重症肺炎支原体肺炎患儿的危险因素分析

Analysis of risk factors in children with severe Mycoplasma pneumoniae pneumonia

目的通过比较重症与轻症肺炎支原体肺炎患儿的临床资料和相关实验室指标,分析儿童重症肺炎支原体肺炎发生的危险因素。方法收集2019年7月—2020年2月于上海交通大学医学院附属儿童医院呼吸科住院的205例肺炎支原体肺炎患儿资料,依据病情程度分为轻症组(85例)和重症组(120例),比较两组的一般资料(性别、年龄、有无合并肺外表现、住院时间、入院时病程)和实验室指标[白细胞计数、CRP、ESR、降钙素原(PCT)、纤维蛋白原、D-二聚体、铁蛋白、乳酸脱氢酶(LDH)和免疫球蛋白(Ig)E],并分析重症肺炎支原体肺炎的独立危险因素。结果重症组患儿合并肺外表现的比例显著高于轻症组,住院时间显著长于轻症组;实验室指标中CRP、ESR、PCT、D-二聚体、铁蛋白、LDH和血清IgE水平均显著高于轻症组(P值均<0.05)。多因素logistic回归分析结果显示,住院时间、CRP、LDH、D-二聚体、血清IgE是儿童重症肺炎支原体肺炎发生的独立危险因素。结论重症肺炎支原体肺炎患儿血浆CRP、LDH、D-二聚体及血清IgE水平显著增高,且是重症肺炎支原体肺炎发生的独立危险因素,其对早期识别重症肺炎支原体肺炎具有一定的指导意义。

Objective To analyze the risk factors of children with severe Mycoplasmal pneumoniae pneumonia by comparing the clinical data and relevant laboratory indicators of children with severe and mild Mycoplasma pneumoniae pneumonia.Methods A retrospective analysis was performed in 205 children with Mycoplasmal pneumoniae pneumonia who were hospitalized in the Shanghai Children’s Hospital from July 2019 to February 2020.According to the severity of illness,the patients were divided into mild group(n=85)and severe group(n=120).Clinical data and laboratory indexes,such as age,gender,hospital stay,course of disease,white blood cell count,CRP,LDH,erythrocyte sedimentation rate(ESR),ferritin,procalcitonin(PCT),fibrinogen,D-dimer,IgE on admission,and extrapulmonary manifestations were collected and analyzed.The risk factors for severe Mycoplasma pneumoniae pneumonia were analyzed.Results The proportion of patients with extrapulmonary manifestations in the severe group was significantly higher than that in the mild group(P<0.05).The hospital stay of the severe group was significantly longer than that in the mild group(P<0.05).The levels of CRP,ESR,PCT,D-dimer,ferritin,LDH and IgE in the severe group were significantly higher than those in the mild group(all P<0.05).Multivariate logistic regression analysis showed that hospital stay,CRP,LDH,D-dimer and IgE were independent risk factors for severe Mycoplasmal pneumoniae pneumonia.Conclusion Serum levels of CRP,LDH,D-dimer and IgE were significantly increased in children with severe Mycoplasmal pneumoniae pneumonia and were independent risk factors for severe Mycoplasmal pneumoniae pneumonia.It will be helpful for the early identification of severe Mycoplasmal pneumoniae pneumonia by closely monitoring the changes of these laboratory indicators.