中国实用儿科杂志

中国实用儿科杂志

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肺炎支原体感染相关性儿童急性良性肌炎临床与实验室检查特点

  

  1. 中国医科大学附属第一医院儿科，辽宁  沈阳  110001
  • 出版日期:2021-08-06 发布日期:2021-09-09

Clinical and laboratory features of acute benign myositis associated with Mycoplasma pneumoniae infection in children

  1. Department of Pediatrics，the First Hospital of China Medical Univerisity，Shenyang  110001，China
  • Online:2021-08-06 Published:2021-09-09

摘要： 目的　探讨肺炎支原体感染相关性儿童急性良性肌炎（BACM）临床与实验室检查特点。方法　回顾性分析2010年2月至2019年2月中国医科大学附属第一医院收治的12例肺炎支原体感染相关性BACM患儿的临床资料。结果　（1）最常见的症状是在呼吸道感染病程中突发下肢腿痛，以双侧小腿肌痛多见；最常见和突出的体征是小腿腓肠肌握痛。（2）12例肌酸激酶（CK）检测值为（645～18 990） μg/L（均值为3697 μg/L），均超过参考区间上限2倍，＞1000 μg/L者11例，＞5000 μg/L者2例。7例血肌红蛋白（Mb）检测结果为（137.6～872.0） μg/L（均值为474.8 μg/L），＞参考区间上限2倍者6例。从检测值的动态变化看 CK于1周内恢复至正常范围内，Mb未超过5 d均恢复到正常，比CK恢复到正常的时间稍快。（3）12例肺炎支原体抗体（MP-Ab）滴度均超过1∶160，其中1∶320者6例，IgM阳性者12例，伴IgG阳性者9例。10例肌钙蛋白I（CTnI）检测值（0～0.04） μg/L均无增高。结论 （1）儿童急性良性肌炎应常规检测MP-Ab。（2）凡是诊断或疑诊BACM时都应同步检测血清CK和Mb并动态观察其变化。（3）肺炎支原体感染相关的BACM患儿除卧床休息，减少肢体活动外，应给予大环内酯类抗生素对因治疗。心肌代谢赋活药、水化碱化是否需要需根据血清肌钙蛋白Ⅰ、心电图、尿潜血试验等研判。

关键词: 儿童急性良性肌炎, 肺炎支原体, 肺炎支原体抗体

Abstract: Objective　To investigate the clinical and laboratory features of acute benign myositis associated with Mycoplasma pneumoniae  infection in children. Methods　We conducted a retrospective analysis on the data of 12 cases of acute benign myositis related to Mycoplasma pneumoniae infection in children in the First Hospital of China Medical University. Results　1.The most common symptom was sudden leg pain in the course of respiratory tract infection and bilateral lower leg myodynia was more common. The most common and prominent sign is calf pain and gastrocnemius grip. 2.The values of 12 cases of creatine kinase（CK） were （645-18 990） μg/L（mean 3697 μg/L），greater than twice the upper limit of reference interval，with 11 cases＞1000 μg/L and 2 cases＞5000 μg/L. The results of serum myoglobin（Mb） in 7 cases were （137.6-872.0） μg/L （mean 474.8 μg/L），with 6 cases greater than twice the upper limit of reference interval. From the dynamic changes of the detection value，CK decreased to normal range within one week，and Mb decreased to normal range within 5 days，slightly faster than CK. 3.The titer of MP-Ab of 12 cases was greater than 1∶160，including 6 cases of 1∶320，12 cases of IgM positive and 9 cases of IgG positive. The detection values of troponin I in 10 cases were （0.00-0.04） μg/L，with no increase. Conclusion　1.Mycoplasma pneumoniae antibody should be routinely examined in children with acute benign myositis. 2.In the case of diagnosing or suspecting BACM，serum CK and Mb should be detected simultaneously and their changes should be observed dynamically. 3.BACM children with Mycoplasma pneumoniae infection should be treated with macrolide antibiotics in addition to bed rest and less physical activity. The need for myocardial metabolism activating drugs and hydration alkalization is judged according to serum troponin Ⅰ，electrocardiogram，urine occult blood test，etc.

Key words: BACM, MP, MP-Ab