肺炎支原体肺炎患儿发生后遗症的危险因素研究

Risk factors of developing sequelae after Mycoplasma pneumoniae pneumonia in children

目的探讨肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)患儿发生后遗症的相关危险因素,以指导临床治疗,减少后遗症的发生。方法回顾性分析北京儿童医院2002年1月-2006年10月1705例住院MPP患儿的临床资料,根据急性期后2个月胸片或肺CT表现分为后遗症组(144例)和对照组(190例)。记录两组患儿的年龄、性别、热程、喘息、胸腔积液、肺外并发症,肺CT(或胸片)病变部位、肺部病变类型,WBC(N%、L%)、ESR、CRP,发病后开始应用大环内酯类抗生素的时间及开始应用丙种球蛋白、糖皮质激素的时间;对两组上述各项指标进行组间对照研究,先行单因素分析,对单因素分析结果P<0.2的指标进一步行多因素Logistic回归分析。结果Logistic回归分析结果显示,热程>10d(P<0.05,OR=1.987)、胸腔积液(P<0.01,OR=7.724)、病变部位位于右上肺(P<0.01,OR=3.547)、病变类型为大片状阴影(P<0.01,OR=2.009)、肺外并发症(P<0.05,OR=2.232)为肺炎支原体肺炎后遗症的独立危险因素,胸腔积液是较强危险因素。结论热程、胸腔积液、病变部位、病变类型、肺外并发症均与肺炎支原体肺炎后遗症的发生相关。

Objectives To identify the risk factors for the sequelae in children with Mycoplasma pneumoniae pneumonia （MPP） and thus provide instructions for the clinical therapy to minimize risk of the sequelae. Methods The Clinical data of 1705 children with MPP were retrospectively reviewed from Jan. 2002 to Oct. 2006 in Beijing Children＇s Hospital. Based on the findings of X-ray and/or the CT scan, the subjects were divided into two groups, the sequelae group （144 cases） and the control group （190 cases）. The comparison was made between two groups in age, gender, fever, wheeze, pleural effusion, complication diseases, the manifestation of pneumonia on X-ran and/or CT scan, white blood cell count （WBC）, erythrocyte sedimentation rate （ESR）, and C reaction protein （CRP）. If the results of single factor regression showed P 〈 0.2, the indicators were analyzed by the muhifactor logistic regression. Results The results of logistic regression indicated that the independent risk factors included fever lasting more than 10 days （P 〈 0.05, OR = 1.987）, pleural effusion （P 〈 0.01, OR = 7.724）, location of the pneumonia at the right upper lung （P 〈 0.01, OR = 3.547）, the large patchy shadow （P 〈 0.01, OR = 2.009）, and complication diseases （P 〈 0.05, OR = 2.232）. Pleural effusion was the most important factor. Conclusions Fever, pleural effusion, complication diseases, location of the pneumonia, and the pattern of radiography are factors associated with the sequelae.