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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (6): 475-479.

• 论著 • 上一篇    下一篇

左氧氟沙星联合糖皮质激素和丙种球蛋白治疗儿童肺炎支原体脑炎4例病例系列报告

刘兴楼,张展,舒赛男,周华,方峰   

  1. 华中科技大学同济医学院附属同济医院儿科学系 武汉，430030
  • 收稿日期:2021-12-10 修回日期:2022-12-13 出版日期:2022-12-25 发布日期:2022-12-25
  • 通讯作者: 方峰

Levofloxacin combined with glucocorticoid and gamma globulin for treatment of mycoplasma pneumoniae encephalitis in 4 children: A case series report

LIU Xinglou, ZHANG Zhan, SHU Sainan, ZHOU Hua, FANG Feng    

  1. Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  • Received:2021-12-10 Revised:2022-12-13 Online:2022-12-25 Published:2022-12-25
  • Contact: FANG Feng

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摘要： 背景 肺炎支原体脑炎（MPE）诊断困难，有效治疗药物选择受限。 目的 总结MPE患儿的临床特点和诊治经过。 设计 病例系列报告。 方法 对2017年1月至2019年12月收治的 MPE连续住院患儿的临床表现、实验室检查和影像学改变、治疗经过及转归进行回顾性分析。 主要结局指标病情反复或复发。 结果 4例MPE患儿纳入本文分析，均为男孩，无基础疾病，以发热和神经系统异常为主要表现，2例伴有呼吸道症状，1例伴有消化道症状；血清肺炎支原体（MP）IgM抗体均阳性，其他常见病原学检查均阴性；脑脊液有核细胞增高3例，蛋白弱阳性1例，免疫球蛋白升高1例；均有头颅MR多发病灶和异常脑电图表现。1例经2次甲泼尼龙和3次IVIG冲击治疗后病情反而逐渐加重，经左氧氟沙星治疗3周联合甲泼尼龙冲击和维持治疗后病情改善。另3例给予左氧氟沙星联合糖皮质激素和IVIG冲击治疗后病情好转。4例MPE患儿出院后随访病情均持续好转，未出现病情反复或复发。 结论 依据MP血清学结合脑炎的临床和影像学特征，在排除其他常见病原后，可临床诊断MPE；左氧氟沙星联合糖皮质激素和IVIG治疗MPE疗效明显，预后良好。

关键词: 儿童, 肺炎支原体脑炎, 左氧氟沙星, 丙种球蛋白, 甲泼尼龙

Abstract: Background It is difficult to dignose mycoplasma pneumoniae encephalitis (MPE) and the available medicine is limited. Objective To summarize the clinical features, diagnosis and treatment of children diagnosed with MPE. DesignCase series report. Methods The clinical manifestations, laboratory examination and imaging changes, treatment and outcomes in consecutively hospitalized patients diagnosed with MPE from January 2017 to December 2019 were retrospectively analyzed. Main outcome measures Recurrence or relapse. Results A total of 4 patients were all boys without any other underlying diseases. All of them mainly presented with fever and nervous system abnormality, 2 of whom had respiratory symptoms and 1 developed gastrointestinal symptoms. Serum mycoplasma pneumoniae (MP) IgM antibody detection was positive and other common pathogens were negative in all cases. As to cerebrospinal fluid test, 3 cases showed increased nucleated cell number, 1 case had weak positive protein and 1 case presented increased cerebrospinal fluid immunoglobulin. Multiple lesions in cranial magnetic resonance imaging (MRI) and abnormal electroencephalographic (EEG) were showed in all patients. Only one patient's condition was gradually worsened after 2 times of methylprednisolone and three times of intravenous immunoglobulin (IVIG) treatment, but the following condition was improved after three weeks of levofloxacin therapy combined with methylprednisolone pulse treatment and maintenance therapy. The other three patients' conditions were improved after receiving three weeks of levofloxacin therapy combined with IVIG pulse treatment and glucocorticoid. Follow-up after discharge showed that all patients' conditions continued to improve without recurrence or relapse. Conclusion The diagnosis of MPE can be established based on positive serological MP-IgM and the clinical manifestations and imaging features of encephalitis after other common pathogens were excluded. Levofloxacin combined with glucocorticoid and gamma globulin can achieve obvious efficacy and improve the prognosis of MPE.

Key words: Children, Mycoplasma pneumoniae encephalitis, Levofloxacin, Immune globulin, Methanone nylon