儿童肺炎支原体性胸腔积液特点分析

Clinical characteristics of pleural effusion in children with Mycoplasma pneumoniae

目的 探讨肺炎支原体性胸腔积液临床特点.方法 回顾性分析肺炎旁胸腔积液（PPE）患儿的临床资料,比较支原体感染与非支原体感染患儿的差异,并对单因素分析中有统计学差异的指标行多因素logistic 回归分析,绘制受试者工作特征（ROC）曲线,得出各指标的诊断界值及回归模型的诊断准确度.结果 支原体感染与非支原体感染患儿的年龄、外周血白细胞数、血清乳酸脱氢酶（LDH）、免疫球蛋白IgA 及IgM,胸腔积液中多核粒细胞比例、葡萄糖及乳酸,以及胸腔积液纤维分隔形成、胸膜增厚的差异均有统计学意义（P均 〈 0.05）;多因素logistic 回归分析示,年龄、血清IgM及LDH,胸腔积液中乳酸（LAC）在支原体感染组及非支原体感染组间的差异也有统计学意义（P 〈 0.05）,其诊断界值分别为ROC曲线下面积（AUC）=0.887（95% CI：0.830 ~ 0.944,P 〈 0.001）.结论 对于病原不明确的PPE患儿,若存在年龄 〉 3.92岁,血清IgM 〉 1.29 g/L 及LDH 〉 367 U/L,胸腔积液LAC 〈 4.02 mmol/L时,应高度怀疑支原体感染的可能.

Objective To explore the clinical characteristics of pleural effusion caused byMycoplasma pneumoniae in children.MethodsThe clinical data from children with pleural effusion caused byMycoplasma pneumoniae were retrospectively analyzed. Differences of clinical characteristics in children with pleural effusion caused byMycoplasma pneumoniae infection and non-Mycoplasma pneumoniae infection were compared. Moreover, multiple logistic regression analysis was performed on the factors that were identified to have statistical differences in single factor analysis. Receiver operating characteristic (ROC) curve was performed and the diagnostic boundary value of each factor and the diagnostic accuracy of the regression model were calculated.ResultsThere were statistical differences between children with pleural effusion caused byMycoplasma pneumoniae infection and by non-Mycoplasma pneumoniae infection in age, white blood cell count, lactic dehydrogenase (LDH), levels of IgA and IgM, and the proportion of multiple nuclei, glucose and lactic acid (LAC) in pleural effusion, pleural thickening, and formation of ifbrous separation (allP?<?0.05). Multifactor logistic regression found the differences of age, levels of IgM and LDH, level of LAC are statistically different between the two groups (allP<?0.05), with their diagnostic boundary value of 3.92 years old, 1.29 g/L, 367 U/L and 4.02 mmol/L, respectively.ROC under the curve (AUC) was 0.887 (95%CI: 0.830-0.944,P<?0.001).ConclusionIn children having pleural effusion caused by pneumonia of unknown pathogen, if their age is?>?3.92 years, serum IgM?>?1.29 g/L, LDH?>?367 U/L and pleural effusion LAC?<?4.02 mmol/L, Mycoplasma pneumoniae infection should be highly suspected.