肺炎支原体感染致塑型性支气管炎的临床特征及危险因素分析

Analysis of clinical characteristics and risk factors of plastic bronchitis caused by Mycoplasma pneumoniae infection

目的分析肺炎支原体(MP)感染致塑型性支气管炎(PB)的临床特征,并探讨其危险因素。方法回顾性分析2011年1月至2017年12月在苏州大学附属儿童医院呼吸科住院经支气管镜确诊的有塑型形成的MP肺炎(MPP)患儿的临床及实验室资料,并与同期无塑型形成的MPP患儿进行比较,同时采用Logistic回归分析探寻MP感染致PB的危险因素。结果306例MPP患儿中PB组50例,非PB组256例。PB组患儿年龄[(82.74±35.17)个月比(66.63±35.67)个月]、中性粒细胞比例(N)(0.7058±0.1391比0.6057±0.1626)、C反应蛋白(CRP)[17.40(10.21,42.86)mg/L比11.43(4.55,23.66)mg/L]、D-二聚体(DD)[1071(279.5,2386.5)μg/L比523(233.0,1099.5)μg/L]、乳酸脱氢酶(LDH)[491.1(342.3,607.4)U/L比394.9(319.1,512.8)U/L]、红细胞沉降率(ESR)[25.0(17.0,36.0)mm/1 h比15.5(9.0,28.0)mm/1 h]、天冬氨酸转氨酶(AST)[33.5(26.1,49.3)U/L比29.2(24.0,37.2)U/L]、丙氨酸转氨酶(ALT)[19.1(11.45,31.50)U/L比13.6(10.30,23.15)U/L]、IgA[1.46(0.98,2.12)mg/L比1.15(0.64,1.60)mg/L]、CD3^(-)CD_((16+56))^(+)(0.1550±0.0886比0.1202±0.0715)、过敏史[44.0%(22/50例)比25.8%(65/256例)]、混合感染[38.0%(19/50例)比24.6%(63/256例)]、镜下黏膜糜烂[10.0%(5/50例)比2.3%(6/256例)]等方面均高于非PB组,差异均有统计学意义(均P<0.05)。Logistic回归分析显示过敏史(OR=5.604,95%CI:1.937~16.216)、年龄(OR=3.142,95%CI:1.425~6.929)、N(OR=2.387,95%CI:1.088~5.238)、CRP(OR=3.959,95%CI:1.072~14.662)、DD(OR=7.824,95%CI:2.824~21.673)是MP感染致PB的独立危险因素(均P<0.05),其中年龄、N、CRP、DD的临界值分别为64个月、0.70、35 mg/L、2000μg/L。结论MP感染后发生PB往往见于年龄较大、有过敏体质的儿童,存在更强的炎症反应、免疫紊乱及高凝状态。

Objective To analyze the clinical characteristics of patients suffering from plastic bronchitis(PB)caused by Mycoplasma pneumoniae(MP)and explore its risk factors as well.Methods A retrospective analysis on clinical and laboratory data of PB children caused by MP and treated in Department of Respiratory in Children′s Hospital of Soochow University from January 2011 to December 2017,compared with MP pneumonia(MPP)children without PB in the same period.Meanwhile,Logistic regression analysis was performed.Results Among the 306 MPP children,there were 50 cases in the PB group and 256 cases in the non-PB group.Compared with children in the non-PB group,children in PB group were higher in terms of age[(82.74±35.17)months vs.(66.63±35.67)months],percentage of neutrophils(0.7058±0.1391 vs.0.6057±0.1626),C reactive protein(CRP)[17.4(10.21,42.86)mg/L vs.11.43(4.55,23.66)mg/L],D-dimer(DD)[1071(279.5,2386.5)μg/L vs.523(233,1099.5)μg/L],lactate dehydrogenase(LDH)[491.1(342.3,607.4)U/L vs.394.9(319.1,512.8)U/L],erythrocyte sedimentation rate(ESR)[25.0(17.0,36.0)mm/1 h vs.15.5(9.0,28.0)mm/1 h],aspartate aminotranferase(AST)[33.5(26.1,49.3)U/L vs.29.2(24.0,37.2)U/L],alanine aminotransferase(ALT)[19.1(11.45,31.50)U/L vs.13.6(10.3,23.15)U/L],IgA[1.46(0.98,2.12)mg/L vs.1.15(0.64,1.60)mg/L],CD3^(-)CD_((16+56))^(+)(0.1550±0.0886 vs.0.1202±0.0715),allergy history[44.0%(22/50 cases)vs.25.8%(65/256 cases)],mixed infection[38.0%(19/50 cases)vs.24.6%(63/256 cases)],and microscopic mucosal erosion[10.0%(5/50 cases)vs.2.3%(6/256 cases)](all P<0.05).Logistic regression analysis displayed that allergy history(OR=5.604,95%CI:1.937-16.216),age(OR=3.142,95%CI:1.425-6.929),percentage of neutrophils(OR=2.387,95%CI:1.088-5.238),CRP(OR=3.959,95%CI:1.072-14.662),and DD(OR=7.824,95%CI:2.824-21.673)were independent risk factors for PB caused by MP infection(all P<0.05).The cut-off values of age,percentage of neutrophils,CRP,and DD were 64 months,0.70,35 mg/L,and 2000μg/L.Conclusions Children with PB caused by MP often develop in older and allergic children who have stronger inflammatory reactions,immune disorders,and hyperfibrinolysis.