C反应蛋白对肺炎支原体肺炎的预测价值

Predictive value of C-reactive protein on Mycoplasma pneumoniae pneumonia

目的探讨预测大环内酯类抗菌药物对小儿大环内酯类耐药的肺炎支原体(MRMP)肺炎功效的潜在实验室指标。方法本研究纳入108例肺炎支原体肺炎患者。根据23SrRNA基因域特异点突变结果将患者分为MRMP组和大环内酯类敏感的肺炎支原体(MSMP)组,并将MRMP组分为大环内酯类无效(MNE)组和大环内酯类有效(ME)组,分别比较每两组患者的一般资料、实验室检查、影像学检查结果。并通过逐步逻辑分析和ROC曲线评价预测大环内酯类药物效力的有效指标。结果 MRMP组患者住院时间、启动治疗后发热时期、治疗启动后超过72h的发热持续时间较MSMP组明显延长,差异有统计学意义(P<0.05)。与ME亚组相比,MNE亚组血清C反应蛋白(CRP)和鼻咽呼吸道白细胞介素-6水平明显增高。在逐步逻辑回归分析中,CRP是预测大环内酯类药物对MRMP肺炎效力的重要因素,在ROC曲线分析中CRP曲线下面积为0.76,CRP最佳截断值是44.9mg/L,灵敏度是42.6%,特异度是95.0%。结论 CRP是预测大环内酯类药物效力的有效指标,对指导临床治疗和改善MRMP肺炎患者的预后具有重要意义。

Objective To investigate the potential laboratory indicators for predicting the efficacy of macroli‐des in treating children patients with macrolides‐resistant Mycoplasma pneumoniae（MRMP） pneumonia .Methods A total of 108 patients with Mycoplasma pneumoniae pneumonia were enrolled in this study .According to the results of specific point mutations in 23S rRNA gene domain ,the children patients were divided into the MRMP and macrolide‐sensitive （MSMP） groups .Moreover the MRMP group was re‐divided into the macrolide non‐effect（MNE） subgroup and the macrolide effect（ME） subgroup .The general data ,laboratory detection ,imageological dexamination results were compared between each of two groups .The stepwise logistic regression model and receiver operating character‐istic （ROC） curve analysis were adopted to analyze the effective laboratory indicators for predicting the efficacy of macrolides in MRMP pneumonia .Results Compared with MSMP group ,the hospital stays ,febrile periods after initi‐ation of macrolides treatment and fever time more than 72 h in the MRMP group were significantly extended ,the differences were statistically significant（P〈0 .05） .Compared with the ME subgroup ,the serum CRP level and naso‐pharyngeal respiratory tract IL‐6 levels in the MNE subgroup were significantly increased .In the stepwise logistic re‐gression analysis ,CRP was the significant factor predicting the efficacy of macrolides in the patients with MRMP pneumonia .The area under the curve of CRP was 0 .76 in ROC curve analysis .The optimal cutoff value of CRP was 44 .9 mg/L ,with a sensitivity of 42 .6% and a specificity of 95 .0% .Conclusion Serum CRP could be an effective in‐dicator for predicting the efficacy of macrolides ,and has an important significance to guide the clinical treatment and improve the prognosis in the patients with MRMP pneumonia .