肺炎支原体肺炎继发儿童感染性心内膜炎临床特征与诊治分析

doi:10.12372/jcp.2026.25e0096

摘要/Abstract

摘要：

目的探讨儿童肺炎支原体肺炎（MPP）合并感染性心内膜炎（IE）这一罕见并发症的临床特点、诊断、治疗及预后，以提高临床医生对该疾病的认识和早期诊断。方法回顾性分析2023年1月至2024年11月本院收治的5例MPP合并IE患儿的临床资料，包括临床表现、实验室检查、影像学结果、病原学检测、治疗及随访情况。结果 5例患儿发病年龄9（5~9.5）岁，男女比例3∶2，所有患儿均有发热、咳嗽表现，仅1例合并剑突下疼痛；发热持续时间12（9.5~15）天，发现赘生物时间为病程第10（8~12）天；所有患儿均经超声心动图诊断，D二聚体5.09(4.35~7.90)μg/mL 及FDP 10.56(7.20~24.71) mg/L明显增高，IL-6 55.45(33.02~95.56 ) pg/mL及乳酸脱氢酶746(568.45~838.9) U/L水平亦有增高。所有患儿呼吸道标本MP核酸检测阳性，但仅1例血流宏基因检测检出MP。所有患儿均接受手术切除赘生物，术后病理均证实为IE。经手术治疗后所有患者均给予抗感染及抗凝治疗，3例合并肺栓塞患者出院后继续给予抗凝治疗1~6个月。出院后复查彩色多普勒超声心动图均未见赘生物复发，无气促、胸痛、喘息等症状。结论 MPP所致感染性心内膜炎早期症状隐匿，缺乏特异性临床表现。MPP患儿若伴高凝状态，建议行彩色多普勒超声心动图筛查以便早期发现IE赘生物，避免漏诊，及时治疗预后良好。

关键词: 肺炎支原体肺炎, 感染性心内膜炎, 儿童

Abstract:

Objective To investigate the clinical features, diagnosis, treatment, and prognosis of the rare complication of infectious endocarditis (IE) in children with Mycoplasma pneumoniae pneumonia (MPP), aiming to enhance clinicians' understanding and facilitate early diagnosis of this condition. Methods A retrospective analysis was conducted on the clinical data of 5 children with MPP complicated by IE admitted to our hospital from January 2023 to November 2024. The analysis included clinical manifestations, laboratory tests, imaging findings, etiological test results, treatment, and follow-up information. Results The median age of onset was 9 years (5-9.5) years, with a male-to-female ratio of 3:2. All patients presented with fever and cough; only one exhibited concomitant subxiphoid pain. Median duration of fever was 12 (9.5-15) days, and vegetations were detected on echocardiography at a median of 10 (8-12) days after disease onset. Elevated D-dimer levels 5.09 (4.35-7.9) μg/mL and fibrin degradation products 10.56 (7.2-24.71) mg/L indicated marked hypercoagulability, while increased IL-6 55.45 (33.02-95.56) pg/mL and lactate dehydrogenase 746 (568.45-838.9) U/L suggested significant systemic inflammation and tissue injury. All children tested positive for MP nucleic acid in respiratory specimens; however, only one had MP DNA detected in blood via metagenomic next-generation sequencing (mNGS). All underwent surgical excision of vegetations, with histopathological examination confirming the diagnosis of IE. Postoperatively, all received antimicrobial therapy and anticoagulation. Among them, three patients with confirmed pulmonary embolism continued long-term anticoagulation for 1-6 months post-discharge. Follow-up echocardiography revealed no vegetation recurrence, and no patient reported symptoms such as dyspnea, chest pain, or wheezing during the monitoring period. Conclusion MPP-related IE presents with nonspecific and often insidious early manifestations, posing challenges for timely diagnosis. In pediatric patients with MPP and evidence of hypercoagulability, routine echocardiographic screening is strongly recommended to enable early detection of IE and prevent diagnostic delays. With prompt diagnosis and comprehensive management, the prognosis is favorable.

Key words: Mycoplasma pneumoniae pneumonia, infective endocarditis, child

中图分类号:

刘敏, 王琪, 苏军, 崔利丹, 孙绘霞, 宁文慧. 肺炎支原体肺炎继发儿童感染性心内膜炎临床特征与诊治分析[J]. 临床儿科杂志, 2026, 44(1): 25-30.

LIU Min, WANG Qi, SU Jun, CUI Lidan, SUN Huixia, NING Wenhui. Clinical features, diagnosis, and treatment of Mycoplasma pneumoniae pneumonia secondary to infective endocarditis in children[J]. Journal of Clinical Pediatrics, 2026, 44(1): 25-30.

图/表 5

表1

5例MPP合并感染性心内膜炎患儿病例资料"

患儿	临床症状	IL-6/ pg·mL^-1	LDH/ U·L^-1	D二聚体 /μg·ml^-1	FDP/ mg·L^-1	胸部增强CT	赘生物情况		确诊依据（DUKE标准）
患儿	临床症状	IL-6/ pg·mL^-1	LDH/ U·L^-1	D二聚体 /μg·ml^-1	FDP/ mg·L^-1	胸部增强CT	部位及大小	病理结果	确诊依据（DUKE标准）
1	咳嗽，剑突下疼痛	55.45	746	5.09	20.7	左下肺动脉肺栓塞，其远端分支变少、纤细	三尖瓣，11 mm ×9 mm× 9.6 mm	纤维素性渗出物凝块内较多中性粒细胞浸润，结合临床，符合感染性心内膜炎所致内膜赘生物形成。	病理学+临床主要标准2、3+次要标准2、3
2	咳嗽	62.02	818.8	4.44	8.34	-	右心房，20 mm ×16 mm× 16 mm	镜下见粉染无结构纤维素性渗出凝块及出血，其间可见大量中性粒细胞浸润，结合临床，符合感染性心内膜炎所致内膜赘生物形成	病理学+临床主要标准2、3+次要标准2
3	胸痛、咳嗽、咯血、呼吸困难	24.86	424.3	5.57	10.56	右下肺动脉远端分支局部栓塞	右心房+三尖瓣，20 mm ×15 mm× 15 mm	镜下见粉染无结构纤维素性渗出物凝块，其间可见大量中性粒细胞浸润，结合临床，符合感染性心内膜炎所致内膜赘生物形成。	病理学+临床主要标准2、3+次要标准2、3
4	咳嗽	129.1	859	4.26	6.06	-	右心室，15 mm ×10 mm× 10 mm	纤维素性渗出物凝块内较多中性粒细胞、组织细胞和少许淋巴细胞、浆细胞浸润，符合感染性心内膜炎所致炎性纤维素性赘生物形成。	病理学+临床主要标准2、3+次要标准2
5	咳嗽、呼吸困难，低氧、低血压	41.18	712.6	10.23	28.72	右肺各叶局部肺动脉分支及叶间动脉内多发条片状、斑片状充盈缺损，考虑栓塞	右心室+三尖瓣（瓣膜撕裂），25 mm ×20 mm×15 mm	纤维素性渗出物凝块内较多中性粒细胞、组织细胞、淋巴细胞浸润，结合临床，符合感染性心内膜炎所致内膜赘生物形成。	病理学+临床主要标准2、3+次要标准2、3、5

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表2

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患儿	治疗方案				随访
患儿	抗凝	抗感染	手术	其他	随访
1	低分子肝素（200 U·kg^-1·d^-1）31 d（期间因气道黏膜糜烂出血停用10 d）	左氧氟沙星+万古霉素	是	面罩吸氧	院外继续低分子肝素抗凝1月，1月后复查肺部增强CT示左肺下叶片影明显欠均匀强化，其内血管影聚拢，未见明显充盈缺损，复查彩超正常，凝血功能正常，停抗凝。6个月随访，生活良好
2	低分子肝素（200 U·kg^-1·d^-1）22 d	左氧氟沙星+利奈唑胺	是	鼻氧管吸氧	1个月复查凝血功能正常，彩超正常，6个月随访生活良好，复查彩超正常
3	肝素（初始25 U·kg^-1·h^-1，维持3 U· kg^-1·h^-1）18 d+利伐沙班（20 mg， 1天1次）口服7 d	左氧氟沙星	是	经鼻高流量吸氧	院外继续口服利伐沙班抗凝1月，1个月后因患儿家属拒绝增强检查，复查胸部CT提示肺内片影部分吸收，凝血功能恢复正常，家属自行停抗凝药；6个月随访，生活良好，复查彩超正常
4	术前低分子肝素（200 U·kg^-1·d^-1）2 d +术后肝素（3~5 U·kg^-1·d^-1）25 d	左氧氟沙星+利奈唑胺	是	鼻氧管吸氧	1个月复查凝血功能正常，彩超正常，6个月随访生活良好，复查彩超正常
5	肝素（初始20 U·kg^-1·h^-1，维持5 U·kg^-1· h^-1）6 d+低分子肝素（200 U·kg^-1·h^-1）18 d（期间因血性胸水停用7 d）	左氧氟沙星+美罗培南	是	ECMO+机械通气	院外低分子肝素抗凝治疗6月，6个月随访，生活良好，复查彩超三尖瓣返流，复查增强CT右上肺原有充盈缺损未见，右下肺肺动脉充盈缺损范围明显减小