儿童肺炎支原体肺炎治愈后反复呼吸道感染的影响因素研究

Influencing Factors of Recurrent Respiratory Tract Infection in Cured Children with Mycoplasma Pneumoniae Pneumonia

目的探讨儿童肺炎支原体(MP)肺炎治愈后反复呼吸道感染(RRTI)的影响因素。方法选取2010年3月—2015年3月榆林市吴堡县医院收治的因MP肺炎住院治疗且治愈后能完成1年随访的患儿478例,通过门诊随访收集患儿临床资料,分析MP肺炎治愈后RRTI的影响因素。结果 478例MP肺炎患儿治愈后发生RRTI 169例(占35.36%),作为RRTI组;未发生RRTI 309例(占64.64%),作为非RRTI组。RRTI组与非RRTI组患儿性别、Ig G水平、Ig M水平比较,差异无统计学意义(P>0.05);RRTI组患儿年龄、免疫调节剂使用率、CD_4^+/CD_8^+细胞比值、Ig A水平低于非RRTI组,药物使用不当率、MP抗体阳性或阴转阳率高于非RRTI组(P<0.05)。多因素logistic回归分析结果显示,年龄〔OR=2.36,95%CI(1.17,4.74)〕、药物使用不当〔OR=3.47,95%CI(2.78,10.36)〕、MP抗体阳性或阴转阳〔OR=4.39,95%CI(1.51,13.71)〕、CD_4^+/CD_8^+细胞比值〔OR=10.39,95%CI(3.34,31.86)〕、Ig A〔OR=1.94,95%CI(1.13,3.45)〕为MP肺炎患儿治愈后RRTI的危险因素,免疫调节剂〔OR=0.27,95%CI(0.13,0.83)〕为保护因素(P<0.05)。结论年龄、药物使用不当、MP抗体阳性或阴转阳、CD_4^+/CD_8^+细胞比值、Ig A为MP肺炎患儿治愈后RRTI的危险因素,免疫调节剂为保护因素。

Objective To investigate the influencing factors of recurrent respiratory tract infection(RRTI)in cured children with mycoplasma pneumoniae(MP)pneumonia. Methods From March 2010 to March 2015,a total of 478 children with MP pneumonia were selected in Wubu County Hospital,Yulin,all of them were cured and successfully followed up for 1 year,clinical data was collected through outpatient follow - up,and the influencing factors of RRTI were analyzed. Results Of the 478 children,169 cases( accounting for 35. 36% ) occurre RRTI( served as A group),309 cases( accounting for 64. 64% ) did not occurre(served as B group). No statistically significant differences of gender,IgG or IgM was found between the two groups( P > 0. 05 );age,utilization rate of immunomodulator,CD +4 / CD +8 cell ratio and IgA of A group were statistically significantly lower than those of B group,while drug misuse ratio,positive rate or turned positive rate of MP antibody of A group were statistically significantly higher than those of B group( P < 0. 05). Multivariate logistic regression analysis showed that,age〔OR = 2. 36,95% CI(1. 17,4. 74)〕,drug misuse〔 OR = 3. 47,95% CI(2. 78,10. 36)〕,positive expression of MP antibody〔 OR = 4. 39,95% CI(1. 51,13. 71)〕,CD +4 / CD +8 cell ratio〔 OR = 10. 39,95% CI(3. 34, 31. 86)〕and IgA〔 OR = 1. 94,95% CI(1. 13,3. 45)〕 were risk factors of RRTI in cured children with MP pneumonia, while immunomodulator〔OR = 0. 27,95% CI(0. 13,0. 83)〕 was the protective factor( P < 0. 05). Conclusion Age, drug misuse,positive expression of MP antibody,CD +4 / CD +8 cell ratio and IgA are risk factors of RRTI in cured children with MP pneumonia,while immunomodulator is the protective factor.