儿童重症肺炎支原体肺炎并发动脉缺血性脑卒中的临床特征：基于32例病例的系统分析

Clinical Characteristics of Severe Mycoplasma Pneumoniae Pneumonia Complicated with Arterial Ischemic Stroke in Children: A Systematic Analysis of 32 Cases

摘要: 目的：分析儿童肺炎支原体肺炎(Mycoplasma Pneumoniae Pneumonia, MPP)并发急性动脉缺血性脑卒中(Arterial Ischemic Stroke, AIS)的流行病学特征、高危因素、临床特点及治疗现状，以提升临床认识，指导早期防治。方法：本研究采用病例分析与文献复习相结合的回顾性研究方法。报道1例重症MPP (Severe Mycoplasma Pneumoniae Pneumonia, SMPP)，同时对本例及文献报道的31例SMPP进行系统分析，总结MPP合并AIS的临床特点。为探讨其年龄分布特征，将本队列与一项包含129例各类病因儿童AIS的大样本队列进行横向对比。由两名研究者独立进行文献筛选、数据提取与交叉核对。结果：本研究共纳入32例SMPP并发AIS患儿，男女比例1.1:1.0，中位年龄5岁，75%的病例集中于4~7岁。与整体AIS队列相比，本研究患儿年龄分布高度集中，学龄前及学龄期(3~10岁)占93.8%，而婴幼儿组(28天~3岁)无一例发生(0%)。实验室检查显示D-二聚体显著升高，异常率为88.0%。肺部影像以肺实变(65.6%)和胸腔积液(56.3%)最常见。AIS多发生于病程第10天(中位数)，主要症状为偏瘫(75.0%)，最常累及大脑中动脉。经抗血小板、抗凝等综合治疗后，患儿预后良好(好转或治愈，78.1%)，死亡4例(12.5%)。结论：SMPP并发AIS呈现出高度集中的年龄分布，主要累及学龄前及学龄期儿童(3~10岁)，婴幼儿少见。SMPP与AIS的发生密切相关。D-二聚体水平升高与AIS发生密切相关，但不能忽略D-二聚体水平正常的SMPP患儿。

Abstract: Objective: To analyze the epidemiological characteristics, high-risk factors, clinical features, and current treatment status of Mycoplasma pneumoniae pneumonia (MPP) complicated by arterial ischemic stroke (AIS) in children, with the aim of enhancing clinical awareness and guiding early prevention and management. Methods: This study employed a retrospective research method combining case analysis and literature review. One case of severe MPP (SMPP) was reported, and a systematic analysis was conducted on this case along with 31 SMPP cases reported in the literature to summarize the clinical characteristics of MPP combined with AIS. To explore the age distribution pattern, this cohort was compared with a large-sample cohort of 129 pediatric AIS cases of various etiologies. Two researchers independently performed literature screening, data extraction, and cross-verification. Results: A total of 32 children with SMPP complicated by AIS were included. The male-to-female ratio was 1.1:1.0, with a median age of 5 years, and 75% of cases were concentrated in the 4~7-year age group. Compared to the general AIS cohort, the age distribution in this study group was highly concentrated, with the preschool and school-age group (3 to 10 years) accounting for 93.8% of cases, while no cases (0%) occurred in the infant and toddler group (28 days to 3 years). Laboratory tests showed significantly elevated D-dimer levels, with an abnormality rate of 88.0%. Pulmonary imaging most commonly revealed pulmonary consolidation (65.6%) and pleural effusion (56.3%). AIS occurred most frequently on the 10th day of the disease course (median), with hemiplegia as the main symptom (75.0%), and the middle cerebral artery was the most commonly involved vessel. After comprehensive treatment, including antiplatelet and anticoagulant therapies, 78.1% of the children had a favorable prognosis (improvement or cure), while 4 cases (12.5%) died. Conclusions: SMPP-associated AIS exhibits a highly concentrated age distribution, primarily affecting preschool and school-age children (3~10 years), and is rare in infants and toddlers. SMPP is closely associated with the occurrence of AIS. Elevated D-dimer levels are strongly correlated with the development of AIS, but SMPP children with normal D-dimer levels should not be overlooked.