小儿肺炎支原体肺炎合并全身炎症反应综合征时炎性相关因素的变化及临床意义

Changes of inflammation-associated factors in children with Mycoplasma pneomoniae pneumonia and concomitant systemic inflammatory response syndrome

目的检测肺炎支原体肺炎(MPP)患儿血清C-反应蛋白(CRP)和降钙素原(PCT)、血沉(ESR)及血常规白细胞(WBC)和中性粒细胞(NE),探讨它们的变化与MPP病情轻重的关系,以利于临床评估病情,防止病情恶化,判定疗效。方法住院MPP急性期患儿92例,入选MPP患儿分为全身炎症反应综合征(SIRS)组和非SIRS组。SIRS组中符合小儿SIRS诊断标准2项者为S1组,符合≥3项者为S2组。入院初及治疗1周后分别检测血清CRP,PCT,ESR及血常规。结果①入院时CRP均值各组均增高,增加值S2组>S1组>非SIRS组(P<0.01,0.05)。治疗1周后,各组CRP指标较入院时均明显下降,但S2组仍高于S1组和非SIRS组(P<0.01)。②入院时PCT均值非SIRS及S1组无增高,S2组明显高于前两组(P<0.01);治疗1周后,非SIRS组和S1组较入院时比较差异无显著性(P>0.05),S2组较入院初明显下降(P<0.01),但S2组仍显著高于S1组和非SIRS组(P<0.01)。③入院初S2组ESR较非SIRS组和S1组显著增快,各组ESR入院初与治疗1周后比较无明显变化。④S1和S2组入院时血WBC计数和NE均高于非SIRS组,且S2组高于S1组(P<0.05),治疗1周后S1和S2组血WBC计数和NE与入院初比较有所下降。⑤在各项炎性相关因素指标(CRP,PCT,ESR,WBC/NE)中,非SIRS组中以CRP单项增高为主,占65%;S1组2项增高为主,占56%;S2组以3项及以上同时增高为主,占70.4%。结论CRP是MPP急性期炎症反应的敏感检测指标,动态监测CRP可判断MPP病情轻重、帮助判断治疗效果,结合PCT,ESR,WBC及NE多项感染炎症指标检测结果,能更准确地预测MPP病情严重程度、发生合并症及混合细菌感染的可能。

Objective To study the relationship between the changes of inflammation-associated factors, C-reactive protein （CRP）, procalcitonin （PCT）, erythrocyte sedimentation rate （ESR）, white blood cell （WBC） and neutrophils, and the severity in children with Mycoplasma pneomoniae pneumonia （MPP）. Methods Ninety-two children with acute MPP consisting of 52 cases with concomitant systemic inflammation response syndrome （SIRS） and 40 cases without SIRS were enrolled in this study. The 52 cases with concomitant SIRS were classified into two groups based on the severity of SIRS： mild SIRS （n = 25） and severe SIRS （n --27）. CRP, PCT, ESR and WBC count and the percentage of neutrophils （ NE% ） were detected on admission and one week after anti-inflammation treatment. Results All of patients showed increased serum CRP contents at admission. The serum CRP contents were the highest in the severe SIRS group, followed by the mild SIRS and non-SIRS groups on admission （P 〈 0.05 or 0.01 ）. The serum CRP contents were reduced in all of patients after 1-week treatment. The severe SIRS group still demonstrated higher serum CRP contents than the non- SIRS and the mild SIRS groups （ P 〈 0.01 ）. The severe SIRS group had increased serum PCT contents on admission, which were significantly higher than those of the mild SIRS and non-SIRS groups （P 〈 0.01 ）. After 1-week treatment, the serum PCT contents were reduced in the severe SIRS group but remained higher than in the mild SIRS and non-SIRS groups （P 〈 0. 01 ）. ESR increased significantly in the severe SIRS group than in the mild SIRS and non-SIRS groups on admission （P 〈 0.01 ）. One-week treatment did not significantly decrease ESR in all three groups. The WBC count and NE% in the mild and severe SIRS groups were significantly higher than in the non-SIRS group and the severe SIRS group had higher WBC count and NE% than the mild SIRS group on admission （ P 〈 0.05 ）. The WBC count and NE% decreased after 1-week treatment in the mild and severe SIRS groups （ P 〈 0.05 ）. One inflammation-associated factor （only CRP） increase was predominant in the non-SIRS group （65%）, 2 factors increase in the mild SIRS group （56%）, and three or more factors increase in the severe SIRS group （ 70.4% ）. Conclusions The detection of inflammationassociated factors, CRP, PCT, ESR, WBC and neutrophils, are valuable to the evaluation of severity in MPP.