“热毒血瘀”与儿童肺炎支原体肺炎的相关性研究

Correlation Between “Heat Toxin and Blood Stasis” and Mycoplasma Pneumoniae Pneumonia in Children

【目的】探讨儿童肺炎支原体肺炎(MPP)病程中“热毒血瘀”理论与实验室检查指标的关系及其辅助诊断重症肺炎支原体肺炎(SMPP)的价值。【方法】回顾性收集195例MPP患儿和75例SMPP患儿的临床资料,分析2组患儿出、入院时实验室检查指标的差异及其预测SMPP的价值。【结果】(1)入院时,SMPP组患儿的白细胞总数(WBC)、中性粒细胞百分比(N%)、红细胞分布宽度(RDW)、大血小板总数(PLC)、血小板比积(PCT)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)水平均明显高于MPP组,组间比较,差异均有统计学意义(P<0.05或P<0.01),联合诊断SMPP时ROC曲线下面积(AUC)为0.734[95%CI(0.668-0.800)]。(2)出院时,MPP组患儿和SMPP组患儿的WBC、N%、CRP均较入院时降低,血小板(PLT)、PCT均较入院时升高,差异均有统计学意义(P<0.01)。【结论】“热毒血瘀”在MPP病程中起重要作用,“热毒(炎症反应)”出现时间早,易于祛除;“血瘀(凝血功能改变)”出现时间晚,疾病后期应适当应用活血化瘀药物。WBC、N%、RDW、PLC、PCT、CRP、LDH水平升高对SMPP有一定诊断价值,联合应用时可提高诊断准确性。

Objective To investigate the correlation of the traditional Chinese medicine(TCM)pathogenesis of“heat toxin and blood stasis”with the laboratory indices in the course of mycoplasma pneumoniae pneumonia(MPP)in children and to explore its value in aiding the diagnosis of severe mycoplasma pneumoniae pneumonia(SMPP).Methods The clinical data of 195 children with MPP and 75 children with SMPP were collected.And then the differences in laboratory indicators at admission and at discharge between the two groups were analyzed retrospectively for the exploration of their value in predicting SMPP.Results(1)At admission,children with SMPP had significantly higher levels of total white blood cell count(WBC),neutrophil percentage(N%),red blood cell distribution width(RDW),total large platelet count(PLC),plateletcrit(PCT),C-reactive protein(CRP)and lactate dehydrogenase(LDH)than the children with MPP,and the intergroup comparison showed that the differences were statistically significant(P<0.05 or P<0.01).The area under the ROC curve(AUC)for the joint diagnosis of SMPP was 0.734[95%CI(0.668-0.800)].(2)At discharge,children in MPP group and in SMPP group had lower WBC,N%and CRP,and had higher platelet(PLT)count and PCT than those at admission,and the differences were all statistically significant(P<0.01).Conclusion The TCM pathogenesis of“heat toxin and blood stasis”plays an important role in the course of MPP:“heat toxin(inflammatory reaction)”appears early and can be easily removed;“blood stasis(changes in blood clotting function)”appears later and should be eliminated by using herbs of activating blood and removing stasis appropriately in the later stages of the disease.Elevated levels of WBC,N%,RDW,PLC,PCT,CRP and LDH exert certain values for the early diagnosis of SMPP and have high accuracy when they are used in combination.