背景：
Baer等學者研究兒童社區性肺炎的原因發現1~3歲、>3~7歲及>7歲肺炎黴漿菌(Mycoplasma pneumoniae)所占的比例分別為22%、35%及40%。顯見肺炎黴漿菌感染為兒童社區性肺炎的主要原因之一。
臨床上常以血清檢驗方式來診斷肺炎黴漿菌感染。然而，此檢驗方式的準確性並不完美(詳見第二章第五節－相關於肺炎黴漿菌感染診斷困境的文獻總結)。如此的診斷不準確性將衍生出抗生素使用與醫療資源浪費的問題。
本研究將以回顧性的方式，分析南台灣某區域教學醫院兒科病房下呼吸道感染住院病童的病歷資料。目的在探討依現行間接血液凝集試驗(Indirect hemagglutination test)的檢驗方式[台富－速樂定黴漿菌試驗(FTI-Serodia-myco II test)]，結合臨床症狀(Symptoms)、徵象 (Signs)與其他實驗檢查結果一起來分析，希望藉此由臨床症狀、徵象與檢驗數據來提升肺炎黴漿菌感染的診斷正確性。

設計：
本研究為回顧性（Retrospective）研究設計。樣本對象為兒科病房下呼吸道感染的住院病童。排除逾18歲、嚴重感染症、嚴重自體免疫疾病、自動出院或轉院、住院未滿24小時、未檢驗間接血液凝集試驗者。區分出肺炎黴漿菌感染病童與非因肺炎黴漿菌感染之下呼吸道感染住院的病童兩組。所得資料以SPSS for Windows第19.0版進行描述性統計、獨立樣本t檢定與卡方檢定及單因子變異數分析。

結果：
有效樣本283份。黴漿菌間接血液凝集試驗檢驗值>1:320計67份、<1:320計216份。
本研究結果肺炎黴漿菌感染病童男：女為1：1.09；年齡分佈：<5歲占41.79%、>5~<10歲占46.27%、>10~<14歲占11.94%，平均5.87歲(SD=2.88)；平均住院天數為4.13+2.04天；多數集中在春、夏季節(3~8月，占67.16%)。
兒科下呼吸道感染住院病童初次血液常規檢驗項目中的嗜酸性球(eosinophil)百分比、血小板數及與黴漿菌間接血液凝集檢驗結果> 1:320的相關性具有統計學顯著性(分別為p=0.009與p=0.039)。並且胸部X光檢查出現斑塊對於肺炎黴漿菌感染具特異性(p=0.000)。

結論：
由於血液常規檢驗僅需時不到一小時，而黴漿菌間接血液凝集檢驗最快需時三小時，而且通常不提供急診檢驗。因此，檢驗血液常規檢驗項目中的嗜酸性球百分比與血小板數可提供臨床醫師於急診、門診或住院時面對下呼吸道感染的病童時能即時地適切診斷並提供治療。
希望研究結果能提供醫院管理者對於兒科系處置該類病童時實證的思考，有效的醫治病童，包括醫病溝通，減少非必要的抗生素使用及合理的醫療費用支出。

Background
Mycoplasma pneumoniae (M. pneumoniae) is a major cause of pediatric community&#8208;acquired pneumonia (CAP), accounting for approximately 15% of all CAP cases. Treatment with macrolide antibiotics is recommended. However, diagnosis of M. pneumoniae infection based on clinical symptoms is difficult. Diagnostic uncertainty can lead to the prescription of inappropriate antibiotics, which may worsen patients’ clinical prognosis, increase their antibiotic resistance, and generate medical waste.
Any information that can contribute to achieving an effective diagnosis is extremely valuable. Thus, this study investigates the clinical features and laboratory and radiographic findings of patients with lower respiratory tract infections to facilitate diagnosis of M. pneumoniae infection.

Design
A retrospective review of medical records was conducted to obtain patient data, including their sex, age, and duration of hospitalization (Appendix 3). All lower respiratory tract infection patients admitted to the pediatric ward at the Zuoying branch of the Kaohsiung Armed Forces General Hospital (a local teaching hospital) between January 2009 and August 2012 were included in this study. Patients who were over 18 years of age, diagnosed with critical illnesses, discharged against medical advice, or had a hospitalization duration of less than 24 hours were excluded. The remaining patients were divided into two groups according to whether their indirect hemagglutination test (IHT) results showed values below or above 1:320.
Data were analyzed using Statistical Packages for Social Sciences (SPSS) software for Windows, version 19.0. A p value of < 0.05 was considered significant.

Results
The total number of cases examined was 283. Of these, 67 had titer values equal to or greater than 1:320 (infection group), and 216 had values below 1:320 (non-infection group).
The patients’ mean age and average hospitalization duration for the infection group were 5.87 + 2.88 years and 4.13 + 2.04 days, and 5.13 + 2.86 years and 4.20 + 1.86 days for the non-infection group. Between the 2 groups, 3 variables achieved statistical significance (p < 0.05), namely, chest X-ray film patches (p = 0.000), eosinophil percentage (p = 0.009), and platelet count (p = 0.039).

Conclusion
The results for patients’ eosinophil percentage and platelet count in routine blood tests showed statistical significance for M. pneumoniae infection. Furthermore, the results could be obtained more rapidly using routine blood tests compared to IHT, specifically, less than 1 hour versus at least 3 hours. In addition, the performance of IHT is not suitable for emergency purposes. Physicians can use the eosinophil percentage identified in routine blood tests to rapidly and adequately diagnose patients with lower respiratory tract infections in not only outpatient and inpatient departments, but also in emergency departments. Consequently, more appropriate antibiotics can be administered, thereby reducing medical waste.

論文審定書 i
誌謝 ii
中文摘要 iii
Abstract v
目錄 viii
圖目錄 x
表目錄 xi
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 1
第二章 文獻探討 2
第一節 黴漿菌的介紹 2
第二節 肺炎黴漿菌的臨床表現 3
第三節 肺炎黴漿菌感染的臨床診斷 6
第四節 肺炎黴漿菌的治療 9
第五節 相關於肺炎黴漿菌感染診斷困境的文獻總結 9
第三章 研究方法 13
第一節 研究設計 13
第二節 研究架構 13
第三節 研究問題 16
第四節 研究假設 16
第五節 各變項說明與名詞解釋 16
第六節 研究對象與資料收集 18
第七節 資料處理與統計分析 19
第八節 研究對象權益維護 19
第四章 研究結果 20
第一節 病童臨床症狀、徵象與檢驗數據的描述性統計 20
第二節 獨立樣本T檢定與卡方檢定 27
第三節 單因子變異數分析結果 29
第四節 假設驗證 31
第五章 討論 32
第一節 肺炎黴漿菌感染與X光檢查出現斑塊之相關性 32
第二節 肺炎黴漿菌感染與嗜酸性球百分比之相關性 33
第三節 肺炎黴漿菌感染與血小板數之相關性 36
第六章 結論與建議 37
第一節 結論與建議 37
第二節 研究貢獻 37
第三節 研究限制 38
第四節 未來研究延伸 39
參考文獻 40
附錄1－衛署醫器製壹字第000260號Myco II檢驗說明 44
附錄2－衛署藥輸字第021830號仿單 46
附錄3－病歷資料萃取表格 48
附錄4－人體試驗審查委員會通過證明 49

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中文文獻

台灣兒科肺炎診療指引編定小組(民97年1月13日)。兒童社區性肺炎處置建議【線上論壇】。取自http://www.pediatr.org.tw/member/bedside_info.asp?id=2.
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李秉穎(民94)。第4章兒童常見的呼吸道感染性疾病。載於國立臺灣大學醫學院(主編)，實用小兒科學(49-71頁)。台北市：台大醫學院。
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