婴幼儿支原体肺炎后反复发作性呼吸道感染因素分析

Risk factors for recurrent respiratory tract infections after mycoplasma pneumonia in infants

目的:分析婴幼儿支原体(MP)肺炎后反复发作性呼吸道感染(RRTI)的因素,以便为临床诊治提供依据。方法:将支原体肺炎患儿300例作为研究对象,入组对象家属愿意配合研究,签署《知情同意书》,出院后均进行为期1年以上随访,对患儿出院前后MP-Ig M、MP-Ig G双抗体滴度及免疫功能进行测定,并记录随访期间呼吸道感染与用药情况,实施统计学分析。结果:在300例支原体肺炎患儿中,有45例发生RRTI,发生率30. 00%;经多因素分析,显示年龄为3~6岁(OR=2. 31,95%CI:1. 23~4. 68)、HP抗体阳性或转阳(OR=4. 51,95%CI:1. 56~13. 27)、CD4/CD8下降(OR=10. 33,95%CI:3. 45~32. 02)及Ig A下降(OR=1. 96,95%CI:1. 12~3. 47)属于RRTI诱发的危险因素;而应用免疫增强剂(OR=0. 31,95%CI:0. 14~0. 82)对反复发作性呼吸道感染有预防作用,属于保护因素。结论:婴幼儿支原体肺炎属于比较常见疾病,而且容易出现RRTI,多因素分析可知RRTI发生危险因素主要有年龄3~6岁、HP抗体阳性或转阳、CD4/CD8下降、Ig A下降,同时MP肺炎患儿治愈后出现免疫功能障碍也极易出现RRTI,采取免疫增强剂治疗可减少RRTI出现,临床应加强重视。

Objective To analyze the factors of recurrent respiratory tract intection （RRTI） after infantile Mycoplasma pneumonia （MP） in order to provide the basis for clinical diagnosis and treatment. Method 300 children with mycoplasma pneumonia were enrolled. The relatives of the subjects were willing to cooperate with the study and sign the informed consent. All patients were followed up for more than one year after discharge,The titers and immune function of MP -IgM and MP -IgG double antibody before and after discharge were measured, and respiratory infections and drug use during follow - up were recorded, and statistical analysis was performed. Results In 300 cases of mycoplasma pneumonia,45 patients had RRTI, the incidence rate was 30. 00%. According to multivariate analysis,age was 3 to 6 years old （OR = 2. 31,95 % CI：1. 23 -4.68）, HP antibody positive or positive, （OR = 4. 51,95% CI：1. 56 - 13.27） ,decreased CD4/CD8 （OR = 10. 33,95% CI：3.45 - 32. 02） and decreased IgA （OR = 1.96,95% CI：1. 12 - 3.47 ） was a risk factor for RRTI -induced;while the use of immune enhancers （OR = 0. 31, 95% CI： 0. 14 - 0. 82 ） for the prevention of recurrent respiratory tract infections were protective factors. Conclusion Mycoplasma pneumonia in infants and young children are more common diseases, and prone to RRTI, multivarite analysis showed that RRTI risk factors are mainly aged 3 to 6 years old, HP antibody positive or positive, CD4/ CD8 decreased, IgA decreased,while MP pneumonia children with immunocompromised immune dysfunction is also prone to RRTI, the use of immune enhancer therapy can reduce RRTI appear,clinical should pay more attention.