儿童重症肺炎支原体肺炎合并心脏内血栓的临床特征与预后：一项单中心回顾性研究

doi:10.12372/jcp.2025.25e0342

Abstract

Abstract:

Objective To investigate the clinical features, therapeutic strategies, and outcomes in pediatric patients with severe Mycoplasma pneumoniae pneumonia (SMPP) complicated by intracardiac thrombosis. Methods A retrospective analysis was performed on the clinical records of 19 children diagnosed with SMPP and concurrent intracardiac thrombosis admitted between January 2020 and May 2024. Results Among the 19 children, 13 were boys and 6 were girls, with a median age of 8 (7-10) years. All children presented with fever and cough, and 11 (57.89%) exhibited additional extracardiac thrombotic events. Laboratory findings revealed elevated levels of C-reactive protein 58.91 (25.62-98.19) mg/L, lactate dehydrogenase 559 (442-791) U/L, and D - dimer 6.06 (3.44-7.52) mg/L. The median time from symptom onset to diagnosis was 12 (10-17) days, with all thrombi identified via echocardiography; the majority (n=14, 73.69%) were located in the right ventricle. Six patients underwent immediate surgical intervention due to hemodynamic instability (shock), large thrombus size (diameter>30 mm), or presence of multiple mobile thrombi with high embolic risk. Thirteen patients initially received anticoagulation therapy; seven showed marked reduction in thrombus burden, while one experienced embolization during early treatment and five required conversion to surgical thrombectomy due to inadequate response. During follow-up (3-5 months), none of the 11 surgically treated patients developed new thromboses or cardiac complications. Among the 8 non-surgical cases, 6 achieved complete thrombus resolution within 3 months, while one patient was lost to follow-up and one experienced embolization.Conclusion Pediatric SMPP with intracardiac thrombosis presents with nonspecific symptoms and carries a significant risk of systemic embolization. Dynamic monitoring of echocardiography and D-dimer levels during the first 1-2 weeks of illness is recommended for early detection. Prompt anticoagulant or surgical management is associated with favorable outcomes; however, therapeutic decisions should be individualized based on thrombus morphology, hemodynamic status, and embolic risk.

Key words: child, Mycoplasma pneumoniae, pneumonia, intracardiac, thrombus

CLC Number:

CHEN Dan, REN Jiaying, SUN Lifang, WEI Zhenghu, SUN Xiaomin. Clinical features and prognosis of severe Mycoplasma pneumoniae pneumonia combined with intracardiac thrombus in children: a single-center retrospective study[J].Journal of Clinical Pediatrics, 2026, 44(1): 17-24.

Figures/Tables 4

Table 1

Figure 1

Table 2

Diagnosis and treatment process of children with severe mycoplasma pneumoniae pneumonia complicated with intracardiac thrombosis"

患儿	确诊时程/d	栓子大小/mm	心脏栓子部位及活动度	心包积液	其他栓塞部位	抗凝治疗时间/d	手术取栓治疗	出院时栓子大小 /mm
1	12	18×16×10	右房内近下腔入口，活动度大	有（少量）	无	7	是	消失
2	13	12.6×8.7	右室内三尖瓣腱索处，活动度大	无	两下肺分支局部栓塞	4	无	消失
3	16	17.8×13.8×13.2	右室室间隔基底段	有（少量）	两肺下叶肺动脉部分分支	16	无	16.9×14.0×12.6
4	18	7.6×5.2	室间隔右室面近隔瓣处；附着于三尖瓣腱索	无	无	12	无	2.1×1.8
5	8	17.2×13.5	右室内三尖瓣腱索处,活动度大	有	无	10	无	16.0×9.5
6	13	37.1×17.4	右室内侧壁旁	无	无	0	是	消失
7	21	20×18×10	右室近心尖部室间隔处	有	无	6	是	消失
8	10	21.6×14.9	右心室腔内近心尖室间隔旁,活动度大	有	右肺动脉、分支及叶间动脉多发栓塞	0	是	消失
9	16	18×6×25	二尖瓣后瓣	无	脾栓塞、肾梗死	14	是	消失
10	14	15.6×13.3	右室内三尖瓣后叶腱索处	无	右下肺动脉栓塞	28	无	10.8×7.5
11	20	10.5×9.3	右室心尖处近右室流入道与流出道交界处	有	右肺下叶肺动脉部分分支	15	无	9.8×4.8
12	11	23×20×9、 13×10×7	右房内下腔静脉入口：附着于右房游离壁，活动度大，舒张期部分可进入三尖瓣口	无	无	0	是	消失
13	13	19.4×10.9、 20.7×6.7	右房内近三尖瓣隔瓣及后瓣瓣根处,可变形，活动度大	无	右下肺动脉分支	0	是	消失
14	10	14.7×12.4×37	右室腔内附着在隔瓣及腱索相移行处	无	左下肺动脉及部分分支	0	是	消失
15	10	11×9	右室腔内	无	无	8	无	9.6×9.5
16	8	14.6×7.8、 15×10×10	右室内隔后瓣腱索根部	无	双侧颈内静脉及上腔静脉	0	是	消失
17	14	20×16×10	右房近下腔静脉入口处，活动度大	有	无	10	是	消失
18	20	16×16×20	右室右外侧游离壁与前、后瓣腱索间	有（少量）	右肺上叶肺动脉	12	是	消失
19	10	8.9×8.6	右室内近室间隔侧	无	右肺下叶肺动脉分支	8	无	6.9×6.6

Table 2

Figure 2

References 24

[1]	刘凯, 付红敏, 陆权. 中国儿童肺炎支原体肺炎流行病学新进展[J]. 中华儿科杂志, 2024, 62(7): 696-699.
	Liu K, Fu HM, Lu Q. Advancement in epidemiology of mycoplasma pneumoniae pneumonia in children in China[J]. Zhonghua Erke Zazhi, 2024, 62(7): 696-699.
[2]	中华人民共和国国家卫生健康委员会. 儿童肺炎支原体肺炎诊疗指南(2023年版)[J]. 国际流行病学传染病学杂志, 2023, 50(2): 79-85.
	National Health Commission of the People's Republic of China. Guidelines for diagnosis and treatment of mycoplasma pneumoniae pneumonia in children (2023 edition)[J]. Int J Epidemiol Infect Dis, 2023, 50(2): 79-85.
[3]	刘莉萍, 杨泽玉, 王玉, 等. 儿童重症肺炎支原体肺炎的临床特征及相关危险因素分析[J]. 中国小儿急救医学, 2023, 30(6): 451-456.
	Liu LP, Yang ZY, Wang Y, et al. Clinical features and related risk factors of severe Mycoplasma pneumoniae pneumonia in children[J]. Zhongguo Xiaoer Jijiu Yixue, 2023, 30(6): 451-456.
[4]	陈梦雪, 李京阳, 杨芬, 等. 儿童大环内酯类耐药重症肺炎支原体肺炎的临床特征及危险因素分析[J]. 临床儿科杂志, 2024, 42(3): 187-192.
	Chen MX, Li JY, Yang F, Tian Y, et al. Clinical features and risk factors of macrolide-resistant severe Mycoplasma pneumoniae pneumonia in children[J]. Linchuang Erke Zazhi, 2024, 42(3): 187-192.
[5]	罗丽君, 崔云, 张明军, 等. 儿童重症肺炎支原体肺炎并发肺栓塞的临床研究[J]. 中华实用儿科临床杂志, 2025, 40(10): 775-779.
	Luo LJ, Cui Y, Zhang MJ, et al. Clinical study of severe Mycoplasma pneumoniae pneumonia complicated with pulmonary embolism in children[J]. Zhonghua Shiyong Erke Linchuang Zazhi, 2025, 40(10): 775-779.
[6]	Bolluyt DC, Euser SM, Souverein D, et al. Increased incidence of mycoplasma pneumoniae infections and hospital admissions in the Netherlands, November to December 2023[J]. Euro Surveill, 2024, 29(4): 2300724.
[7]	Todkill D, Lamagni T, Pebody R, et al. Persistent elevation in incidence of pneumonia in children in England, 2023/24[J]. Euro Surveill, 2024, 29(32): 2400485.
[8]	赵顺英, 陈志敏, 刘瀚旻, 等. 国家卫生健康委员会《儿童肺炎支原体肺炎诊治指南(2023年版)》重点解读[J]. 临床儿科杂志, 2023, 41(3): 224-228.
[9]	Wang Y, Xiao Y, Deng X, et al. Cardiac thrombus and stroke in a child with mycoplasma pneumoniae pneumonia: A case report[J]. Medicine, 2021, 100(5): e24297.
[10]	刘娜, 马静, 孟晨, 等. 肺炎支原体感染引起儿童心脏栓塞10例临床分析[J]. 中华实用儿科临床杂志, 2021, 36(16): 1253-1256.
	Liu N, Ma J, Meng C, et al. Clinical analysis of 10 cases of cardiac embolism caused by mycoplasma pneumoniae infection in children[J]. Zhonghua Shiyong Erke Linchuang Zazhi, 2021, 36(16): 1253-1256.
[11]	Hahn DW, Atkinson CE, Le M. Multiple anatomic sites of infarction in a pediatric patient with M. pneumoniae infection, a case report[J]. BMC Pediatr, 2021, 21(1): 372. doi: 10.1186/s12887-021-02845-3 pmid: 34465285
[12]	张育才, 孙汀. 儿童肺炎支原体相关凝血功能障碍与血栓形成[J]. 中国小儿急救医学, 2021, 28(1): 16-19.
	Zhang YC, Sun T. Mycoplasma pneumoniae-associated coagulopathy and thrombosis in children[J]. Zhongguo Xiaoer Jijiu Yixue, 2021, 28(1): 16-19.
[13]	殷勇, 陈健德. 儿童大环内酯类耐药肺炎支原体肺炎诊疗理念与实践[J]. 临床儿科杂志, 2024, 42(3): 177-181.
	Yin Y, Chen JD. Diagnosis and treatment of macrolide-resistant mycoplasma pneumoniae pneumonia in children: concepts and practice[J]. Linchuang Erke Zazhi, 2024, 42(3): 177-181.
[14]	杨白云, 韩晓华. 儿童肺炎支原体肺炎相关高凝状态及炎症指标的临床研究进展[J]. 国际儿科学杂志, 2022, 49(4): 270-273.
	Yang BY, Han XH. Research progress on hyper-coagulability and inflammatory markers in children with mycoplasma pneumoniae pneumonia[J]. Guoji Erke Kexue Zazhi, 2022, 49(4): 270-273.
[15]	刘峰. 肺炎支原体肺炎与预后相关的临床指标[J]. 临床儿科杂志, 2022, 40(4): 247-251.
	Liu F. Clinical indicators related to prognosis of Mycoplasma pneumoniae pneumonia[J]. Linchuang Erke Zazhi, 2022, 40(4): 247-251.
[16]	Hou J, Sun R, Zhang X, et al. Pulmonary embolism in children with mycoplasma pneumonia: Can it be predicted?[J]. Eur J Clin Microbiol Infect Dis, 2025, 44(2): 393-403. doi: 10.1007/s10096-024-05014-3
[17]	中国医药教育协会儿科专业委员会, 中华医学会儿科学分会呼吸学组, 中国医师协会呼吸医师分会儿科呼吸工作委员会, 等. 儿童肺血栓栓塞症诊断与治疗专家共识[J]. 中华实用儿科临床杂志, 2025, 40(2): 81-91.
	Pediatric Committee of China Medicine Education Association, Respiratory Group of the Pediatrics Branch of the Chinese Medical Association, Pediatric Respiratory Working Committee of the Chinese Respiratory Physician Association, et al. Expert consensus on diagnosis and treatment of pulmonary thromboembolism in children[J]. Zhonghua Shiyong Erke Linchuang Zazhi, 2025, 40(2): 81-91.
[18]	Liu J, He R, Wu R, et al. Mycoplasma pneumoniae pneumonia associated thrombosis at Beijing Children’s Hospital[J]. BMC Infect Dis, 2020, 20(1): 51. doi: 10.1186/s12879-020-4774-9
[19]	孙妍, 张宁, 张红菊, 等. 肺炎支原体肺炎合并右心室血栓超声特点分析及鉴别诊断[J]. 心肺血管病杂志, 2021, 40(12): 1234-1238.
	Sun Y, Zhang N, Zhang HJ, et al. Ultrasonic features analysis and differential diagnosis of mycoplasma pneumoniae pneumonia complicated with right ventricular thrombus[J]. Xinfeixueguanbing Zazhi, 2021, 40(12): 1234-1238.
[20]	李奇蕊, 袁越, 林利, 等. 肺炎支原体肺炎并发心腔内血栓二例[J]. 中华儿科杂志, 2018, 56(12): 950-951.
	Li QR, Yuan Y, Lin L, et al. Two cases of intracardiac thrombosis complicating mycoplasma pneumoniae pneumonia[J]. Zhonghua Erke Zazhi, 2018, 56(12): 950-951.
[21]	Oishi T, Ouchi K. Recent trends in the epidemiology, diagnosis, and treatment of macrolide-resistant mycoplasma pneumoniae[J]. J Clin Med, 2022, 11(7): 1782. doi: 10.3390/jcm11071782
[22]	黄坤玲, 牛波, 路素坤, 等. 肺炎支原体肺炎并发心腔内血栓、肺栓塞1 例并文献复习[J]. 临床儿科杂志, 2021, 39(6): 421-424.
	Huang KL, Niu B, Lu SK, et al. Mycoplasma pneumoniae pneumonia complicated with cardiac thrombus and pulmonary embolism: a case report and literature review[J]. Linchuang Erke Zazhi, 2021, 39(6): 421-424.
[23]	董春娟, 徐勇胜, 宁静, 等. 溶栓治疗儿童肺炎支原体肺炎并心腔血栓及肺栓塞2例[J]. 中华实用儿科临床杂志, 2022, 37(19): 1495-1497.
	Dong CJ, Xu YS, Ning J, et al. Thrombolytic therapy for two children with mycoplasma pneumoniae pneumonia complicated by intracardiac thrombosis and pulmonary embolism[J]. Zhonghua Shiyong Erke Linchuang Zazhi, 2022, 37(19): 1495-1497.
[24]	Battisha A, Madoukh B, Sawalha K, et al. Iatrogenic right atrial thrombus complicated by pulmonary embolism: management and outcomes[J]. Curr Cardiol Rev, 2021, 17(4): e230421188336.

患儿	性别	年龄 /岁	入院时病程/d	肺炎支原体耐药基因	其他临床表现	WBC /×10⁹·L^-1	D-二聚体 /mg·L^-1	CRP /mg·L^-1	LDH /U·L^-1	抗磷脂抗体	肺坏死	胸腔积液
1	男	7	10	_	胸痛、气促	15.81	7.62	100.10	1 158	阴性	有	有（右侧）
2	男	12	9	_	咯血	6.07	6.06	17.41	422	-	无	无
3	女	10	7	阳性	胸痛	8.51	7.55	33.36	770	阳性	无	无
4	男	8	17	阳性	无	12.13	7.21	9.5	385	阴性	有	无
5	男	7	8	-	气促	16	7.52	30.39	442	-	无	有（右侧）
6	男	12	13	阳性	无	13.3	2.12	48.93	559	-	有	有（右侧）
7	男	7	21	阳性	气促	17.73	6.8	183.45	429	阳性	有	有（左侧）
8	女	10.1	10	阳性	呼吸困难、休克	22.62	10.23	58.91	993	-	有	有（双侧）
9	男	13	16	阳性	气促、胸痛	32.2	2.82	35.24	791	阴性	有	无
10	男	8	10	阳性	无	17.56	2.47	60.85	456	阳性	无	有（双侧）
11	男	4.6	20	阳性	无	14.91	3.44	101.24	535	阴性	有	无
12	女	9.8	11	阴性	无	17.91	4.44	86.27	818.8	-	有	有（左侧）
13	男	9.2	13	阳性	咯血、胸痛、呼吸困难	14.66	6.62	106.44	424.3	阴性	有	有（左侧）
14	男	7	3	阳性	呼吸困难	11.84	5.69	7.66	538	-	无	有（右侧）
15	男	8.8	9	阳性	无	30.26	5.09	17.74	746	-	有	有（左侧）
16	男	5.8	7	阳性	胸痛	22.45	4.26	48.25	859	-	无	有（左侧）
17	女	8	11	阳性	胸痛	29.38	8.83	98.19	656	-	有	无
18	女	4.3	8	阳性	无	22.24	2.1	58.93	680	-	有	无
19	女	5.1	3	阳性	无	8.08	2.18	25.62	552	-	无	无

Clinical features and prognosis of severe Mycoplasma pneumoniae pneumonia combined with intracardiac thrombus in children: a single-center retrospective study

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