免疫低下儿童合并急性呼吸窘迫综合征的预后

Clinical outcomes of immunocompromised children with acute respiratory distress syndrome

目的探讨免疫功能低下对儿童急性呼吸窘迫综合征（PARDS）预后的影响。方法本研究为回顾性分析，时间段共纳入56例PARDS患儿，其中免疫功能低下组20例。通过病案查询系统收集患者的临床数据，使用单因素及多因素分析方法研究免疫功能低下患儿预后。结果免疫功能低下患儿相对于对照组，有着较高的年龄及体质量（P=0．003及P〈0．01）；较低的外周血白细胞、中性粒细胞及血小板水平（P=0．060，P=0．006及P=0．023）；较少使用高频振荡机械通气（HFOV）（P=0．015）以及较高的PICU住院病死率（P=0．003）。危险因素分析提示非生存组中免疫功能低下比例及呼吸机相关性肺损伤的发生率均高于生存组（P=0．003；P=0．046）；多因素Logistic回归分析进一步明确免疫功能低下与PARDS患者结局相关（OR=6．986，95％CI：1．812～26．930，P=0．005）。生存曲线亦表明免疫功能低下患儿的28d生存率较对照组低（P=0．022）。结论免疫功能低下合并PARDS儿童PICU住院病死率高于免疫功能正常者，是PARDS儿童预后不良的主要危险因素。

Objective To investigate the clinical outcomes of immunocompromised （IC） children with pediatric acute respiratory distress syndrome （PARDS） in pediatric intensive care unit （PICU）. Methods Fifty-six PADRS children were enrolled and the data of clinical characteristics, immunological status, complications, treatments and outcomes were collected and analyzed by using univariate and multivariate regression models.Results There were 20 children in the immunocompromised group and 36 in the control group. Immunocompromised children were older and weighted greater than the control ones （P=0.003 and P〈0.01, respectively）. Peripheral blood leukocyte, neutrophil and platelet counts were significantly lower in IC group compared with control group （P=0.060, P=0.006 and P=0.023, respectively）. In addition, high-frequency oscillatory ventilation （HFOV） was used less frequently in the IC group （P=0.015）. The PICU mortality of the IC group was significantly higher than that of control group （P=0.003）. The proportion of IC patients and the incidence of ventilator-associated lung injury differed significantly between survivors and non-survivors （P=0.003 and P=0.046, respectively）. After adjusting for other confounding factors by using multivariate logistic regression analysis, IC was associated with a higher mortality （OR=6.986, 95% CI：1.812-26.930, P=0.005）. Survival analysis also indicated that IC children with ARDS had lower 28-day survival rate than the non-IC children （P=-0.022）. Conclusions IC children with PARDS have a higher PICU mortality than children with normal immune fimction. Immunocompromise is an important predictor of poor outcomes in children with PARDS.