小儿MPP并发塑型性支气管炎的临床特点、胸部CT影像学特征及相关因素分析

Clinical Characteristics,Chest CT Imaging Characteristics and Related Factors of Plastic Bronchitis in Children with MPP

目的分析小儿肺炎支原体肺炎(MPP)并发塑型性支气管炎(PB)的临床特点、胸部CT影像学特征及相关影响因素。方法选取2019年2月-2023年3月于我院住院治疗的MPP患儿206例作为研究对象,依据支气管镜检查结果分为PB组(n=48)和非PB组(n=158),对两组患儿临床资料、实验室指标、胸部CT、支气管镜检查报告进行回顾性分析,并采用多因素Logistic回归分析影响小儿MPP并发PB的重要相关因素。结果PB组患儿热峰、热程、住院时间、支气管镜次数,呼吸困难和肺部啰音的发生率均高于非PB组(P<0.05);PB组患儿C-反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、红细胞沉降率(ESR)和D-二聚体(DD)水平均高于非PB组(P<0.05);PB组患儿胸部CT双肺实变、胸腔积液、节段性肺不张、支气管黏液嵌塞征和累及胸膜病变的发生率高于非PB组(P<0.05);PB组患儿支气管镜下可见痰栓堵塞呼吸道,堵塞部位以右下20.83%(10/48)和≥2个肺叶累积29.17%(14/48)最为多见,PB组患儿发生黏膜坏死的比例明显高于非PB组(P<0.05)。多因素Logistic回归分析结果显示,热程>11d、胸腔积液征、CRP>36.82mg/L和LDH>545.29U/L是MPP患儿并发PB的重要影响因素。结论MPP患儿并发PB热峰高、热程较长,有CRP、LDH、CK-MB、ESR明显升高的特征,胸部CT表现有胸腔积液,伴肺不张;热程>11d、胸腔积液征、CRP>36.82mg/L和LDH>545.29U/L是MPP患儿并发PB的重要危险因素。

Objective To analyze the clinical characteristics,chest CT imaging characteristics and related influencing factors of plastic bronchitis(PB)in children with Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 206 children with MPP treated in the hospital were enrolled as the research objects between February 2019 and March 2023.According to bronchoscopy results,they were divided into PB group(n=48)and non-PB group(n=158).The clinical data,laboratory indexes,results of chest CT and bronchoscopy in both groups were retrospectively analyzed.The influencing factors of PB in MPP children were analyzed by multivariate Logistic regression analysis.Results The thermal spike,fever duration,hospitalization time,times of bronchoscopy,incidence of dyspnea and lung rales in PB group were higher than those in non-PB group(P<0.05),levels of C-reactive protein(CRP),procalcitonin(PCT),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB),erythrocyte sedimentation rate(ESR)and D-dimer(D-D)were higher than those in non-PB group(P<0.05),and incidence of double-lung consolidation,pleural effusion,segmental atelectasis,bronchial mucus impaction and pleural lesions was higher than that in non-PB group(P<0.05).In PB group,there was sputum bolt block in respiratory tract under bronchoscopy,which was common in the lower right site[20.83%(10/48)]and lung lobes[29.17%(14/48)].The proportion of cases with mucosal necrosis in PB group was significantly higher than that in non-PB group(P<0.05).The results of multivariate Logistic regression analysis showed that fever duration>11d,pleural effusion,CRP>36.82mg/L and LDH>545.29U/L were important influencing factors of PB in MPP children.Conclusion There is high thermal spike,long fever duration,significant increase of CRP,LDH,CK-MB and ESR,pleural effusion and atelectasis in MPP children.Fever duration>11d,pleural effusion,CRP>36.82mg/L and LDH>545.29U/L are important influencing factors of PB in MPP children.