儿童难治性支原体肺炎危险因素的系统评价

Risk factors for refractory mycoplasma pneumoniae pneumonia in children: a systematic review

目的系统评价儿童难治性支原体肺炎的危险因素。方法计算机检索PubMed、The Cochrane Library、EMbase、CNKI、CBM、VIP和WanFang Data数据库,搜集有关儿童难治性支原体肺炎危险因素的病例-对照研究和队列研究,检索时限均从建库至2021年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入27个病例-对照研究,难治性肺炎支原体肺炎患儿3 967例,普通肺炎支原体肺炎患儿11 613例。Meta分析结果显示:热程[OR=2.07,95%CI(1.98,2.16),P<0.000 01]、住院时间[OR=1.42,95%(1.14,1.69),P<0.000 01]、反复呼吸道感染[OR=8.51,95%CI(6.15,11.77),P<0.000 01]、IL-6[OR=21.95,95%CI(20.85,23.06),P<0.000 01]、CRP[OR=2.41,95%CI(1.94,2.87),P<0.000 01]、LDH[OR=0.79,95%CI(0.53,1.06),P<0.000 01]、ESR[OR=2.65,95%CI(1.13,4.18),P=0.000 6]、合并胸腔积液[OR=9.42,95%CI(3.65,24.31),P<0.000 01]、合并肺外并发症[OR=3.33,95%CI(2.42,4.58),P<0.000 01]、肺大片实变[OR=12.31,95%(5.42,27.99),P<0.000 01]均是儿童难治性支原体肺炎的危险因素。结论当前证据表明,热程、长住院时间、反复呼吸道感染、IL-6增高、CRP增高、LDH增高、ESR增高、合并胸腔积液、合并肺外并发症、肺大片实变均是儿童难治性支原体肺炎的危险因素。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the risk factors of refractory mycoplasma pneumoniae pneumonia(RMPP) in children. Methods PubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP, and WanFang Data databases were electronically searched for case-control studies and cohort studies on the risk factors of RMPP in children from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 27 casecontrol studies involving 3 967 children with RMPP and 11 613 children with common MPP were included. The results of meta-analysis showed that heat course(OR=2.07, 95%CI 1.98 to 2.16, P<0.000 01), length of hospital stay(OR=1.42,95%CI 1.14 to 1.69, P<0.000 01), recurrent respiratory tract infection(OR=8.51, 95%CI 6.15 to 11.77, P<0.000 01), level of IL-6(OR=21.95, 95%CI 20.85 to 23.06, P<0.000 01), level of CRP(OR=2.41, 95%CI 1.94 to 2.87, P<0.000 01), level of LDH(OR=0.79, 95%CI 0.53 to 1.06, P<0.000 01), level of ESR(OR=2.65, 95%CI 1.13 to 4.18, P=0.000 6), combined pleural effusion(OR=9.42, 95%CI 3.65 to 24.31, P<0.000 01), combined with extrapulmonary complications(OR=3.33, 95%CI2.42 to 4.58, P<0.000 01), large lung consolidation(OR=12.31, 95%CI 5.42 to 27.99, P<0.000 01) were the risk factors for RMPP. Conclusions Current evidence indicates that heat course, length of hospital stay, repeated respiratory tract infection, high level of IL-6, high level of CRP, high level of LDH, high level of ESR, combined pleural effusion, combined extrapulmonary complications, and large lung consolidation are risk factors for children with RMPP. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.