目的 对比重症肺炎支原体肺炎（MPP）与重症肺炎链球菌肺炎（SPP）的临床特征。方法 回顾性分析2015年1月—2020年1月收治的77例重症MPP和40例重症SPP患儿，对比两组患儿的一般情况、临床表现、辅助检查等资料。结果 重症MPP患儿组男性48例（62.3%），年龄为44(24~78)月。重症SPP患儿组男性22例（55.0%），年龄为14(9~25)月。96.1%（74/77）的重症MPP患儿与80.0%（32/40）的重症SPP患儿在入院前使用抗生素（P=0.007）。与重症SPP患儿相比，重症MPP患儿出现发热、高热比例较高，出现喘息、神经系统症状比例较低（P均<0.05）。重症SPP患儿更易在肺部闻及湿啰音、哮鸣音，且双侧均出现体征患儿比例更高（P均<0.05）。与重症SPP患儿相比，重症MPP患儿WBC较低、LDH水平较高，胸部CT更易出现支气管充气征（均P<0.05）。两组患儿支气管镜镜下表现及肺泡灌洗液常规检查结果的差异无明显统计学意义（P均>0.05）。结论 重症MPP与重症SPP患儿临床特征常不典型，年龄、发热、高热、喘息、肺部体征、神经系统表现、外周血白细胞计数、外周血乳酸脱氢酶水平等对临床鉴别有提 示作用。

Objective To compare the differences of clinical features between severe Mycoplasma pneumoniae pneumonia (MPP) and severe Streptococcus pneumoniae pneumonia (SPP). Methods Seventy-seven patients with severe MPP and 40 patients with severe SPP admitted to the respiratory ward of Children's Hospital Affiliated to Chongqing Medical University from January 2015 to January 2020 were retrospectively analyzed, and the general conditions, clinical manifestations, auxiliary examinations and other data of the two groups were compared. Results There were 48 boys (62.3%) in the severe MPP group with a median age of 44(24-78) months. In the severe SPP group, there were 22 boys (55.0%) with a median age of 14(9-25) months. 96.1% (74/77) of children with severe MPP and 80.0% (32/40) of children with severe SPP received antibiotics before admission (P=0.007). Compared with children with severe SPP, the proportion of fever and hyperpyrexia was higher, and the proportion of wheezing and nervous system symptoms was lower in children with severe MPP (P<0.05). The children with severe SPP were more likely to have crackles and rhonchi in the lungs, and the proportion of children with signs on both sides was higher (P<0.05). Compared with children with severe SPP, children with severe MPP had lower WBC and higher LDH levels, and were more likely to have aerated bronchus signs on chest CT (all P<0.05). There was no significant difference in bronchoscopy and routine examination results of bronchoalveolar lavage fluid between the two groups (all P>0.05). Conclusions The clinical characteristics of children with severe MPP and severe SPP are often atypical. Age, fever, hyperpyrexia, wheezing, pulmonary signs, nervous system manifestations, peripheral WBC, and peripheral blood LDH levels are helpful for clinical differentiation.