刘 凯, 付红敏, 陆 权. 儿童肺炎支原体肺炎的流行病学新进展[J]. 中华儿科杂志, 2024, 62(7): 696-699.
18 吴 云, 李 懿, 刘亚丽, 等. 肺炎支原体的感染治疗及对大环内酯类药物的耐药现状和机制[J]. 中华微生物学和免疫学杂志, 2024, 44(8): 718-726.
19 胡明晰,彭荣,龚倩.肺炎支原体的致病机制及对大环内酯类抗菌药物耐药机制的研究进展[J]. 检验医学与临床, 2024, 21(S01): 154-158.
20 Yan M, Tao R, Li S, Xiong J, et al. Clinical characteristics and Logistic regression analysis of macrolide-resistant Mycoplasma pneumoniae pneumonia in children[J]. Eur J Clin Microbiol Infect Dis, 2024, 43(9): 1825-1835.
21 Meyer Sauteur PM, Jacobs BC, Spuesens EB, et al. Antibody responses to Mycoplasma pneumoniae: role in pathogenesis and diagnosis of encephalitis?[J]. PLoS Pathog, 2014, 10(6): e1003983.
22 Wang X, Li M, Luo M, et al. Mycoplasma pneumoniae triggers pneumonia epidemic in autumn and winter in Beijing: A multicentre, population-based epidemiological study between 2015 and 2020[J]. Emerg Microbes Infect, 2022, 11(1): 1508-1517.
23 Gong C, Huang F, Suo L, et al. Increase of respiratory illnesses among children in Beijing, China, during the autumn and winter of 2023[J]. Euro Surveill, 2024, 29(2): 2300704.
24 Georgakopoulou VE, Lempesis IG, Sklapani P, et al. Exploring the pathogenetic mechanisms of?Mycoplasmapneumoniae?(Review)[J]. Exp Ther Med, 2024, 28(1): 271.
25 Andronikou S, Lambert E, Halton J, et al. Guidelines for the use of chest radiographs in community-acquired pneumonia in children and adolescents[J]. Pediatr Radiol, 2017, 47(11): 1405-1411.
26 O’Grady KF, Torzillo PJ, Frawley K, et al. The radiological diagnosis of pneumonia in children[J]. Pneumonia(Nathan), 2014, 5(Suppl 1): 38-51.
27 Franquet T. Imaging of community-acquired pneumonia[J]. J Thorac Imaging, 2018, 33(5): 282-294.
28 Yao TC, Huang YW, Chang SM, et al. Association between oral corticosteroid bursts and severe adverse events: A nationwide population-based cohort study[J]. Ann Intern Med, 2020, 173(5): 325-330.
29 Lee JK, Lee T, Kim YJ, et al. Clinical Manifestations, Macrolide Resistance, and Treatment Utilization Trends of Mycoplasma pneumoniae Pneumonia in Children and Adolescents in South Korea[J]. Microorganisms, 2024, 12(9): 1806.
30 Ding G, Zhang X, Vinturache A, et al. Challenges in the treatment of pediatric Mycoplasma pneumoniae pneumonia[J]. Eur J Pediatr, 2024, 183(7): 3001-3011.
31 Liu J, He R, Zhang X, et al. Clinical features and “early” corticosteroid treatment outcome of pediatric mycoplasma pneumoniae pneumonia[J]. Front Cell Infect Microbiol, 2023, 13: 1135228.
32 Nordholm AC, S?borg B, Jokelainen P, et al. Mycoplasma pneumoniae epidemic in Denmark, October to December, 2023[J]. Euro Surveill, 2024, 29(2): 2300707.
33 Cai B, Yang L, Li X, et al. Effect of early oral administration of doxycycline on macrolide resistance in children with mycoplasma pneumoniae pneumonia: A retrospective study[J]. Br J Hosp Med(Lond), 2024, 85(12): 1-12.
34 Bolormaa E, Park JY, Choe YJ, et al. Treatment of macrolide-resistant mycoplasma pneumoniae pneumonia in Children: A meta-analysis of macrolides versus tetracyclines[J]. Pediatr Infect Dis J, 2025, 44(3): 200-206.

备注/Memo

备注/Memo:

基金项目: 重庆市卫生健康委员会医学领域名师计划(CQYC20220203178)
通信作者: 陈 虹, Email: hopehong@126.com

常用功能

更新日期/Last Update: 2025-02-20