支原体肺炎患儿并发肺外消化系统损害情况及影响因素

Study on related risk factors of mycoplasma pneumonia in children com-plicated with extrapulmonary digestive system damage

目的 研究支原体肺炎患儿发生消化系统损害的危险因素。方法 选取2012年5月~2014年3月温州医科大学附属乐清医院收入的支原体肺炎患儿,根据是否并发消化系统损害分为消化系统损害组（37例）和无消化系统损害组（63例）。采用胶体金法检测血清中支原体特异性Ig M抗体,被动凝集法检测特异性Ig G抗体。观察比较两组患儿发热情况、发热持续时间、病程和大环内酯类抗感染起始时间等情况,检测患儿C反应蛋白（CRP）和红细胞沉降率（ESR）情况。结果 100例肺炎支原体患儿中,共有37例发生消化系统损害,发生率为37.00%,主要表现为恶心、呕吐和腹泻等,大多数发生在病程早期,持续时间1~5 d。单因素分析显示：两组患儿发热持续时间、发热程度和大环内酯类药物抗感染起始时间差异有统计学意义（P〈0.05）,而年龄、性别、住院时间、CRP和ESR水平差异无统计学意义（P〉0.05）。将单因素分析差异有统计学意义的变量进行非条件性Logistic回归分析,结果显示：发热程度、发热持续时间和大环内酯类抗感染起始时间是支原体肺炎患儿并发肺外消化系统损害的独立影响因素（P〈0.05）。结论 治疗支原体肺炎患儿应注意发热情况以及大环内酯类药物使用,持续发热是引发肺外消化系统损伤的重要因素之一,而早期给予大环内酯类抗生素可以有效减少对患儿肺外消化系统的损伤。

Objective To study the related risk factors of children with mycoplasma pneumonia complicated with extra- pulmonary digestive system damage. Methods Children with mycoplasma pneumonia in Yueqing Hospital Affiliated to Wenzhou Medical University from May 2012 to March 2014 were selected. According to whether suffered with digestive system damage, children were divided into the group with digestive system damage （37 cases） and group without diges- tive system damage （63 cases）. Colloidal gold method was used for serum specific IgM antibodies detection, passive agglutination method was used for serum specific IgG antibodies detection. The fever, fever duration, course of disease, start time of macrolide used for anti-infection of children in the two groups were observed and compared. The levels of C reactive protein （CRP） and erythrocyte sedimentation rate （ESR） were also detected and compared. Results Among 100 cases of children with mycoplasma pneumonia, 37 cases had digestive system damage, the occurrence rate was 37.00%. Nausea, vomiting and diarrhea werer the main clinical manifestations, most occurred early in the course of the disease duration, lasted for 1 to 5 days. Single factor analysis showed that fever duration, fever degree and start time of macrolide used for anti-infection between the two groups had significant differences （P 〈 0.05）, but there were no sta- tistically significant differences in age, gender, hospitalization time, CRP and ESR （P 〉 0.05）. Variables which had statistically significant differences in the single factor analysis were included in the non-conditional Logistic regression analysis, results showed that the fever degree, fever duration and start time of macrolide used for anti-infection were in- dependent related factors of children with mycoplasma pneumonia complicated with extrapulmonary digestive system damage （P 〈 0.05）. Conclusion The treatment of mycoplasma pneumonia in children, should pay attention to the fever and macrolide drug use. Fever is one of the important factors caused extrapulmonary digestive system damage, and ear- ly given macrolide antibiotics treatment can effectively reduce extrapulmonary digestive system damage.