儿童肺炎支原体肺炎并呼吸道黏液栓形成的早期预测指标

Early predictors of childhood Mycoplasma pneumoniae pneumonia associated with airway mucus plug

目的研究黏液栓堵塞呼吸道的儿童肺炎支原体肺炎（MPP）的早期预测指标。方法回顾性分析2016年9月至2017年1月在吉林大学第一医院儿科住院的130例行纤维支气管镜灌洗术的MPP患儿病历资料，依据纤维支气管镜下有无黏液栓堵塞呼吸道分为黏液栓组（60例）和对照组（70例），比较2组患儿的一般资料、临床特点、实验室检查、影像学、纤维支气管镜下表现及治疗情况，将有临床意义及统计学意义的单因素进行多因素Logistic回归分析和受试者工作特征（ROC）曲线分析，了解儿童MPP呼吸道黏液栓形成的早期预测指标。结果黏液栓组热峰[39.8 ℃（39.5 ℃，40.0 ℃）比39.5 ℃（39.0 ℃，39.8 ℃）]、热程[（11.3±3.1） d比（7.8±2.4） d]、住院时间[（13.5±3.8） d比（8.5±3.2） d]、外周血白细胞总数（WBC）[（9.4±3.7）×10^9/L比（8.2±2.9）×10^9/L]、中性粒细胞比例（0.698±0.112比0.623±0.119）、C－反应蛋白（CRP）[48.2 （19.8，91.0） mg/L比12.4 （7.1，25.4） mg/L]、乳酸脱氢酶（LDH）水平[466.5 （371.5，639.0） U/L比323.0（273.2，376.8） U/L]，以及合并胸腔积液（56.7%比17.1%）、肺不张（23.3%比7.1%）、肺坏死（16.7%比0）、累及肺叶≥2（40.0%比21.4%）均明显高于对照组，差异均有统计学意义（Z＝－3.394，t＝－6.957、－8.021、－2.046、－3.672，Z＝－6.402、－6.433，χ^2＝22.074、6.786、12.639，5.306，均P〈0.05）。多因素Logistic回归分析显示热程、CRP、LDH是儿童MPP并呼吸道黏液栓形成的独立预测指标，其ROC曲线临界值分别为热程≥9.5 d[曲线下面积（AUC）＝0.810，95%可信区间（CI）：0.738～0.883]、CRP≥30.4 mg/L（AUC＝0.826，95%CI：0.757～0.895）、LDH≥343.5 U/L（AUC＝0.828，95%CI：0.756～0.900）。结论热程≥9.5 d、CRP升高（≥30.4 mg/L）、LDH升高（≥343.5 U/L）可作为儿童MPP并呼吸道黏液栓形成的早期预测指标之一。

ObjectiveTo investigate the early predictors of Mycoplasma pneumoniae pneumonia （MPP） in children with blockage of airway mucous plug.MethodsRetrospective analysis was executed on the clinical data of 130 children, who were diagnosed as MPP and treated with fiberoptic bronchoscopy at the Department of Pediatrics, the First Hospital of Jilin University, from September 2016 to January 2017.The patients were divided into the mucus plug group （60 cases）and the control group（70 cases） according to the performance of flexible bronchoscopy.The general information, clinical manifestations, laboratory examination, radiological features, bronchofibroscopic findings and treatment were compared between 2 groups.The multiple Logistic regression analysis and receiver operating characteristic （ROC） curve were used for the single factor with clinical and statistical significance to identify the early predictors of the MPP with blockage of airway mucus plug.ResultsCompared with the control group, the fever peak [39.8 ℃（39.5 ℃, 40.0 ℃） vs. 39.5 ℃（39.0 ℃, 39.8 ℃）], the fever duration[（11.3±3.1） d vs.（7.8±2.4） d], hospitalization time[（13.5±3.8） d vs.（8.5±3.2） d], white blood cells （WBC）[（9.4±3.7）×10^9/L vs.（8.2±2.9）×10^9/L], the percentage of neutrophils （NE） （0.698±0.112 vs.0.623±0.119）, C-reactive protein （CRP） [48.2 （19.8, 91.0） mg/L vs.12.4 （7.1, 25.4） mg/L], lactic dehydrogenase（LDH） [466.5（371.5, 639.0） U/L vs. 323.0（273.2, 376.8） U/L], the proportion of combined with pleural effusion（56.7% vs.17.1%）, atelectasis（23.3% vs.7.1%）, necrosis （16.7% vs.0）and involved lobes more than 2 （40.0% vs. 21.4%） were higher in the mucus plug group, and these indicators had significantly statistical differences（Z=-3.394, t=-6.957, -8.021, -2.046, -3.672, Z=-6.402, -6.433, χ^2=22.074, 6.786, 12.639, 5.306, all P〈0.05）. The multiple Logistic regression analysis showed that the febrile time, CRP and LDH were independent predictors for the MPP with blockage of airway mucus plug.The ROC curve analysis showed that the cut-off values of the 3 predictors were febrile time≥9.5 d[area under curve （AUC）=0.810, 95% confidence interval（CI）： 0.738-0.883], CRP≥30.4 mg/L（AUC=0.826, 95%CI： 0.757-0.895）, and LDH≥343.5 U/L （AUC=0.828, 95%CI： 0.756-0.900）.ConclusionThe fever duration ≥9.5 d, increased CRP （≥30.4 mg/L）, and increased serum LDH （≥343.5 U/L） can be applied as one of the early predictors for MPP in children with mucus plug.