儿童重症肺炎支原体肺炎所致塑型性支气管炎的临床特点及危险因素分析

Clinical characteristics and risk factors for plastic bronchitis caused by severe mycoplasma pneumonia in children

目的:总结儿童重症肺炎支原体肺炎所致塑型性支气管炎的临床特点,寻找发生塑型性支气管炎的危险因素,为判断预后和综合制定治疗方案提供参考。方法:回顾性分析2017年1月至2019年12月中国医科大学附属盛京医院小儿呼吸内科收治的急性期行支气管镜检查的重症肺炎支原体肺炎患儿的临床资料(146例),按照是否为塑型性支气管炎,分为塑型性支气管炎组(68例)和非塑型性支气管炎组(78例),并收集患儿性别、年龄、实验室检查指标、影像学特征和治疗情况,将有临床意义及统计学意义的单因素进行多因素Logistic回归分析。结果:两组患儿性别、年龄、热程、白细胞数、C-反应蛋白值、白细胞介素-6值比较差异均无统计学意义(均P>0.05)。塑型性支气管炎组中性粒细胞百分比、丙氨酸转氨酶、天冬氨酸转移酶、乳酸脱氢酶、D-二聚体、胸腔积液例数、住院时间、支气管镜检查次数均高于非塑型性支气管炎组,右肺上叶实变例数少于非塑型性支气管炎组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,胸腔积液(OR=4.898,95%CI 2.195-10.926)、乳酸脱氢酶(OR=1.051,95%CI 1.003-1.101)是儿童重症肺炎支原体肺炎发生塑型性支气管炎的独立预测指标。结论:重症肺炎支原体肺炎患儿,如肺CT提示非右肺上叶均一致密实变影且合并胸腔积液,乳酸脱氢酶明显增高,应注意发生塑型性支气管炎的可能,需及时完善纤维支气管镜检查,可能缩短病程,减少并发症的发生。

Objective To summarize the clinical characteristics of plastic bronchitis caused by severe mycoplasma pneumoniae pneumonia in children,to find the risk factors for plastic bronchitis,and to provide references for judging the prognosis and comprehensively formulating treatment plans.Methods We retrospectively analyzed the clinical data(146 cases)of children with severe mycoplasma pneumoniae pneumonia who underwent bronchoscopy in the Department of Pediatric Respiratory Medicine of Shengjing Hospital of China Medical University from January 2017 to December 2019.According to whether it was plastic bronchitis,all patients were divided into plastic bronchitis group(68 cases)and non-plastic bronchitis group(78 cases),and the gender,age,laboratory examination indicators,imaging characteristics and treatment of children were collected under the circumstances.The single factor with clinical significance and statistical significance would be subjected to multivariate Logistic regression analysis.Results There were no significant differences in gender,age,heat duration,white blood cell count,C-reactive protein value,and interleukin-6 value between the two groups(all P>0.05).The percentage of neutrophils,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,D-dimer,number of cases of pleural effusion,length of hospital stay,and number of endoscopy in the plastic bronchitis group were higher than those in non-plastic bronchitis group,the number of right upper lobe consolidation cases was less than that in the non-plastic bronchitis group,and the differences were statistically significant(P<0.05).Multiple Logistic regression analysis showed that pleural effusion(OR=4.898,95%CI 2.195-10.926)and lactate dehydrogenase(OR=1.051,95%CI 1.003-1.101)were independent predictors of plastic bronchitis in children with severe mycoplasma pneumoniae pneumonia.Conclusion For children with severe mycoplasma pneumoniae pneumonia,if lung CT shows that the upper lobe of the non-right lung is uniformly compacted and complicated with pleural effusion,lactate dehydrogenase is significantly increased,and attention should be paid to the possibility of plastic bronchitis.Timely improvement of fiberoptic bronchoscopy may shorten the course of the disease and reduce the occurrence of complications.