儿童肺炎支原体肺炎行多次支气管肺泡灌洗术的危险因素分析

Analysis of risk factors for multiple bronchoalveolar lavagein children with mycoplasma pneumoniae pneumonia

目的探究儿童肺炎支原体肺炎(MPP)行多次支气管肺泡灌洗术(BAL)的危险因素。方法回顾性分析2021年3月至2023年3月期间在潍坊市人民医院儿科住院治疗并行支气管肺泡灌洗术的176例肺炎支原体肺炎患儿的临床资料,根据行支气管肺泡灌洗术的次数,将患儿分为单次组和多次组(≥2次),对两组的相关影响因素进行单因素分析和多因素Logistic回归分析,使用受试者工作特征(ROC)曲线分析相关因素评估肺炎支原体肺炎患儿行多次支气管肺泡灌洗术的预测价值。结果176例患儿中单次组为129例,多次组为47例。多次组BAL前热程、胸腔积液比例、中性粒细胞百分比、血小板计数(PLT)、C反应蛋白(CRP)、血沉(ESR)、D-二聚体(DD)、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、肺炎支原体抗体(MP-IgG、MP-IgM)、塑形痰栓或堵塞比例均高于单次组,差异有统计学意义(t/Z/χ^(2)值介于-9.140~66.458之间,P<0.05);多因素Logistic回归分析结果显示,DD(OR=2.395,95%CI:1.262~4.544)、BAL前热程(OR=1.675,95%CI:1.048~2.678)、中性粒细胞百分比(OR=1.120,95%CI:1.001~1.254)、ALT(OR=1.056,95%CI:1.006~1.108)及塑形痰栓或堵塞(OR=279.875,95%CI:10.925~7170.118)是MPP患儿行多次支气管肺泡灌洗术的独立危险因素(P<0.05);ROC曲线提示DD曲线下面积(AUC)为0.951(95%CI:0.920~0.982,P<0.001),最佳截断值为2.085ug/mL;BAL前热程AUC为0.862(95%CI:0.803~0.921,P<0.001),最佳截断值为7.5天;中性粒细胞百分比AUC为0.806(95%CI:0.735~0.876,P<0.001),最佳截断值为69.25%;ALT的AUC为0.774(95%CI:0.691~0.850,P<0.001),最佳截断值为20.5U/L。结论过强的免疫炎症反应、ALT的显著升高及塑形性支气管炎的形成是MPP患儿行多次BAL的危险因素。

Objective To investigate the risk factors of multiple bronchoalveolar lavage(BAL)in children with mycoplasma pneumoniae pneumonia(MPP).Methods A retrospective analysis was conducted on clinical data of 176 children diagnosed with MPP and treated with BAL at the Department of Pediatrics,Weifang People's Hospital from March 2021 to March 2023.According to the times of BAL,the children were divided into single group and multiple group(≥2 times).Both univariate and multivariate logistic regression analyses were used to analyze the relevant influencing factors of the two groups,receiver operating characteristic(ROC)curve was used to analyze that the relevant factors to evaluate the predictive value of multiple BAL in MPP children.Results Among the 176 children,129 were in the single group and 47 were in the multiple group.The multiple group exhibited significantly higher pre-BAL fever duration,pleural effusion ratio,neutrophil percentage,platelet count(PLT),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),D-dimer(DD),alanine aminotransferase(ALT),lactate dehydrogenase(LDH),mycoplasma pneumoniae antibodies(MP)-IgG,MP-IgM,and the proportions of plastic sputum plugs or obstruction compared to the single group(t/Z/χ^(2)=-9.140-66.458,P<0.05).The results of multivariate logistic regression analysis showed that DD(OR=2.395,95%CI:1.262-4.544),pre-BAL fever duration(OR=1.675,95%CI:1.048-2.678),neutrophil percentage(OR=1.120,95%CI:1.001-1.254),ALT(OR=1.056,95%CI:1.006-1.108),and presence of plastic sputum plugs or obstruction(OR=279.875,95%CI:10.925-7170.118)as independent risk factors for multiple BAL in children with MPP(P<0.05).The ROC curve analysis indicated that DD had an area under the curve(AUC)of 0.951(95%CI:0.920-0.982,P<0.001)with the optimal cutoff value of 2.085μg/mL.Pre-BAL fever duration had an AUC of 0.862(95%CI:0.803-0.921,P<0.001)with the optimal cutoff value of 7.5 days.Neutrophil percentage had an AUC of 0.806(95%CI:0.735-0.876,P<0.001)with the optimal cutoff value of 69.25%.ALT had an AUC of 0.774(95%CI:0.691-0.850,P<0.001)with the optimal cutoff value of 20.5 U/L.Conclusion Excessive immune inflammatory response,significant elevation of ALT and the development of plastic bronchitis are risk factors for multiple BAL in children with MPP.