目的

探讨肺炎支原体脑炎（MPE）患儿伴双眼复视的临床特点、诊治策略和患儿预后。

方法

选择2023年11月甘肃省定西市中医医院收治的1例MPE 伴双眼复视患儿（患儿1）为研究对象。采用回顾性分析方法，对其临床资料进行分析，并检索国内外数据库中MPE 患儿相关研究进行文献复习，总结该病临床特点、诊治策略和患儿预后。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。监护人对患儿1的诊治知情同意。

结果

①患儿1，男，9岁，以发热、头痛、头晕、双眼复视起病，无其他神经系统受累表现。其血清肺炎支原体（MP）-Ig M 抗体呈阳性。其脑脊液检查结果显示，脑压正常，脑脊液为无色水样液体、清晰透明，黏蛋白定性为阴性；脑脊液生化检查结果显示，葡萄糖水平正常，乳酸脱氢酶及氯水平降低；脑脊液细菌培养呈阴性。对其采取阿奇霉素抗感染、MPE治疗5 d后，患儿1上述症状均迅速缓解，住院5 d痊愈出院。对其出院诊断为MPE。出院2个月后随访无复发，未发生神经系统后遗症。②文献复习结果：对11篇MPE相关研究文献纳入的241例MPE患儿，以及本研究患儿1，共242例MPE患儿临床资料进行分析的结果如下。242例MPE患儿中，以发热（73.9%）、头痛（72.3%）、意识障碍（47.9%）为主要临床表现，脑膜刺激征（46.7%）及病理征（21.4%）多为阳性；辅助检查中，阳性率高的分别是脑电图（77.3%）、血清MP-Ig M 呈阳性（73.1%）及脑脊液白细胞计数较正常值增高（41.7%）。MPE 患儿合并肺炎较多，而出现幻觉、幻听、幻视者少见，笔者文献复习尚无伴双眼复视MPE 患儿研究的文献报道。这242例患儿均采取大环内酯类药物治疗，重症患儿联合甲泼尼龙琥珀酸钠或丙种球蛋白治疗，早期诊断和治疗的MPE 患儿多数预后良好。

结论

MPE 患儿可发生双眼复视，这对MPE 患儿的早期诊断有一定参考和治疗意义。

Objective

To investigate the clinical characteristics，diagnosis，treatment and prognosis of children with Mycoplasmapneumoniae encephalitis（MPE）complicated with binocular diplopia.

Methods

A child （patient 1）diagnosed with MPE and experiencing binocular diplopia was admitted to Dingxi Hospital of Traditional Chinese Medicine in November 2023，was selected as the subject of this research.A retrospective analysis was conducted to evaluate the clinical data of patient 1，and relevant studies on children with MPE were reviewed from both domestic and international databases to summarize the clinical characteristics，diagnosis，treatment and prognosis of the disease.The procedures followed in this study adhered to the WorldMedicalAssociationDeclarationof Helsinki revised in 2013.The guardian provided informed consent for the diagnosis and treatment of patient 1.

Results

①Patient 1，male，9 years old，developed with fever，headache，dizziness，and binocular diplopia，without other manifestations of nervous system involvement.The serum Mycoplasmapneumoniae（MP）-Ig M antibody was positive.Cerebrospinal fluid examination showed that cerebral pressure was normal，with colorless，water-like liquid，clear and transparent，mucin was qualitatively negative.Biochemical analysis of cerebrospinal fluid showed that glucose level was normal，lactate dehydrogenase and chlorine levels were decreased；Bacterial culture in cerebrospinal fluid was negative.After 5 days of treatment with azithromycin for anti-infection and MPE，the above symptoms of patient 1 were quickly relieved and cured，and was discharged from hospital for 5 days hospitalization.The discharge diagnosis was MPE.There were no recurrence and no neurological sequelae during follow up of 2 months after discharge.②Literature review results：there were 241 children with MPE in 11 MPE related studies and plus patient 1，the clinical data of 242 children with MPE were analyzed as follows.Among the 242 children with MPE，fever （73.9%），headache（72.3%），disturbance of consciousness （47.9%）were the main clinical manifestations，and most of the meningeal irritation signs （46.7%）and pathological signs （21.4%）were positive.In auxiliary examinations，the higher positive rates were electroencephalogram （77.3%），serum MP-Ig M positive（73.1%），and increased white blood cell count in cerebrospinal fluid （41.7%），respectively.Moreover，more children with MPE have pneumonia，but hallucinations，auditory hallucinations，and visual hallucinations were rare.MPE with binocular diplopia has not been reported yet.All 242 children were treated with macrolides，and severe children were treated with methylprednisolone sodium succinate or gamma globulin.Most children with MPE diagnosed and treated early had a good prognosis.

Conclusion

Binocular diplopia can occur in children with MPE，which has certain reference for early diagnosis and treatment of children with MPE.