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目的探讨小儿肺炎支原体(MP)脑炎的临床表现、诊断、疗效及预后。方法分析40例肺炎支原体脑炎患儿的临床资料,按起病原因不同分为两组,第1组18例,以发热、头痛、呕吐为首发症状,病程中始终无咳嗽;第2组22例,以发热、咳嗽等为首发症状,病程第7～12天出现神经系统症状。两组患儿均应用PCR法检测脑脊液(CSF)MP-DNA,采用颗粒凝聚试验检测其血清MP特异性IgM和IgG抗体,并行脑电图及头颅影像学检查。总结小儿肺炎支原体脑炎的临床特点。结果①肺炎支原体(MP)导致的脑炎多见于5岁以上儿童,以发热(40/40例)、头痛(29/40例)、嗜睡(28/40例)及呕吐(25/40例)等为主要表现,惊厥(5/40例)少有发生;有呼吸道症状者在病程的7～12d出现神经系统症状。②第1组患儿CSF-MP-DNA阳性,同期血MP特异性IgM和IgG抗体均为阴性;第2组患儿出现神经系统症状后,CSF-MP-DNA阴性,MP特异性IgM和IgG抗体均阳性。③脑电图异常(慢波)25例,6例患儿MRI呈脑灰质多灶异常信号,脑室旁斑片状高信号,经阿奇霉素抗感染、甘露醇降颅压及解痉等治疗,患儿均痊愈出院。结论 MP是引起小儿中枢神经系统感染的病原体之一,其中枢神经系统症状可在肺炎病程中或无肺部症状时出现,其临床症状与病毒性脑炎鉴别困难。脑脊液MP-DNA检测阳性及血清MP特异性IgM和IgG抗体增高,对确诊MP感染,指导治疗预后评估有主要意义。肺炎支原体脑炎通常预后良好。
Objective To investigate the clinical manifestations, diagnosis, curative effect and prognosis of children with Mycoplasma pneumoniae (MP) encephalitis. Methods The clinical data of 40 cases of Mycoplasma pneumoniae encephalitis children were divided into two groups according to their cause of attack. The first group consisted of 18 cases with fever, headache and vomiting as the first symptom. No cough was found in the course of the disease. Group 2 For example, fever, cough, etc. as the first symptom, the course of the first 7 to 12 days of neurological symptoms. MP-DNA of cerebrospinal fluid (CSF) was detected by PCR in both groups. MP-specific IgM and IgG were detected by particle agglutination test, and EEG and cephalic imaging were performed. Summary of clinical features of children with Mycoplasma pneumoniae mycoplasma. Results ① Mycoplasma pneumoniae caused by MP was more common in children over 5 years old with fever (40/40), headache (29/40), drowsiness (28/40) and vomiting (25/40) As the main performance, convulsions (5/40 cases) rare occurrence; respiratory symptoms in the course of 7 ~ 12d appear neurological symptoms. ② CSF-MP-DNA was positive in group 1 and negative for MP-specific IgM and IgG in blood during the same period. CSF-MP-DNA negative, MP-specific IgM and IgG were found in group 2 after neurological symptoms Antibodies are positive. ③ Electroencephalogram abnormalities (slow wave) in 25 cases, 6 cases MRI showed multiple abnormalities of cerebral gray matter signal, ventricular patchy high signal, anti-infection by azithromycin, mannitol intracranial pressure and spasm and other treatment, patients All children were discharged. Conclusion MP is one of the pathogens that cause central nervous system infection in children. The symptoms of central nervous system may appear during the course of pneumonia or without pulmonary symptoms. The clinical symptoms are difficult to identify with viral encephalitis. Cerebrospinal fluid MP-DNA test positive and serum MP-specific IgM and IgG antibodies increased, the diagnosis of MP infection, guide the evaluation of the prognosis of treatment of great significance. Mycoplasma pneumoniae usually has a good prognosis.