孙增贤 高丽娟 张亚丽 赵中伟

[摘要] 目的 探討血浆纤维蛋白单体（FM）、D-二聚体（DD）、CRP在评估小儿肺炎支原体（MP）肺炎病情严重程度及预后中的价值。 方法 回顾性分析2014年5月～2016年5月本院儿科病房诊断为肺炎支原体肺炎（MPP）的患儿。入院当天采集咽拭子行MP的DNA及大环内酯类耐药基因检测，根据耐药基因检测结果分为耐药基因阳性组（n=138）和耐药基因阴性组（n=32），分析两组的临床特点及实验室指标。根据治疗效果及预后将耐药基因阳性组患儿分为治疗有效组（n=110）和无效组（n=28），检测并比较两组初始及治疗72 h后血浆FM、DD及CRP水平。 结果 耐药基因阳性组中咳嗽持续时间、总发热时间、住院时间更长，血浆FM、DD、CRP更高，双侧大叶性肺实变发生率更高，差异有统计学意义（P<0.05）；有效组和无效组初始血浆FM、DD和CRP水平比较差异无统计学意义（P>0.05）；无效组治疗72 h后血浆FM、DD和CRP值较有效组高，差异有统计学意义（P<0.05）；有效组治疗后FM、DD和CRP值较治疗前明显改善（P<0.05）；而无效组治疗前后改善不明显（P>0.05）。 结论 血浆FM、DD、CRP水平变化对肺炎支原体肺炎病情评估及预后判断具有一定的指导意义，治疗后血浆FM、DD和CRP水平能否有效改善对患儿预后评估有重要意义。

[关键词] 血浆纤维蛋白单体；D-二聚体；CRP；肺炎支原体肺炎；肺炎支原体耐药基因检测

[中图分类号] R446.1 [文献标识码] A [文章编号] 1673-9701（2018）07-0009-04

[Abstract] Objective To investigate the value of plasma fibrin monomer （FM）， D-dimer （DD） and CRP in the assessment of the severity and prognosis of children with mycoplasma pneumoniae pneumonia（MPP）. Methods A retrospective analysis of children diagnosed as mycoplasma pneumoniae pneumonia（MPP） in the pediatric ward of Lishui Central Hospital from May 2014 to May 2016 was conducted. On the day of admission， throat swabs were collected for the detection of DNA and macrolide resistance genes. According to the results of drug resistance gene detection， the patients were divided into drug-resistant gene positive group （n=138） and drug-resistant gene negative group （n=32）. The clinical features and laboratory indexes of the two groups were analyzed. According to the therapeutic effect and prognosis， the children patients with positive drug resistance gene were divided into two groups： treatment-effective group （n=110） and non-effective group（n=28）. The levels of plasma FM， DD and CRP in the two groups were detected and compared at the beginning and 72 hours after treatment. Results In the positive group of drug resistance gene， the cough duration time， fever time and the length of hospital stay were longer， and the plasma FM， DD and CRP were higher（P<0.05）. The incidence rate of bilateral lobar lung consolidation was higher，and the difference was statistically significant；there was no statistically significant difference in initial plasma FM， DD and CRP levels between the effective group and the non-effective group（P>0.05）. The levels of plasma FM， DD and CRP in the invalid group after 72 h treatment were higher than those in the effective group， and the difference was statistically significant（P<0.05）； the FM， DD and CRP values in the effective group after treatment were significantly improved than those before treatment（P<0.05）； the improvement after the treatment in the ineffective group was not significant（P>0.05）. Conclusion The changes of plasma FM， DD and CRP levels may be of a guiding significance in the assessment and prognosis judgment of mycoplasma pneumoniae pneumonia. After treatment， whether the plasma FM， DD and CRP levels can effectively improve the prognosis assessment of patients children has an important significance.

[Key words] Plasma fibrin monomer； D-dimer； CRP； Mycoplasma pneumoniae pneumonia（MPP）； Mycoplasma pneumoniae drug-resistant gene detection

肺炎支原体（Mycoplasma pneamoniae，MP）目前在我国社区获得性肺炎的病原体中的比重越来越大，且好发于学龄前期和学龄期儿童。近年来由大环内酯类耐药菌株引起的肺炎支原体肺炎病例逐年增多[1-2]，其基因突变主要表现为MP 23S rRNA编码基因上2063或2064位置的点突变[3]。部分肺炎支原体肺炎（Mycoplasma pneamoniae pneumonia，MPP）患兒症状重，进展快，常导致严重肺内外并发症[4]，如胸腔积液、肺不张、肺坏死等，给儿童健康带来极大威胁。……