儿童重症肺炎支原体肺炎的高危因素分析

Risk factor analysis about severe mycoplasma pneumoniae pneumonia in children

目的通过对肺炎支原体肺炎(MPP)患儿临床资料的分析,探讨儿童重症MPP(SMPP)的高危因素,为SMPP的早期诊断和激素的早期应用提供依据。方法收集2014年10月―2015年10月于上海市儿童医院呼吸科住院的急性期MPP患儿321例,分为重症组(84例)和非重症组(237例)。采集可能与SMPP发生相关的指标,进行单因素分析和多因素logistic回归分析,研究SMPP发生的独立危险因素。结果重症组患儿的年龄显著大于非重症组,发热时间显著长于非重症组,CRP、红细胞沉降率(ESR)、乳酸脱氢酶(LDH)、IL-6、IL-8、IL-10和TNF-α水平均显著高于非重症组(P值均<0.05)。两组间的性别构成、白细胞计数,以及降钙素原(PCT)、IL-1B和IL-12p70水平的差异均无统计学意义(P值均>0.05)。高肺炎支原体(MP)抗体滴度(χ~2=32.93,P<0.01)、高DNA拷贝数(χ~2=11.42,P=0.003)和多种病原抗体阳性(χ~2=23.601,P<0.01)均与SMPP的发生相关(P值均<0.05)。两组间有无明显肺外表现和并发症的患儿比例的差异具有统计学意义(χ~2=65.735,P<0.01),而是否伴有混合感染的患儿(血液、痰液或咽拭子病原DNA/RNA检测阳性或病原培养阳性的病例,不包括确诊为多种病原抗体阳性的患儿)比例的差异无统计学意义(χ~2=0.494,P=0.482)。将单因素分析有意义的变量,如年龄、发热时间、CRP、ESR、LDH、IL-6、IL-8、IL-10、TNF-α、MP抗体滴度、DNA拷贝数、多种病原抗体阳性、明显的肺外表现和并发症进行赋值,经多因素logistic回归分析,结果显示,发热时间(OR=1.347, 95%CI为1.158～1.568,P=0.000)、CRP(OR=1.023, 95%CI为1.005～1.041,P=0.012)、LDH(OR=1.015, 95%CI为1.010～1.021,P=0.000)、IL-8(OR=1.008, 95%CI为1.003～1.014,P=0.004)、高MP抗体滴度度(OR=2.171, 95%CI为1.204～3.912,P=0.010)、多种病原抗体阳性(OR=2.344, 95%CI为1.144～4.804,P=0.020)、明显的肺外表现和并发症(OR=15.733, 95%CI为4.262～58.072,P=0.000)是儿童SMPP的独立危险因素。结论发热时间、CRP、LDH、IL-8、高MP抗体滴、多种病原抗体阳性、明显的肺外表现和并发症是儿童SMPP的独立危险因素,对儿童SMPP的早期识别具有重要的指导意义。

Objective To explore the risk factors of severe mycoplasma pneumoniae pneumonia(SMPP) in children through retrospective analysis of clinical data of children with mycoplasma pneumoniae pneumonia(MPP), and to provide evidence for early diagnosis and early application of glucocorticoid. Methods Clinical data of 372 children with MPP at acute phase, who were admitted to Shanghai Children’s Hospital from October 2015 to October 2016, were collected. The children were divided into SMPP group(84 cases) and non-SMPP group(237 cases). Risk factors associated with SMPP were studied by univariate and multivariate logistic regression analysis between two groups. Results Compared with the non-SMPP group, the children was significantly older and the fever time was significantly longer in the SMPP group(both P<0.05). C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), lactate dehydrogenase(LDH), interleukin(IL)-6, IL-8, IL-10 and tumor necrosis factor(TNF)-α levels in the SMPP group were significantly higher than those in the non-SMPP group(all P<0.05). However, there were no significant differences in sex composition, white blood cell count, procalcitonin(PCT), IL-1 B or IL-12 p70 between the two groups(all P>0.05). High mycoplasma pneumoniae(MP) antibody titers(χ^2=32.93, P<0.01), high DNA copy number(χ^2=11.42, P=0.003) and multi-positive antibodies(χ^2=23.601, P<0.01) were all associated with SMPP(all P<0.05). In this study, patients with positive DNA/RNA detection results or positive pathogen culture in blood, throat swab or sputum were considered to have a specific mixed infection(patients who has been confirmed to be multi-positive antibodies mentioned above were excluded). Significant differences were found in the proportion of patients with extrapulmonary manifestations and complications between the two groups(χ~2=65.735, P<0.01). But there was no significant difference in the proportion of patients with mixed infection(χ~2=0.494, P=0.482). The variables which were selected from univariate analysis, including fever time, CRP, ESR, LDH, IL-6, IL-8, IL-10, TNF-α, MP antibody titers, DNA copy number, multi-positive antibodies, obvious extrapulmonary manifestations and complications, were assigned, and then the multivariate logistic regression analysis showed that fever time(OR=1.347, 95%CI:1.158-1.568, P=0.000), CRP(OR=1.023, 95%CI:1.005-1.041, P=0.012), LDH(OR=1.015, 95%CI:1.010-1.021, P=0.000), IL-8(OR=1.008, 95%CI:1.003-1.014, P=0.004), high MP antibody titers(OR=2.171, 95%CI:1.204-3.912, P=0.010), multi-positive antibodies(OR=2.344, 95%CI:1.144-4.804, P=0.020), obvious extrapulmonary manifestations and complications(OR=15.733, 95%CI:4.262-58.072, P=0.000) were independent risk factors for SMPP in children. Conclusion Fever time, CRP, LDH, IL-8, higher MP antibody titers, multi-positive antibodies, significant extrapulmonary manifestations and complications are the independent risk factors of SMPP, and may help to make early identification.