儿童肺炎支原体坏死性肺炎危险因素分析

Analysis on the risk factors of Mycoplasma pneumoniae necrotizing pneumonia in children

目的分析儿童肺炎支原体坏死性肺炎(MPNP)的危险因素。方法收集2021年1月至2022年12月山西省儿童医院呼吸科收治的151例重症肺炎支原体肺炎(SMPP)患儿的临床资料。根据治疗后复查胸部CT结果将其分为MPNP组(50例)和非MPNP组(101例)。采用多因素logistic回归分析影响MPNP发生的危险因素。结果MPNP组入院前病程、发热时间和住院时间均长于非MPNP组,差异有统计学意义(P<0.05)。MPNP组白细胞(WBC)、中性粒细胞、C反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、D-二聚体水平高于非MPNP组,总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)水平低于非MPNP组,差异均有统计学意义(P<0.05)。MPNP组出现胸腔积液、胸膜增厚、支气管肺泡灌洗液(BALF)米汤样浑浊,以及使用其他抗生素、低分子量肝素钙的人数比例大于非MPNP组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,较高水平的WBC、D-二聚体,以及出现BALF米汤样浑浊是儿童MPNP发生的独立危险因素(P<0.05),较高水平的PA是抑制儿童MPNP发生的保护因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,WBC、D-二聚体、PA均具有诊断儿童MPNP的应用价值(P<0.05),联合三个指标可进一步提高诊断效能[AUC(95%CI)=0.932(0.886~0.979)],灵敏度、特异度分别为0.920、0.851。结论WBC、D-二聚体、PA和BALF米汤样浑浊是MPNP发生的影响因素,临床医师应密切关注指标的变化情况,对怀疑并发坏死性肺炎的患儿,应进一步完善相关检查以明确病情,及早进行干预,改善患儿预后情况。

Objective To analyze the risk factors of Mycoplasma pneumoniae necrotizing pneumonia(MPNP)in children.Methods The clinical data of 151 children with severe Mycoplasma pneumoniae pneumonia(SMPP)who were admitted to the Respiratory Department of Shanxi Children′s Hospital from January 2021 to December 2022 were collected.According to the results of chest computed tomography(CT)reexamination after treatment,the patients were divided into MPNP group(50 cases)and non-MPNP group(101 cases).Multivariate logistic regression was used to analyze the risk factors of MPNP.Results The duration of the disease before admission,fever time and hospital stay in the MPNP group were longer than those in the non-MPNP group,and the differences were statistically significant(P<0.05).The levels of white blood cells(WBC),neutrophils,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH)and D-dimer in the MPNP group were higher than those in the non-MPNP group,while the levels of total protein(TP),albumin(ALB)and prealbumin(PA)in the MPNP group were lower than those in the non-MPNP group,and the differences were statistically significant(P<0.05).The proportion of the patients with pleural effusion,pleural thickening and rice-water-like bronchoalveolar lavage fluid(BALF),and the proportion of the patients receiving other antibiotics and low molecular weight heparin calcium in the MPNP group were higher than those in the non-MPNP group,and the differences were statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that higher levels of WBC,D-dimer and rice-water-like BALF were independent risk factors for developing MPNP in the children(P<0.05),and higher levels of PA were protective factors for inhibiting MPNP in the children(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that WBC,D-dimer and PA all had diagnostic value for MPNP in the children(P<0.05),and the combination of the three indicators could further improve the diagnostic efficiency[AUC(95%CI)=0.932(0.886-0.979)].The sensitivity and the specificity were 0.920 and 0.851,respectively.Conclusion WBC,D-dimer,PA and rice-water-like BALF are factors affecting the occurrence of MPNP.Clinicians should pay close attention to the changes of these indicators.For the children suspected to be complicated with necrotizing pneumonia,the relevant examinations should be further improved to clarify the children′s conditions,and early intervention should be carried out to improve the prognosis of the children.