儿童重症肺炎支原体肺炎的临床特征及相关危险因素分析

Analysis of clinical characteristics and related risk factors of severe mycoplasma pneumoniae pneumonia in children

目的探讨儿童重症肺炎支原体肺炎(SMPP)的临床特征及其危险因素,为临床早期识别SMPP提供指导依据。方法回顾性分析2019年1月至2021年12月在安徽省儿童医院呼吸科住院的263例肺炎支原体肺炎患儿的临床资料,根据病情严重程度将其分为重症组(88例)和轻症组(175例),比较两组患儿一般情况、临床表现、实验室检查、影像学特征和支气管镜下表现的差异,进行统计学分析。结果两组患儿的性别、发病季节差异无统计学意义(P>0.05)。重症组年龄大于轻症组(P<0.05),按照年龄分组,其中婴幼儿组SMPP发生率(14.10%)低于学龄前组(45.00%)及学龄组(37.65%)(P<0.05),而学龄前组与学龄组比较,差异无统计学意义(P>0.05)。重症组发热程度、肺外并发症的比例高于轻症组,热程、住院时间、大环内酯类药物使用时间长于轻症组(P均<0.05)。两组患儿白细胞计数/淋巴细胞计数、C-反应蛋白(CRP)、前白蛋白、谷丙转氨酶、乳酸脱氢酶(LDH)、免疫球蛋白G、免疫球蛋白A、降钙素原、红细胞沉降率(ESR)、D-二聚体、肺泡灌洗液中肺炎支原体DNA(MP-DNA)拷贝数的差异有统计学意义(P均<0.05)。重症组肺部大片状阴影、胸膜增厚、肺不张、胸腔积液、支气管肺泡灌洗次数及气道内黏液栓堵塞的比例均高于轻症组(P均<0.05)。多因素Logistic回归分析显示,热程(OR=1.294,95%CI:1.127~1.485)、CRP(OR=1.027,95%CI:1.003~1.052)、LDH(OR=1.006,95%CI:1.002~1.011)、D-二聚体(OR=1.406,95%CI:1.065~1.875)、ESR(OR=1.042,95%CI:1.008~1.077)、大片状阴影(OR=21.811,95%CI:6.205~76.664)和胸腔积液(OR=5.495,95%CI:1.604~18.826)是SMPP的独立危险因素。ROC曲线分析显示,热程、CRP、LDH、D-二聚体、ESR对诊断SMPP有较高预测价值,其最佳阈值分别为8.50 d、25.625 mg/L、412.50 IU/L、0.98 mg/L、36.5 mm/h。结论SMPP患儿的发热程度高,热程、住院时间、大环内酯类药物使用时间长,炎症指标明显升高,肺部影像学及支气管镜下改变重;热程、CRP、LDH、D-二聚体、ESR、大片状阴影和胸腔积液是SMPP的危险因素,当热程>8.50 d、CRP>25.625 mg/L、LDH>412.50 IU/L、D-二聚体>0.98 mg/L、ESR>36.5 mm/h时有助于早期识别SMPP。

Objective To explore the clinical features and risk factors of severe mycoplasma pneumoniae pneumonia(SMPP)in children,and to provide guidance for early identification of SMPP.Methods The clinical data of 263 children with mycoplasma pneumoniae pneumonia admitted to the Respiratory Department at Anhui Children′s Hospital from January 2019 to December 2021 were analyzed retrospectively.According to the severity of the disease,the patients were divided into severe group(n=88)and mild group(n=175).The general conditions,clinical manifestations,laboratory examination,imaging features and bronchoscopic findings between two groups were compared and statistically analyzed.Results There was no significant difference in sex and onset season between two groups(P>0.05).The age of severe group was older than that of mild group(P<0.05).According to the age group,the incidence of SMPP in the infant group(14.10%)was lower than that in the preschool group(45.00%)and the school age group(37.65%)(P<0.05),but there was no significant difference between preschool group and school age group(P>0.05).The degree of fever and the proportion of extrapulmonary complications in severe group were higher than those in mild group,and the duration of fever,length of hospital stay and use of macrolides in severe group were longer than those in mild group(P<0.05).There were significant differences in white blood cell count/lymphocyte count,C-reactive protein(CRP),prealbumin,glutamic pyruvic transaminase,lactate dehydrogenase(LDH),immunoglobulin G,immunoglobulin A,procalcitonin,erythrocyte sedimentation rate(ESR)and D-dimer between two groups(all P<0.05).There was significant difference in the copies of mycoplasma pneumoniae DNA in bronchoalveolar lavage fluid between two groups(P<0.05).The proportion of large shadow,pleural thickening,atelectasis,pleural effusion,bronchoalveolar lavage and airway mucus thrombus blockage in severe group were higher than those in mild group(P<0.05).Multivariate Logistic regression analysis showed that hot course(OR=1.294,95%CI:1.127-1.485),CRP level(OR=1.027,95%CI:1.003-1.052),LDH level(OR=1.006,95%CI:1.002~1.011),D-dimer level(OR=1.406,95%CI:1.065~1.875),ESR(OR=1.042,95%CI:1.008-1.077),large shadow(OR=21.811,95%CI:6.205~76.664)and pleural effusion(OR=5.495,95%CI:1.604-18.826)were independent risk factors for SMPP.ROC curve analysis showed that thermal path,CRP level,LDH level,D-dimer level and ESR had high predictive value in the diagnosis of SMPP,and the best thresholds were 8.50 d,25.625 mg/L,412.50 IU/L,0.98 mg/L and 36.5 mm/h,respectively.Conclusion Children with SMPP had high degree of fever,long duration of fever,length of hospital stay,long use of macrolides,significantly increased inflammatory indexes,and severe changes in pulmonary imaging and bronchoscopy.Hot course,CRP level,LDH level,D-dimer level,ESR,large shadow and pleural effusion are risk factors for SMPP.It is helpful for early identification of SMPP when the hot course is>8.50 d,CRP>25.625 mg/L,LDH>412.50 IU/L,D-dimer>0.98 mg/L,ESR>36.5 mm/h.