目的 分析肺炎支原体肺炎(MPP) 患儿急性期及恢复期肺功能的变化及其临床意义,为临床诊治提供参考。方法 选取2015年6月-2017年6月在延安市人民医院住院的3～10岁肺炎支原体肺炎急性期(发病1周内)患儿60例为观察组,行常规肺功能检测,随访至恢复期(发病后第3周),再次行常规肺功能检测;另选取同期健康儿童 60 例作为对照组。结果 观察组患儿急性期各项肺功能通气指标(FVC、FEV1、FEV1/FVC、PEF、MEF75、 MEF50、 MEF25、MMEF)较对照组均下降(t=-6.719、-6.835、-1.754、-6.171、-6.926、-5.661、-6.889、-6.874, P＜0.05) ;恢复期各项指标均较急性期明显升高,与对照组比较,FVC、FEV1、FEV/FVC、PEF差异无统计学意义(P>0.05),而MEF75、 MEF50、 MEF25、MMEF仍明显降低(t=-2.306、-1.995、-3.305、-2.557,P＜0.05)。结论 MPP患儿的肺功能在急性期均有不同程度损害,在恢复期大气道各项指标均基本恢复;小气道各项指标虽较急性期恢复,但未完全恢复正常。故在临床上需动态监测MPP患儿肺功能的变化,对治疗的评估和预后有一定的临床意义。
Abstract
Objective To analyse the changes and clinical significance of pulmonary function in children with mycoplasma pneumoniae pneumonia(MPP) during acute and convalescent periods. Methods A total of 60 children aged 3 to 10 years with acute MPP in Yan'an People's Hospital were selected as observation group from June 2015 to June 2017,and 60 healthy children were selected as control group at the same time.All children took routine pulmonary function test,and the observation group was followed up to the recovery period(on the third weeks after the onset). Results The indexes of pulmonary function ventilation(FVC,FEV1,FEV1/FVC,PEF,MEF75,MEF50,MEF25,MMEF) in the acute stage of MPP were significantly lower than those in normal control group(t=-6.719,-6.835,-1.754,-6.171,-6.926,-5.661,-6.889,-6.874,P<0.05).And all indexes in the recovery period obviously increased than the acute stage.Compared with the normal control group,FVC,FEV1,FEV1/FVC and PEF in the recovery period of MPP children recovered basically,while MEF75,MEF50,MEF25 and MMEF were still lower(t=-2.306,-1.995,-3.305,-2.557,P<0.05). Conclusions The pulmonary function of MPP children have different degrees of damage in the acute stage.All the indexes of large airway in the recovery period are basically recovered,but the indexes of small airway still not rise to the normal level.Therefore,it is necessary to dynamically monitor lung function in clinical practice,which is of great significance in the evaluation and prognosis of treatment of MPP children.
关键词
支原体肺炎 /
肺功能 /
儿童
Key words
mycoplasma pneumonia /
pulmonary function /
children
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参考文献
[1] Defilippi A,Silvestri M,Tacchella A,et al.Epidemiology and clinical features of mycoplasma pneumoniae infection in children[J].Respir Med,2008,102(12):1726-1768.
[2] 柯莉芹,王凤美,李银杰,等.儿童肺炎支原体肺炎流行病学特征[J].中国当代儿科杂志,2013,15(1):33-36.
[3] Cosentini R,Tarsia P,Canetta C,et al.Severe asthma exacerbation:role of acute chlamydophila pneumoniae and mycoplasma pneumoniae infection [J].Respir Res,2008,9:48.
[4] 江载芳.实用小儿呼吸病学[M].北京:人民卫生出版社,2010:240-246.
[5] Noorbakhsh S,Farhadi M,Tabatabaei A,et al.Searching m -ycoplasma pneumonia by serology ＆amp;PCR in children with adenoid hypertrophy and rhinosinusitis:A case control study,Tehran,Iran[J].Iran J Microbiol,2013,5(1):63-67.
[6] Biondi E,McCulloh R,Alverson B,et al.Treatment of mycoplasma pneumonia:a systematic review[J].Pediatrics,2014,133(6):1081-1090.
[7] 朱蕾.临床肺功能[M].北京:人民卫生出版社,2014.
[8] 诸福棠.实用儿科学[M].北京:人民卫生出版社,2015.
[9] 中华医学会儿科学会分会呼吸学组,中华儿科杂志编辑委员会.儿童社区获得性肺炎管理指南(2013年修订)上[J].中华儿科杂志,2013,51(10):745-752.
[10] Kraft M,Cassell GH,Henson JE,et al.Detection of mycoplasma pneumoniae in the airways of adults with chronic asthma[J].Am J Respir Crit Care Med,1998,158(3):998-1001.
[11] 魏云.咳嗽变异性哮喘与肺炎支原体感染关系的临床研究[J].中国当代医药,2012,19(7):91-92.
[12] 朱炜春.支原体肺炎的治疗对气道高反应发生的影响[J].中国医药科学,2012,2(10):203-204.
[13] Kannan TR,Jacqueline J,Coalson,et al.Synthesis and distribution of CARDS toxin during mycoplasma pneumoniae infection in a murine model[J].J Infect Dis,2011,204(10):1596-1604.
[14] 孙红,孙红妹.肺炎支原体直接损伤及其免疫学致病机制研究进展[J].中华微生物学和免疫学杂志,2015,31(1):65-68.
[15] Guilbert TW,Denlinger LC.Role of infection in the development and exacerbation of asthma [J].Expert Rev Respir Med,2010,4(1):71-83.
[16] Hyvrinen M,Piippo-Savolainen E,Korhonen K,et al.Teenage asthma after severe infantile bronchiolitis or pneumonia[J].Acta Paediatr,2005,94(10):1378-1383.
[17] 吴勇,蔡俊伟,李立浩,等.重症肺炎支原体肺炎患儿的肺功能变化及临床意义[J].吉林医学,2015,36(13):2743-2744.
[18] 中华医学会儿科学会分会呼吸学组,临床儿科杂志编辑委员会.糖皮质激素雾化吸入疗法在儿科应用的专家共识[J].临床儿科杂志,2018,36(2):95-107.
基金
陕西省延安市科学技术研究发展计划项目(2018ks-20)
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