儿童肺炎支原体肺炎合并外周血淋巴细胞计数减少的临床分析

Clinical features of children with Mycoplasma pneumoniae pneumonia and peripheral lymphocytopenia

摘要:

目的 探讨儿童肺炎支原体肺炎（MPP）合并外周血淋巴细胞计数减少的临床特征。方法 纳入2018年6月至2019年6月进行支气管肺泡灌洗的MPP住院患儿310例作为研究对象，包括单纯MPP患儿241例（未合并外周血淋巴细胞减少），MPP合并外周血淋巴细胞减少患儿69例，比较两组患儿临床资料及治疗转归。结果 与单纯MPP组比较，MPP合并淋巴细胞计数减少组的热程和住院时间均较长，C反应蛋白、乳酸脱氢酶、支气管肺泡灌洗液中肺炎支原体DNA拷贝数值均显著升高（P < 0.05）。MPP合并淋巴细胞计数减少组肺实变、肺外并发症、支气管镜下严重病变（糜烂/痰栓）及重症MPP病例的发生率均明显高于单纯MPP组（P < 0.05）。结论 MPP合并外周血淋巴细胞计数减少患儿存在更严重的免疫损伤；外周血淋巴细胞数量可在一定程度上反映MPP的严重程度。

Abstract:

Objective To study the clinical features of children with Mycoplasma pneumoniae pneumonia (MPP) and peripheral lymphocytopenia. Methods A total of 310 MPP children who were hospitalized and underwent bronchoalveolar lavage from June 2018 to June 2019 were enrolled and divided into two groups: simple MPP group with 241 children (without peripheral lymphocytopenia) and MPP + peripheral lymphocytopenia group with 69 children. The two groups were compared in terms of clinical data and treatment outcome. Results Compared with the simple MPP group, the MPP + peripheral lymphocytopenia group had significantly longer duration of fever and length of hospital stay and significant increases in C-reactive protein, lactate dehydrogenase, and Mycoplasma pneumoniae DNA copies in bronchoalveolar lavage fluid (P < 0.05). Compared with the simple MPP group, the MPP + peripheral lymphocytopenia group had significantly higher incidence rates of intrapulmonary consolidation, extrapulmonary complications, and serious lesions under bronchoscopy (erosion or sputum bolt) and a significantly higher proportion of patients with severe MPP (P < 0.05). Conclusions Children with MPP and peripheral lymphocytopenia tend to have more severe immunologic injury. Peripheral blood lymphocyte count may be used to evaluate the severity of MPP.