儿童面部蜂窝织炎相关临床因素分析

Association of clinical factors with disease severity and prognosis in child facial cellulites

目的研究儿童面部蜂窝织炎相关临床因素对病情评估的意义。方法收集社区获得性面部蜂窝织炎患儿49例。采用Pearson相关分析总病程、住院日及发热天数与年龄、最高体温、WBC、C反应蛋白(CRP)值、静脉抗菌药物起用时间的相关性;采用两独立样本t检验比较起病后48h内及72h内使用不同抗菌药物类型(普通β-内酰胺酶类抗菌药物和加β-内酰胺酶抑制剂抗菌药物或万古霉素)所对应的总病程、住院日及发热天数;以发热天数为因变量(Y),年龄(X_1)、最高体温(X_2)、WBC(X_3)、CRP值(X_4)、静脉抗菌药物起用时间(X_5)为自变量进行多元线性回归分析。结果发热天数与最高体温、CRP值、静脉抗菌药物起用时间均呈正相关(r=0.755、0.455和0.351,均P<0.05),与年龄呈负相关(r=-0.304,P=0.034),与WBC无相关性(r=0.094,P=0.522);住院日与CRP值呈正相关(r=0.442,P=0.001),与其他指标无相关性(均P>0.05);总病程与临床指标均无相关性(均P>0.05)。起病后48h内及72h内使用普通β-内酰胺酶类抗菌药物和使用加β-内酰胺酶抑制剂抗菌药物或万古霉素其总病程、住院日及发热天数比较差异均无统计学意义(均P>0.05)。发热天数(Y)与最高体温(X_2)及静脉抗菌药物起用时间(X_5)具有线性回归关系,回归方程为:Y=-84.200+2.204X_2+0.762 X_5。结论发热天数与年龄、最高体温、CRP值、静脉抗菌药物起用时间具有相关性,即该4项指标对病情评估具有临床意义;早期使用抗菌药物可缩短病程,而使用普通β-内酰胺酶类抗菌药物和使用加β-内酰胺酶抑制剂抗菌药物或万古霉素其疗效无明显差异;最高体温、静脉抗菌药物起用时间对发热病程具有预测意义。

Objective To analyze the association of clinical factors with disease severity and prognosis in child facial cellulitis.Methods A total of 49 children with community-acquired facial cellulites admitted in our hospital from January 2011 to January 2017 were recruited in the study.Pearson correlation analysis was used to analyze the correlation between the total duration of disease,the length of hospital stay,the length of fever and the age,the maximum temperature,white blood cell （WBC） count,C-reactive protein （CRP） value,the start time of intravenous antibiotic.T-test was used to analyze the effect of the choice of antimicrobial agents in the early course of the disease （normal β-lactam antibiotic or β-lactamase inhibitors antibiotics/vancomycin） on the total duration of disease,the length of hospital stay,the length of fever.Multiple linear regression analysis was performed with the length of hospital stay（Y） as the dependent variable,the age（X1）,the maximum temperature （X2）,WBC count（X3）,CRP value（X4）,and the start time of intravenous antibiotic（X5） as the independent variables.Results The length of fever was positively correlated with the maximum temperature,CRP value,and the start time of intravenous antibiotic （r=0.755,0.455 and 0.351,all P〈0.05）,negatively correlated with the age （r=-0.304,P=0.034）,and not correlated with WBC count （r=0.094,P=0.522）.The length of hospital stay was positively correlated with the CRP value（r=0.442,P=0.001）,and not correlated with other indicators （all P 〉0.05）.There was no significance correlation between the duration of disease and other indexes（all P 〉0.05）.There were no significant differences in the duration of disease,the length of hospital stay and the length of fever between patients normal β-lactam antibiotic or β-lactamase inhibitors antibiotics/vancomycin within 48h or 72h of disease onset （all P 〉0.05）.The maximum temperature（X2） and the start time of intravenous antibiotic （X5） had linear regression with the length of fever（Y）,and the regression equation was Y=-84.200＋2.204X2＋0.762X5.Conclusion The length of fever is correlated with the age,the maximum temperature,CRP value and the start time of intravenous antibiotic.The early use of antibiotics can shorten the course of community-acquired facial cellulites,and no matter the normal β-lactam antibiotic or β-lactamase inhibitors antibiotics/vancomycin are used.The maximum temperature and the start time of intravenous antibiotic have predictive significance for the length of fever.