늑막삼출 유무에 따른 마이코플라즈마 폐렴의 임상 양상의 비교
Comparison of Clinical Characteristics of Mycoplasma pneumoniae Pneumonia According to the Pleural Effusion
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목 적 : Mycoplasma pneumoniae는 학동기 소아에서 호흡기 감염의 주된 원인균이며, 마이코플라즈마 폐렴의 호흡기 합병증으로는 무기폐, 늑막 삼출, 폐농양, 폐기종, 기관지 확장증 등이 있다. 이번 연구에서는 마이코플라즈마 폐렴에서 늑막 삼출 유무에 따른 임상 양상의 특징을 비교해보고자 하였다. 방 법 : 2000년 1월부터 2004년 12월까지 동아대학교의료원 소아과에 입원한 마이코플라즈마 폐렴 환자 210명을 대상으로 입원 기록을 후향적으로 비교분석하였다. 마이코플라즈마 폐렴의 진단기준은 항 마이코플라즈마 항체역가가 1:320 이상인 경우로 하였으며 늑막 삼출을 동반한 경우(A군)와 동반하지 않은 경우(B군)로 나누어 성별, 연령, 발생시기, 증상, 이학적 소견, 검사 소견, 흉부 방사선 소견을 비교하였다. 결 과 : A군과 B군 간의 연령, 성별, 발생시기, 증상 및 청진 소견에서는 유의한 차이는 없었다. 발열기간과 입원기간은 A군이 B군보다 의미있게 길었다.(P<0.001) 적혈구 침강속도는 A군에서 49.6±32.9 mm/hr로, B군의 28.7±20.4 mm/hr보다 의미있게 높았으며(P=0.001), C-반응성 단백은 A군에서 23.0±60.4 mg/dL로, B군의 8.7±30.9 mg/dL보다 의미있게 높았고(P= 0.004), SGOT와 SGPT는 A군이 각각 67±74.2 IU/L와 53.6±60.0 IU/L로, B군의 37.4±18.6 IU/L와 26.2±16.9 IU/L보다 의미있게 높았다. (P<0.001) 늑막 삼출 유무와 항 마이코플라즈마 항체역가 사이의 유의성은 없었다. 결 론 : 늑막 삼출이 동반된 마이코플라즈마 폐렴군에서 발열기간, 입원기간, 적혈구 침강속도, C-반응성 단백, SGOT, SGPT가 늑막 삼출이 동반되지 않은 군에 비해 유의하게 증가되어 있어, 이러한 검사 소견들을 통하여 치료 경과를 예측할 수 있을 것으로 생각한다.
Abstract
Purpose : Mycoplasma pneumoniae (M. pneumoniae) is a major cause of respiratory infections in school-aged children. Complications of M. pneumoniae pneumonia include atelectasis, pleural effusion, empyema, pneumothorax and bronchiectasis. We evaluated the clinical characteristics of M. pneumoniae pneumonia with pleural effusion. Methods : A total of 210 medical records of children who were admitted to the Dong-A University hospital due to M. pneumoniae pneumonia from 2000 to 2004 were retrospectively analyzed. Diagnosis of M. pneumoniae pneumonia was based on the single titer of antimycoplasmal antibody higher than 1:320. Enrolled children were divided into Group A (with pleural effusion) and Group B (without effusion). We analysed the differences between the two groups according to sex, age, onset, symptoms, clinical manifestations, laboratory findings and chest x-rays. Results : There were no significant differences in age, sex and clinical manifestations between the two groups. Group A had longer fever durations (9.3±7.8 days vs 5.0±3.7 days), and a longer duration of hospitalization (10.4±6.3 days vs 6.9±6.3 days) compare to Group B. Also, compared to the Group B, Group A had higher ESR (49.6±32.9 mm/hr vs 28.7±20.4 mm/hr), CRP (23.0±60.4 mg/dL vs 8.7±30.9 mg/dL), SGOT (67±74.2 IU/L vs 53.6±60.0 IU/L), SGPT (37.4±18.6 IU/L vs 26.2±16.9 IU/L). There was no significance between antimycoplasmal antibody titer and pleural effusion. Conclusion : This study shows that M. pneumoniae pneumonia with pleural effusion has a longer duration of fever and hospitalization, higher ESR, CRP, SGOT, SGPT compare to the M. pneumoniae pneumonia without pleural effusion. We conclude that these findings could be used as the prognostic factors in M. pneumoniae pneumonia with pleural effusion.
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