2021 年第 7 期 第 16 卷

甲型流行性感冒合并肺炎支原体感染患儿临床特征分析

Clinical characteristics of children with influenza A complicated with mycoplasma pneumoniae infection

作者：张慧敏张艳兰王彩英庞琳

英文作者：Zhang Huimin Zhang Yanlan Wang Caiying Pang Lin

单位：首都医科大学附属北京地坛医院儿科新发突发传染病研究北京市重点实验室100015

英文单位：Department of Pediatrics Beijing Ditan Hospital Capital Medical University Beijing Key Laboratory of Emerging Infectious Diseases Beijing 100015 China

关键词：甲型流行性感冒；肺炎支原体感染；肺炎

英文关键词：InfluenzaA;Mycoplasmapneumoniaeinfection;Pneumonia

• 摘要：

• 目的 探讨冬季甲型流行性感冒（甲型流感）合并肺炎支原体（MP）感染患儿的临床特征。方法 回顾性分析2019年10月至2020年 1月首都医科大学附属北京地坛医院儿科收治的130例甲型流感患儿的病历资料，根据是否合并MP感染，将其分为单纯甲型流感组（A组，82例）和合并MP感染组（B组，48例）。所有患儿均予帕拉米韦静脉滴注，B组患儿联合阿奇霉素静脉滴注。记录患儿的临床资料，比较2组治疗前及治疗3 d后血常规指标、血清免疫学指标水平。结果 2019年10月至2020年1月中以2019年12月甲型流感患儿比例最高［50.0%（65/130）］。各月份MP检出率差异无统计学意义（P=0.41）。新生儿与婴儿、幼儿、学龄前儿童、学龄期及以上甲型流感患儿MP的检出率分别为4.5%(1/22)、30.3%(10/33)、48.2%(27/56)、52.6%(10/19)，差异有统计学意义（χ2=18.75，P<0.01）。B组患儿年龄、发热时间及住院时间、咳嗽症状评分为2~3分及并发肺炎比例均大于/长于/高于A组，合并心肌损害及肝功能异常比例均少于A组，差异均有统计学意义(均P＜0.05)。治疗前，2组患儿血常规及炎性因子检测指标比较，差异均无统计学意义（均P＞0.05）。治疗3 d后，A组患儿白细胞计数、中性粒细胞计数、C反应蛋白（CRP）、降钙素原水平均低于治疗前，淋巴细胞计数高于治疗前；B组患儿中性粒细胞计数、CRP、降钙素原水平均低于治疗前，淋巴细胞计数高于治疗前；B组患儿中性粒细胞计数高于A组，淋巴细胞计数低于A组；差异均有统计学意义（均P＜0.05）。治疗前，B组患儿免疫球蛋白（Ig）G、IgA、IgM水平均高于A组，差异均有统计学意义（均P＜0.05）。治疗3 d后，2组患儿IgG、IgA、IgM水平与治疗前比较，差异均无统计学意义（均P＞0.05）。治疗3 d后，2组CD+4、CD+8水平均高于治疗前，但B组患儿均低于A组［1 068（823,1 503）cells/μl比1 496（1 149,1 918）cells/μl、711（524,1 121）cells/μl比 980（717,1 243）cells/μl］，差异均有统计学意义（均P＜0.05）。结论 冬季甲型流感合并MP感染患儿的比例较高，临床症状及体征较重，治疗前后体液免疫指标较高，治疗后细胞免疫指标恢复较慢。

• Objective To investigate clinical characteristics of children with influenza A complicated with mycoplasma pneumoniae (MP) infection in the winter. Methods From October 2019 to January 2020, medical data of 130 children with influenza A admitted to Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University were retrospectively analyzed. The children were divided into simple influenza A group(group A, 82 cases) and complicated with MP infection group(group B, 48 cases) according to the children whether complicated with MP infection. All children were treated with peramivir intravenous drip, and children in group B were combined with azithromycin intravenous drip. The clinical data of children were recorded, and blood routine indexes and surem immunological indexes were compared between the two groups before and 3 d after treatment. Results The proportion of children with influenza A was the highest in December 2019［50.0%（65/130）］, and there was no significant difference in detection rates of MP among different months(P=0.41). Detection rates of MP in newborns and infants, young children, preschool children and school age and above children were 4.5%(1/22), 30.3%(10/33), 48.2%(27/56), 52.6%(10/19) respectively, and the difference was statistically significant (χ2=18.75， P<0.01). The age, fever time and length of stay, cough symptom score as 2-3 and complicated with pneumonia proportions in group B were older/longer/higher than those in group A, and the proportions of combined with myocardial damage and liver dysfunction in group B were lower than those in group A (all P<0.05). Before treatment, there were no significant differences in blood routine indexes and inflammatory factors between the two groups(all P>0.05). After treatment for 3 d, the white blood cell count, neutrophli count, C-reactive protein(CRP), and procalcitonin levels in group A were lower than those before treatment, and lymphocyte count was higher than that before treatment; the neutrophli count, CRP and procalcitonin levels in group B were lower than those before treatment, and lymphocyte count was higher than that before treatment; the neutrophli count in group B was higher than that in group A, and lymphocyte count in group B was lower than that in group A (all P<0.05). Before treatment, the levels of immunoglobulin(Ig) G, IgA and IgM in group B were higher than those in group A(all P<0.05). There were no significant differences in IgG, IgA and IgM levels of each group before and after treatment(all P>0.05). After treatment for 3 d, the levels of CD+4 and CD+8 in both groups were higher than those before treatment, and those in group B were lower than those in group A［1 068（823,1 503）cells/μl vs 1 496（1 149,1 918）cells/μl, 711（524,1 121）cells/μl vs 980（717,1 243）cells/μl］(all P<0.05). Conclusions The rate of influenza A children complicated with MP infection is high in the winter. Children with MP infection have more severe clinical symptoms and signs, higher humoral immune indexes before and after treatment, and slower recovery of cellular immune indexes after treatment.