儿童肺炎支原体肺炎所致血栓1例并文献复习

Thromboembolism Induced by Mycoplasma Pneumoniae in Children: A Case Report and Literature Review

摘要: 目的：探讨儿童肺炎支原体肺炎(mycoplasma pneumoniae pneumonia, MPP)所致血栓的临床特点、发病机制及诊疗方法。方法：回顾1例儿童MPP合并血栓的资料，分析国内外数据库中相关病例。结果：患儿女，6岁，因为发热、咳嗽8天，腹痛半天入院，肺炎支原体抗体滴度 ≥ 1:320，C-反应蛋白(C-reactive protein, CRP)及D-二聚体升高、抗心磷脂抗体(anticardiolipin antibody, ACA)阳性，胸部CT示右肺实变合并胸腔积液，消化系统彩色多普勒超声未见明显异常，临床诊断重症MPP，治疗至病程第26天体温正常，但右肺呼吸音仍低，伴间断腹痛，胸腹部增强CT发现右侧头臂静脉血栓及脾梗死，经治疗，CRP、D-二聚体下降，ACA转阴，头臂静脉血栓消失，脾梗死范围较前缩小。回顾复习88例相关病例：男57例，女31例，中位年龄7.0岁；发现血栓的中位时间在病程第10.5天；69.57% (16/23)为难治性MPP；70.90% (56/79)合并肺实变及胸腔积液。42例治疗后复查影像学检查发现，35例血栓消失，7例血栓缩小；余46例未复查影像学检查，其中17例临床好转，12例临床痊愈，11例预后不详，3例预后不良，3例死亡。CRP、D-二聚体均水平均有下降，ACA阳性者均转阴。结论：对于MPP患儿，尤其合并肺实变及胸腔积液者，应密切监测CRP、D-二聚体、ACA的变化，彩色多普勒超声、增强CT、CT血管造影、核磁共振、血管造影等影像学检查有利于尽早发现不同部位血栓，及时抗感染、抗炎、抗免疫、抗凝、抗血小板聚集治疗，预后多良好。

Abstract: Objective: To explore the clinical characteristics, pathogenesis, diagnosis, and treatment of throm-bus caused by mycoplasma pneumoniae pneumonia (MPP) in children. Methods: The clinical data of one child’s MPP with thrombosis complication was retrospectively evaluated. Then, domestic and foreign cases of thrombus caused by MPP in children were searched and analyzed. Results: A 6-year-old girl was hospitalized because of a fever, coughing for eight days, and abdominal pain for half a day. Her serum mycoplasma pneumoniae (MP) antibody titer was higher than 1:320, CRP and D-dimer were significantly increased, and anti-cardiolipin antibody (ACA) was positive. A CT scan showed a large area of inflammatory consolidation and pleural effusion in the right lung. Color dop-pler ultrasound of the digestive system was negative. The diagnosis was severe MPP. The body temperature was normal until the 26th day of the course of the disease, but the right lung breath sounds were still low and the abdominal area had occasional pain. The right side of the head arm vein and splenic infarction were found by chest and abdomen enhanced CT scan. In the treatment, CRP and D-dimer were decreased and ACA turned negative while head, arm and vein thrombosis disappeared. At the same time, the extent of splenic infarction was reduced. A total of 88 cases were reviewed, including 57 males and 31 females, with a median age of 7.0 years. The median time of thrombosis was 10.5 days. The proportion of Refractory Mycoplasma pneumoniae pneumonia (RMPP) was 69.57% (16/23) and the MPP complicated with lung consolidation and pleural effusion was 70.9% (56/79). The imaging examination of 42 cases after treatment showed that 35 cases of thrombus disappeared while 7 cases of thrombus were reduced. The remaining 46 cases were not subjected to imaging examination, with 17 cases clinically improved, 12 cases clinically cured, 11 with unknown prognosis, 3 with poor prognosis, and 3 cases died. In all cases, CRP and D-dimer lev-els decreased, and ACA positive patients turned negative. Conclusions: Children with MPP, particu-larly MPP with pulmonary consolidation, and pleural effusion, should be closely monitored for CRP, D-dimer and ACA. For early detection of the thrombosis, color doppler ultrasound, enhanced CT, CT angiography, MRI, and angiography imaging should be used. With timely treatment of anti-infection, anti-inflammatory, immune, anticoagulation, and antiplatelet aggregation, more than a good prog-nosis can be expected.