肺炎支原体肺炎并发塑型性支气管炎患儿的临床特征及危险因素分析

CLINICAL FEATURES OF CHILDREN WITH MYCOPLASMA PNEUMONIAE PNEUMONIA COMPLICATED BY PLASTIC BRONCHITIS AND RELATED RISK FACTORS

目的探讨肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)并发塑型性支气管炎(plastic bronchitis,PB)患儿的临床特征及危险因素,为该病患儿的早期诊疗提供参考。方法选取2021年7月16日—11月6日于我院行支气管镜检查并确诊为MPP患儿75例,按是否取出支气管塑型物分为PB组及非PB组。比较两组患儿的临床资料,并采用logistic回归分析导致MPP并发PB的危险因素,采用蛋白质质谱检测分析PB组患儿支气管塑型物组分。结果PB组患儿发热频次、热程≥10 d患儿构成比、肺实变患儿构成比、肺泡灌洗液中性粒细胞比例、红细胞沉降率(ESR)及C-反应蛋白、乳酸脱氢酶、降钙素原(PCT)、D-二聚体水平均显著高于非PB组(t=2.290~3.793,χ^(2)=5.548、5.659,Z=-2.085,P<0.05)。多因素logistic回归分析结果显示,PCT水平(OR=1.071,95%CI=1.015~1.130,P<0.05)和ESR(OR=1.088,95%CI=1.033~1.146,P<0.05)是PB发生的危险因素。蛋白质质谱分析显示支气管塑型物中含有丰富的纤维蛋白原。结论相较于单纯MPP患儿,并发PB的患儿炎症反应更为强烈,且ESR>25.20 mm/1 h和PCT>0.19μg/L时应警惕MPP并发PB的可能。PB患儿支气管塑型物含有大量纤维蛋白,其可能与炎症反应引起的凝血-纤溶系统异常激活相关。

Objective To investigate the clinical features of children with Mycoplasma pneumoniae pneumonia(MPP)complicated by plastic bronchitis(PB)and related risk factors,and to provide a reference for the early diagnosis and treatment of such disease.Methods A total of 75 children who underwent bronchoscopy and were diagnosed with MPP in our hospital from July 16 to November 6 in 2021 were enrolled,and according to the presence or absence of bronchial plastic casts,they were divided into PB group and non-PB group.Clinical data were compared between the two groups;a logistic regression analysis was used to investigate the risk factors for MPP complicated by PB,and protein mass spectrometry was used to analyze the components of bronchial plastic casts in the children with PB.Results Compared with the non-PB group,the PB group had significantly higher frequency of pyrexia,proportion of children with a duration of fever of≥10 d,proportion of children with pulmonary consolidation,percentage of neutrophils in bronchoalveolar lavage fluid,erythrocyte sedimentation rate(ESR),and levels of C-reactive protein,lactate dehydrogenase,procalcitonin(PCT),and D-dimer(t=2.290-3.793,χ^(2)=5.548,5.659,Z=-2.085,P<0.05).The multivariate logistic regression analysis showed that PCT level(OR=1.071,95%CI=1.015-1.130,P<0.05)and ESR(OR=1.088,95%CI=1.033-1.146,P<0.05)were risk factors for PB.Protein mass spectrometry showed that the bronchial plastic casts contained rich fibrin.Conclusion Compared with children with MPP alone,children with MPP complicated by PB tend to have a stronger inflammatory response,and the possibility of MPP complicated by PB should be considered in case of ESR>25.20 mm/1 h and PCT>0.19μg/L.The bronchial plastic casts of children with PB contain a large amount of fibrinogen,which may be associated with the abnormal activation of coagulation-fibrinolytic system due to inflammatory response.