Abstract: Objective　To analyze the clinical features of 81 children with Chlamydia pneumoniae pneumonia. Methods　A retrospective analysis was conducted on the medical records of 81 children with Chlamydia pneumoniae pneumonia admitted to the Respiratory Department，Shanghai Children’s Hospital，School of Medicine，Shanghai JiaoTong University between January 2024 and May 2025. Data collected included demographic characteristics，clinical manifestations，laboratory parameters，chest imaging findings，and treatment situation. The clinical features were analyzed. Results　The peak incidence occurred in children aged 6~12 years，accounting for 75.31%（61/81） of cases. Male patients（53 cases，65.43%） outnumbered female patients（28 cases，34.57%）. All patients presented with cough，and pulmonary moist rales and fever were observed in 53.09%（43/81） and 46.91%（38/81） of the patients，respectively. Pulmonary consolidation was the most common imaging finding，presenting in 92.59%（75/81） of cases. Totally 52 children（64.20%） had a hospital stay of ≤5 days，while 35.80%（29/81） were hospitalized for 6~10 days. 77.78%（63/81）of the patients underwent diagnosis and treatment using electronic bronchoscopy. Endobronchitis was the predominant bronchoscopic finding； plastic bronchitis and necrotizing pneumonia were observed in only 7.94%（5/63） and 6.35%（4/63） of cases，respectively. The co-infection rate was 53.09%（43/81）， with bacterial co-infection being the most common（25.93%），primarily involving Streptococcus pneumoniae and Haemophilus influenzae. Viral coinfection accounted for 16.05%，predominantly rhinovirus. Severe pneumonia was identified in 48.15%（39/81）of patients. Compared with the mild group，the severe group had higher CRP levels，a higher proportion of patients undergoing electronic bronchoscopy treatment，and a higher incidence of mixed infection （P<0.001），and there were statistically significant differences. In terms of drug treatment，72.84%（59 cases） of the children used minocycline，and 22.22%（18 cases） used macrolide antibiotics alone. About 9.88%（8 cases） received low-dose methylprednisolone due to bronchoscopic findings suggesting plastic，obstructive，or necrotizing pneumonia. All children were followed up with imaging examinations at 1 week to 1 month after discharge，which showed the lung inflammation was significantly absorbed. Conclusion　Chlamydia pneumoniae pneumonia primarily affects school-aged children，with a higher incidence in males. A high proportion of cases are severe，with elevated CRP levels，and high co-infection rates which are the clinical features worthy of concern. In children aged ≥8 years，novel tetracyclines may represent an effective treatment option，and some children may need to be treated with combined glucocorticoid therapy.

Key words:

摘要： 目的　分析81例儿童肺炎衣原体肺炎的临床特征。方法　收集上海交通大学医学院附属儿童医院呼吸科2024年1月至2025年5月收治的81例肺炎衣原体肺炎患儿的病例资料，包括患儿基本资料、临床表现、实验室指标、胸部影像学情况及治疗情况，对其临床特征进行回顾性分析。结果　6~12岁是肺炎衣原体肺炎高发年龄段，占75.31%（61/81）。男性患儿53例（65.43%），高于女性患儿28例（34.57%）。患儿均有咳嗽，肺部湿啰音43例（53.09%），发热38例（46.91%）。肺实变是最常见影像学改变，占92.59%（75/81）。52例患儿（64.20%）住院时间在5d以内；住院6~10d的患儿占35.80%（29/81）。63例（77.78%）接受电子支气管镜诊治。电子支气管镜下主要表现为支气管内膜炎，仅7.94%（5/63）患儿存在塑形性支气管炎，6.35%（4/63）表现为坏死性肺炎。混合感染发生率为53.09%（43/81），以合并细菌感染最常见（25.93%），常见病原体为肺炎链球菌及流感嗜血杆菌；病毒感染次之（16.05%），以鼻病毒居多。重症肺炎患儿占48.15%（39/81），与轻症组相比，重症组患儿的C反应蛋白（CRP）水平更高、接受电子支气管镜诊治的比例更高、混合感染率更高（P<0.001），差异具有统计学意义。在药物治疗方面，59例（72.84%）患儿使用米诺环素，22.22%（18例）单用大环内酯类抗生素。9.88%（8例）因电子支气管镜下提示塑形、闭塞或坏死性肺炎加用小剂量甲泼尼龙。所有患儿于出院后1周至1个月随访影像学检查，均显示肺部炎症明显吸收。结论　肺炎衣原体肺炎主要见于学龄期，以男性多见。重症患儿占比高，其CRP水平升高、混合感染率高是值得关注的临床特征。在≥8岁患儿中，新型西环素类药物可能是一种有效的治疗选择，部分患儿需联合糖皮质激素治疗。

关键词: