儿童肺炎支原体肺炎后发生反复呼吸道感染的多因素分析

Multiple risk factor analysis of recurrent respiratory tract infection after Mycoplasma pneumoniae pneumonia in children

目的探讨肺炎支原体（MP）肺炎治愈一年内儿童发生反复呼吸道感染（RRTI）的情况及其影响因素。方法选择MP肺炎治愈并完成一年随访的133例患儿为研究对象,检测其治愈出院时及出院后3、6、9、12个月时MPIgM、MP-IgG双抗体滴度,免疫功能,并记录是否发生呼吸道感染及呼吸道感染部位,一年内用药情况,并进行分析。结果完成随访的133例患儿中,治愈后一年内RRTI发生率为31.58%。多元logistic回归分析结果显示,年龄为3-6岁（OR=2.29,95%CI：1.13-4.64）;抗体持续阳性或者阴转阳（OR=4.47,95%CI：1.47-13.65）;CD4/CD8降低（OR=10.26,95%CI：3.30-31.90）;IgA低下（OR=1.90,95%CI：1.06-3.40）是发生RRTI的独立危险因素;使用免疫增强剂（OR=0.29,95%CI：0.11-0.78）是预防发生反复呼吸道感染的独立保护因素。在MP抗体持续阳性和阴转阳的85例患儿中,40例无临床症状应用抗生素,16例（40.00%）发生RRTI;45例未用抗生素,18例（40.00%）发生RRTI,两组间差异无统计学意义（P〉0.05）。结论 MP肺炎治愈后一年内免疫功能紊乱的患儿容易发生RRTIs,使用免疫增强剂可降低RRTI发生率。MP抗体持续阳性和阴转阳患儿,在无临床症状时应用抗生素不能预防RRTI。

Objective To investigate the occurrence trend and risk factors of recurrent respiratory tract infection during the first year after Mycoplasma pneumoniae pneumonia（MPP） in children. Methods The clinical data of 133 children completely recoved from MPP and one year follow-up after MPP were included in this study, MPP IgM IgG double antibody titer were measured in different time slots（3 month, 6 months, 9 months, 12 months） after discharge. Information on frequency of recurrent respiratory tract infections, respiratory tract infection site, and drug use within one year were collected. Possible factors affecting the occurrence of recurrent respiratory tract infection were analyzed by means of single factor and multi factor analyses. Results In 133 patients, the recurrent rate was 31.58% in the first year; aged 3-6 years old（OR=2.29,95%CI：1.13-4.64）, or continuous positive or negative to positive antibodies（OR=4.47,95%CI：1.47-13.65）, or low CD4/CD8（OR=10.26,95%CI：3.30-31.90）, or low IgA（OR=1.90,95%CI：1.06-3.40） is independent risk factor of recurrent respiratory tract after MPP; immune enhancer therapy is an independent protective factor（OR=0.29,95%CI：0.11-0.78）. Conclusions Immune function disorders in the first year after MPP were independent risk factors of recurrent respiratory tract infection. MP antibody positive without clinical symptoms and sustained antibody positive can not prevent the recurrence of respiratory tract infection without use of antibiotics. Immune enhancer was advocate to adjust immune function and reduce the incidence of repeated respiratory tract infection.