儿童重症肺炎的实验室检查结果分析

Analysis of laboratory examination results of severe pneumonia in children

目的研究肺炎支原体感染所致的重症肺炎的实验室检查结果,探讨相关危险因素。方法回顾性分析济宁市第一人民医院2018年6月1日至2019年6月1日收治的肺炎支原体感染导致的大叶性肺炎患儿的临床资料,其中确诊为重症肺炎的患儿设为重症组(46例),确诊为非重症肺炎的患儿设为对照组(30例),分析并比较两组患儿的病原学检查等结果。结果重症组C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)水平及肺炎支原体DNA(MP-DNA)、MP-IgM滴度均高于对照组(Z值分别为-2.120、-2.418、-2.159、-2.749、-2.192、-2.834、-2.587,均P<0.05),白蛋白(ALB)水平低于对照组(t=2.485,P<0.05)。多因素Logistic回归分析结果显示,MP-DNA滴度是重症肺炎的独立影响因素,OR=2.074,95%CI:1.161~3.704,表明随着MP-DNA浓度越高,发生重症肺炎的风险越大。ROC曲线分析结果显示,MP-DNA拷贝数大于4.47时,预测重症肺炎的灵敏度和特异度分别为50.00%和96.67%;当MP-IgM滴度大于1∶640时预测重症肺炎的灵敏度和特异度分别为43.48%和93.33%。结论D-二聚体、PCT、CRP、ALT、LDH升高及白蛋白降低有助于识别重症肺炎,MP-DNA是重症肺炎发生的独立影响因素。

Objective To study the laboratory examination of severe lobar pneumonia caused by mycoplasma pneumoniae infection,and to explore related risk factors.Methods The clinical cases of 76 children with lobular pneumonia caused by mycoplasma infection hospitalized in Jining First People’s Hospital from June 1,2018,to June 1,2019,were retrospectively analyzed.Among them,46 children diagnosed with severe pneumonia were set as the severe group,and 30 children diagnosed with non-severe pneumonia were set as the control group.The etiological examinations of the two groups of children were analyzed and compared.Results The levels of D-dimer,procalcitonin(PCT),C-reactive protein(CRP),alanine aminotransferase(ALT),and lactate dehydrogenase(LDH),MP-DNA,and MP-IgM titers in the severe group were all higher than those in the control group(Z=-2.120,-2.418,-2.159,-2.749,-2.192,-2.834 and-2.587,respectively,all P<0.05),the albumin(ALB)level of the severe group was lower than that of the control group(t=2.485,P<0.05).The results of multivariate logistic regression analysis showed that the titer of mycoplasma pneumoniae-DNA(MP-DNA)was an independent factor influencing the severity of pneumonia[OR=2.074(1.161-3.704)].It showed that the higher the concentration of MP-DNA,the greater the risk of severe pneumonia.ROC curve analysis results showed that when the MP-DNA copy number was greater than 4.47,the predictive sensitivity and specificity were 50.00%and 96.67%,respectively.When the antibody titer was greater than 1∶640,severe pneumonia could be predicted with a sensitivity and specificity of 43.48%and 93.33%,respectively.Conclusion Elevated D dimer,PCT,CRP,ALT,LDH and decreased albumin are helpful to identify severe pneumonia.MP-DNA is an independent factor influencing the severity of pneumonia.