儿童支原体肺炎并发器官功能障碍危险因素

Analysis of risk factors of extrapulmonary organ dysfunction in children with severe refractory mycoplasma pneumoniae pneumonia

目的分析总结儿童重症难治性支原体肺炎(severe refractory mycoplasma pneumoniae pneumonia,SRMPP)的临床特征,探讨其并发肺外器官功能障碍的危险因素。方法回顾性总结2017年7月至2019年6月上海市儿童医院重症医学科收治的SRMPP的患儿临床资料,根据是否发生肺外脏器功能障碍分为肺外器官障碍组和单纯呼吸功能障碍组,比较两组临床特征与实验室指标的差异,Logistic回归筛选出发生肺外脏器功能障碍的危险因素。结果两年间PICU合计收治SRMPP 107例,并发胸腔积液44例(41.1%),塑型性支气管17例(15.9%),支原体耐药基因位点(2063,2064)阳性104例(97.2%),住院病死率2.8%(3/107)。107例SRMPP患儿发生肺外脏器功能障碍51例(47.7%),其中心血管功能障碍43例(40.2%)、凝血功能障碍13例(12.1%)、胃肠功能障碍11例(10.3%)肾功能障碍4例(3.7%)脑功能障碍4例(3.7%)肝功能障碍3例(2.8%),多器官功能障碍综合征16例(15.0%)。与单纯呼吸功能障碍组相比,肺外脏器功能障碍组毛细血管渗漏综合征发生率高(52.9%vs.17.9%,P<0.001),毛细血管渗漏指数上升[11.71(4.63,27.07)vs.5.78(2.07,15.71),P=0.019],血白蛋白下降低[(32.2±5.6)g/L vs.(34.7±6.7)g/L,P=0.041],凝血酶原时间明显延长[12.7(11.7,13.8)s vs.12.0(11.4,13.0)s,P=0.009]。Logistic回归结果显示发生毛细血管渗漏综合征(OR=0.278,95%CI 0.102~0.759,P=0.013)和凝血酶原时间延长(OR=1.443,95%CI 1.018~2.046,P=0.039)是SRMPP并发肺外脏器功能障碍的独立危险因素。结论儿童SRMPP约半数发生肺外脏器功能障碍,常见循环凝血和胃肠障碍。发生毛细血管渗漏综合征及凝血酶原时间延长是SRMPP并发肺外脏器功能障碍的独立危险因素。

Objective To analyze the clinical features of severe refractory mycoplasma pneumoniae pneumonia(SRMPP)in children,and explore its risk factors complicated with extrapulmonary organ dysfunction.Methods The clinical data of children with SRMPP who were admitted to the Department of Critical Care Medicine of Shanghai Children's Hospital from July 2017 to June 2019 were retrospectively summarized.The patients were divided into two groups according to the occurrence of extrapulmonary organ dysfunction:the extrapulmonary organ dysfunction group and the respiratory dysfunction group.The differences of clinical features and laboratory indexes between the two groups were compared,and the risk factors of extrapulmonary organ dysfunction were screened out by logistic regression analysis.Results A total of 107 cases with SRMPP were admitted to the Pediatric Intensive Care Unit during the past two years,and there were 44 cases(41.1%)complicated with pleural effusion,17 cases(15.9%)with plastic bronchitis,104 cases(97.2%)with positive results for macrolide resistance genes(2063,2064),with an in-hospital mortality rate of 2.8%(3/107).Among 107 children with SRMPP,there were 51 cases(47.7%)with extrapulmonary organ dysfunction,43 cases(40.2%)with cardiovascular dysfunction,13 cases(12.1%)with coagulation dysfunction,11 cases(10.3%)with gastrointestinal dysfunction,4 cases(3.7%)with renal dysfunction,4 cases(3.7%)with brain dysfunction,3 cases(2.8%)with liver dysfunction,and 16 cases(15.0%)with multiple organ dysfunction.Compared with the respiratory dysfunction group,the incidence of capillary leak syndrome was higher(52.9%vs.17.9%,P<0.001),the capillary leak index was increased[11.71(4.63,27.07)vs.5.78(2.07,15.71),P=0.019],serum albumin was decreased[(32.2±5.6)g/L vs.(34.7±6.7)g/L,P=0.041],and prothrombin time was prolonged significantly[12.7(11.7,13.8)s vs.12.0(11.4,13.0)s,P=0.009].Logistic regression analysis showed that capillary leak syndrome(OR=0.278,95%CI 0.102-0.759,P=0.013)and prolonged prothrombin time(OR=1.443,95%CI 1.018-2.046,P=0.039)were independent risk factors for SRMPP complicated with extrapulmonary organ dysfunction.Conclusions Approximately 50%of children with SRMPP have dysfunction of extrapulmonary organs,such as circulation,coagulation and gastrointestinal disorders.Capillary leak syndrome and prolonged prothrombin time are independent risk factors for SRMPP complicated with extrapulmonary organ dysfunction.