儿童社区获得性肺炎病情严重程度评价相关危险因素分析

Analysis of Risk Factors Related to Severity Evaluation of Community-Acquired Pneumonia in Children

目的:分析研究儿童社区获得性肺炎病情严重程度的相关危险因素,为准确判断社区获得性肺炎患儿的病情严重程度提供依据,对儿童重症社区获得性肺炎早诊断、早治疗,尽可能降低病死率。方法:将2020年10月至2021年9月诊断为社区获得性肺炎且在本院住院治疗的494例患儿,根据重型社区获得性肺炎诊断标准分为普通型428例和重型66例,回顾研究其一般情况、症状体征、实验室指标及影像学特点,对两组患儿的临床特征及影响因素进行比较研究。结果:与428例普通型社区获得性肺炎患儿相比,66例重型社区获得性肺炎患儿年龄偏小,其出现呼吸音减弱、心动过速、肺外并发症、胸腔积液、大叶性肺不张等症状体征出现的比例更高;在实验室检查中,C反应蛋白(CRP)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、白介素IL-6、IL-10的水平更高,差异均有统计学意义。Logistic逐步回归分析显示,CRP、IL-6是儿童重症社区获得性肺炎的独立危险因素。结论:血清CRP、IL-10水平升高对儿童社区获得性肺炎的病情严重程度判断具有较好的准确性,有助于早期识别儿童重症社区获得性肺炎。

Objective:To analyze and study the risk factors related to the severity of community-acquired pneumonia in children,in order to provide a basis for accurately determining the severity of the disease in children with community-acquired pneumonia,to provide early diagnosis and treatment of severe community-acquired pneumonia in children,and to minimise the mortality rate.Methods:Totally 494 children diagnosed with community-acquired pneumonia and hospitalized in our hospital from October 2020 to September 2021 were divided into 428 cases of general type and 66 cases of severe type according to the diagnostic criteria of severe community-acquired pneumonia.Their general conditions,symptoms and signs,laboratory indexes and imaging characteristics were studied retrospectively,and the clinical characteristics and influencing factors of the two groups were compared and studied.Results:Compared to the 428 children with general community-acquired pneumonia,the 66 children with severe community-acquired pneumonia were younger and had a higher proportion of signs and symptoms presenting with decreased breath sounds,tachycardia,extra-pulmonary complications,pleural effusion and lobar atelectasis;in laboratory tests,C-reactive protein(CRP),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB)Logistic stepwise regression analysis showed that CRP and IL-6 were independent risk factors for severe community-acquired pneumonia in children.Conclusion:Elevated serum CRP and IL-10 levels have good accuracy in determining the severity of community-acquired pneumonia in children and help in the early identification of severe community-acquired pneumonia in children.