儿童肺炎支原体肺炎合并胸腔积液临床表现及危险因素分析

Analysis of clinical manifestations and risk factors of mycoplasma pneumoniae pneumonia with pleural effusion in children

目的探究儿童肺炎支原体肺炎(MPP)合并胸腔积液(PE)的临床表现及实验室检测情况,为临床诊治提供依据。方法选取2019年4月1日至12月31日于西安市儿童医院呼吸一科确诊为MPP的137例患儿为研究对象,根据有无合并PE分为单纯MPP组67例及合并PE组70例,比较两组间临床表现、合并症、实验室检查的差异。结果合并PE组热峰、热程、住院时间及总病程均大于单纯MPP组(Z值分别为-3.948、-5.032、-4.268、-5.590,均P<0.05);合并PE组白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)水平均高于单纯MPP组(Z值分别为-3.133、-4.903、-3.853、-5.193,均P<0.05);合并PE组发生肝功能异常、低蛋白血症及心肌损害的比例均高于单纯MPP组(χ^(2)值分别为196.300、23.739、10.880,均P<0.05);合并PE组较单纯MPP组的难治性肺炎支原体肺炎发病率更高,影像学以实变为主,均具有统计学意义(均P<0.05);多因素Logistic回归分析显示热峰>39.95℃、热程>11.5d、CRP>25.335mg/L及PCT>0.155ng/L是MPP合并胸腔积液的独立危险因素,其OR值及95%CI分别为3.577(1.046~12.238)、2.486(1.060~5.831)、3.755(1.570~8.983)、2.599(1.100~6.144),均P<0.05。结论MPP合并PE患儿机体内有过强的免疫炎症反应,需警惕难治性肺炎支原体肺炎可能;较高的热峰、CRP水平、PCT水平及较长的热程是MPP合并胸腔积液的独立危险因素。

Objective To explore the clinical manifestations and laboratory tests of mycoplasma pneumonia pneumoniae pneumonia(MPP)combined with pleural effusion(PE)in children,so as to provide a basis for clinical diagnosis and treatment.Methods A total of 137 children diagnosed with MPP in the department of respiration of Xi’an Children’s Hospital from April 1 st to December 31 st,2019 were selected as the research objects.According to the presence or absence of combined PE,they were divided into 67 cases in simple MPP group and 70 cases in combined PE group.The differences in clinical manifestations,comorbidities,and laboratory tests between the two groups were compared.Results The heat peak,heat duration,hospitalization time and total disease duration of the combined PE group were greater than those of the simple MPP group(Z=-3.948,-5.032,-4.268 and-5.590,respectively,all P<0.05).The white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),and lactate dehydrogenase(LDH)levels in the combined PE group were higher than those in the simple MPP group(Z=-3.133,-4.93,-3.853 and-5.193,respectively,all P<0.05).The proportion of abnormal liver function,hypoproteinemia and myocardial damage in the PE group were higher than those of the simple MPP group(χ^(2)=196.300,23.739 and 10.880,respectively,all P<0.05).The incidence of Mycoplasma pneumoniae pneumonia of combined PE group was higher than the simple MPP group,and the imaging studies were dominant,which was statistically significant(P<0.05);Multivariate logistic regression analysis showed that heat peak>39.95℃,heat duration>11.5 d,CRP>25.335 mg/L and PCT>0.155 ng/L were independent risk factors for MPP combined with PE.The OR values and 95%CIs were 3.577(1.046~12.238),2.486(1.060~5.831),3.755(1.570~8.983),2.599(1.100~6.144),respectively,all P<0.05.Conclusion There was a strong immune inflammatory response in their body of children with MPP combined with PE,so be wary of the possibility of refractory mycoplasma pneumoniae pneumonia.The higher heat peaks,CRP levels,PCT levels and longer heat duration are independent risk factors of MPP combined with pleural effusion.