成人肺炎支原体肺炎179例临床分析

Clinical Analysis of 179 Cases of Mycoplasma Pneumoniae Pneumonia in Adults

摘要: 目的：探讨成人肺炎支原体肺炎(Mycoplasma Pneumoniae Pneumonia, MPP)的临床特点及诊疗转归。方法：对2023年1月~2023年12月在我院呼吸科接受诊治的179例肺炎支原体肺炎的成人患者的临床资料进行回顾性分析。结果：179例肺炎支原体肺炎患者中，男性87例(48.6%)，女性92例(51.3%)。年龄 ≤ 65岁者149例(83.2%)，年龄 > 65岁者30例(16.8%)。发热的患者133例(74.3%)；咳嗽的患者172例(96.1%)；胸部CT改变多以散在斑点、斑片模糊影为主，部分呈现磨玻璃影、实变影，单侧病变87例(48.6%)，双侧病变92例(51.4%)，常累及多个肺叶。外周血白细胞计数高于正常者40例(22.3%)，中性粒细胞高于正常者99例(55.3%)，C反应蛋白(C-Reactive Protein)检测119例(66.4%)增高。通过痰培养及病原体微生物靶向测序提示存在混合细菌感染(30例)及病毒感染(21例)共51例(28.5%)。所有患者采用莫西沙星或左氧氟沙星抗感染治疗，混合感染者据相关病原体联合治疗，预后良好。结论：肺炎支原体肺炎年龄18~65岁患者的感染率明显高于年龄 > 65岁者。发热和咳嗽、咯痰为本病突出的症状。外周血白细胞计数常不升高。胸部CT改变多见散在斑点、磨玻璃影、斑片模糊影或实变影。喹诺酮类治疗疗效良好。要警惕其是否存在混合感染。

Abstract: Objective: To investigate the clinical features, diagnosis and treatment outcomes of Mycoplasma pneumoniae pneumonia in adults. Methods: The clinical data of 179 adult patients with Mycoplasma pneumoniae pneumonia who were diagnosed and treated in the Department of Respiratory Medicine of our hospital from January 2023~December 2023 were retrospectively analyzed. Results: Among the 179 patients with Mycoplasma pneumoniae pneumonia, 87 (48.6%) were males and 92 (51.3%) were females. There were 149 cases (83.2%) aged ≤ 65 years and 30 cases (16.8%) aged > 65 years. There were 133 patients (74.3%) with fever and 172 patients (96.1%) with cough, and the chest CT changes were mainly scattered spots and patchy blurred shadows, some of which showed ground-glass opacities and consolidation shadows, with unilateral lesions in 87 cases (48.6%) and bilateral lesions in 92 cases (51.4%), often involving multiple lobes. There were 40 cases (22.3%) with peripheral white blood cell count higher than normal, 99 cases (55.3%) with neutrophil higher than normal, and 119 cases (66.4%) with elevated C-reactive protein. Sputum culture and targeted sequencing of pathogenic microorganisms showed that there were mixed bacterial infections (30 cases) and viral infections (21 cases), a total of 51 cases (28.5%). All patients were treated with moxifloxacin or levofloxacin anti-infective, and co-infected patients were treated in combination with related pathogens, and the prognosis was good. Conclusion: The infection rate of Mycoplasma pneumoniae pneumonia aged 18~65 years is significantly higher than that of patients aged > 65 years. Fever, cough and sputum are prominent symptoms. Peripheral white blood cell count is usually not elevated. CT changes on the chest are often scattered spots, ground-glass opacities, patchy blurred opacities, or consolidation opacities. Quinolones respond well. Be alert for co-infection.