2023年儿童重症肺炎支原体肺炎所致坏死性肺炎危险因素分析

Analysis of risk factors for necrotizing pneumonia caused by severe mycoplasma pneumoniae pneumonia in children in 2023

目的 分析总结2023年儿童重症肺炎支原体肺炎所致坏死性肺炎的临床表现及胸部影像特征,并探讨发生坏死性肺炎的危险因素。方法 收集2023年9月至11月深圳市儿童医院收治的50例重症肺炎支原体肺炎患儿的临床和胸部CT平扫及增强检查的资料,依据肺实质是否合并坏死,分坏死性肺炎组(28例)和非坏死性肺炎组(22例)。比较两组临床及影像学特点,将单因素分析中差异有统计学意义的指标进行多因素Logistic回归分析,并采用ROC曲线分析不同指标及联合指标的诊断效能。结果 50例患儿中男25例,女25例,平均年龄(6.56±3.13)岁。6例(12.00%)伴基础疾病。两肺多叶多段受累,部分楔形实变、支气管壁增厚,29例(58.00%)伴少量胸腔积液,肺门淋巴结肿大44例(88.00%),肺实质坏死28例(56.00%),典型坏死性肺空洞3例。所有患儿最终均好转出院。坏死性肺炎组和非坏死性肺炎组患儿性别、年龄、低氧血症、高热、C反应蛋白水平差异无统计学意义(P>0.05)。坏死性肺炎组患儿住院时间,D-二聚体、乳酸脱氢酶(lactatede hydrogenase,LDH)、谷丙转氨酶(alanine aminotransferase,ALT)水平及胸腔积液比例均高于非坏死性肺炎组,差异有统计学意义(P <0.05)。多因素Logistic回归分析,LDH升高(OR=1.007,95%CI 1.001~1.013)和胸腔积液(OR=35.060,95%CI 4.523~271.777)是重症肺炎支原体肺炎患儿发生坏死性肺炎的独立危险因素。LDH和胸腔积液联合预测坏死性肺炎的敏感度为0.778,特异度为0.773,曲线下面积为0.852(95%CI0.746~0.958)。结论 重症肺炎支原体肺炎患儿如出现胸腔积液、LDH明显升高,应注意合并坏死性肺炎的可能,尽早识别并进行有效的临床干预。

Objective To analyze and summarize the clinical manifestations and chest imaging features of necrotizing pneumonia caused by severe mycoplasma pneumoniae pneumonia in 2023,and to identify risk factors for necrotizing pneumonia.Method The clinical data and radiology data were collected on 50 children with severe mycoplasma pneumoniae pneumonia treated in Shenzhen Children's Hospital from September to November 2023.Children were examined with the chest CT scan and enhancement,and were divided into necrotizing and non-necrotizing pneumonia groups based on the enhancement of the lung parenchyma with or without necrosis.Clinical and radiology features were compared between two groups.Multivariate Logistic regression analysis was applied to analyze the indexes with significant differences in the univariate analysis.The ROC curve was used to analyze the diagnostic efficiency of different indicators and combined indicators.Result There were 25 males and 25 females among 50 children with a mean age of(6.56±3.13)years.Six cases(12.00%)had underlying diseases.Multiple lobes and segments of both lungs were involved,with partial wedge-shaped consolidation and bronchial wall thickening.Twenty-nine cases(58.00%)had a small amount of pleural effusion,with hilar lymph node enlargement in 44 cases(88.00%),pulmonary parenchyma necrosis in 28 cases(56.00%)and typical necrotizing cavities in 3 cases.All patients recovered and discharged.There was no significant difference in sex,age,hypoxemia,high fever or C-reactive protein between these two groups(P>0.05).The median hospitalization days,D-dimer,actate dehydrogenase(LDH),alanine aminotransferase(ALT)and pleural effusion in necrotizing pneumonia group were significantly higher than those in the non-necrotizing pneumonia group(P<0.05).Multivariate Logistics regression analysis showed that LDH(OR=1.007,95%CI 1.001-1.013)and pleural effusion(OR=35.060,95%CI 4.523-271.777)were independent predictors of necrotizing pneumonia in children with severe mycoplasma pneumoniae pneumonia.When LDH and pleural effusion were used for joint prediction,the sensitivity was 0.778,the specificity was 0.773,and the area under the curve was 0.852(95%CI 0.746-0.958).Conclusion Children with severe mycoplasma pneumoniae who present with pleural effusions and apparently elevated LDH should be alerted to the possibility of combination with necrotizing pneumonia.Early recognition and effective clinical intervention should be performed.