儿童难治性肺炎支原体肺炎中D-二聚体水平的临床意义

Clinical Value of D-dimer Level in Refractory Childhood Mycoplasma Pneumoniae Pneumonia

目的探讨D-二聚体(D-D)水平对肺炎支原体肺炎(MPP)病情严重程度及难治性肺炎支原体肺炎(RMPP)早期预测意义。方法回顾性分析2021年06月—2022年05月濮阳市人民医院住院部收治的MPP 168例,根据病情将其分为普通组和难治组,比较两组之间临床资料、白细胞计数(WBC)、中性粒细胞淋巴细胞比值(NLR)、C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)、D-D的差异,多因素分析寻求RMPP的危险因素,并采用ROC曲线计算各项指标的敏感度和特异度,分析其诊断价值。结果1.难治组院外发热时间、热退时间及住院时间明显长于普通组,CRP、LDH、NLR、D-D明显高于普通组(P<0.05);2.Logistic多因素回归分析显示NLR、CRP、LDH、D-D可作为预测RMPP的独立危险因素;3.D-D对RMPP合并胸腔积液有很好的预测能力。结论1.RMPP患儿D-D水平明显升高;2.血清D-D升高可作为RMPP和并发症发生的早期预测指标。

Objective To explore the clinical value of D-dimer(D-D)level on judging the severity of childhood mycoplasma pneumoniae pneumonia(MPP)and its significance in early identification of refractory mycoplasma pneumoniae pneumonia(RMPP).Methods Retrospective analysis of 168 hospitalized children with MPP from June 2021 to May 2022 in the pediatric inpatient department of Puyang People's Hospital was performed.According to the severity of disease,the children were divided into refractory group(n=51)and general group(n=117).White blood cell(WBC),neutrophil-leukocyte ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT),lactate dehydrogenase(LDH),and D-D were compared between the two groups.Multivariate logistic regression was performed to analyze independent predictors of RMPP.Results(1)Preadmission fever duration,defervescence time and hospitalization time were longer in the refractory group than those in the general group(P<0.05).Meanwhile,CRP,NLR,LDH and D-D were significantly higher in the refractory group than those in the general group(P<0.05).(2)Multivariate logistic regression analysis showed CRP,NLR,LDH and D-D were independent risk factors for RMPP(P<0.05).(3)D-D level has a good ability to predict RMPP with pleural effusion(P<0.05).Conclusion(1)Plasma D-D level was significantly increased in the children with RMPP.(2)Increased level of plasma D-D can be used as an early predictor of RMPP and complications.