儿童难治性肺炎支原体肺炎发生塑型性支气管炎的临床特征及危险因素分析

Analysis on clinical features and risk factors of plastic bronchitis occurrence in children patients with refractory Mycoplasma pneumoniae pneumonia

目的探讨难治性肺炎支原体肺炎(RMPP)患儿发生塑型性支气管炎(PB)的临床特征及危险因素。方法回顾性分析2017年1月至2019年12月在该院住院的RMPP并行纤维支气管镜治疗的399例患儿的临床资料,根据纤维支气管镜下是否可见PB分为PB组(n=142)和非PB组(n=257),比较两组临床特征、实验室检查指标、影像学表现差异,分析儿童RMPP发生PB的危险因素。结果与非PB组比较,PB组低氧血症、肺外并发症发生率及最高体温更高,发热时间、住院时间更长,激素和静脉注射丙种球蛋白(IVIG)治疗比例更高,中性粒细胞百分比(NEUT)、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素(IL)-6、AST、ALT、乳酸脱氢酶(LDH)、肌酸激酶(CK)、D-二聚体水平及肺不张、胸腔积液发生率更高,PLT、淋巴细胞水平更低,差异有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,最高体温、NEUT、PCT、IL-6、AST、LDH可作为RMPP发生PB的预测指标(P<0.05)。多因素logistic回归分析结果显示,最高体温>39.8℃、NEUT>72.90%、IL-6>26.65 pg/mL、AST>49.50 U/L及肺不张是RMPP发生PB的危险因素(P<0.05)。结论应关注RMPP患儿发生PB的危险因素,采取必要的预防措施,以改善RMPP患儿预后。

Objective To investigate the clinical characteristics and risk factors of plastic bronchitis(PB)occurrence in children patients with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods A retrospective analysis was performed on the clinical data of 399 children patients with RMPP treated by fiberoptic bronchoscopy hospitalized in this hospital from January 2017 to December 2019.The patients were divided into the PB group(n=142)and non-PB group(n=257)according to whether or not finding PB under fiberoptic bronchoscopy.The differences in clinical characteristics,laboratory detection in dicators and imageological manifestations were compared between the two groups.The risk factors of PB occurrence in children RMPP were analyzed.Results Compared wit h the non-PB group,the incidence rates of hypoxemia and extrapulmonary complications,and the highest body temperature in the PB group were higher,number of fever days and hospitalization days was longer,the proportions of hormone and intravenous injection of immunoglobulin were higher,the levels of NEUT,CRP,IL-6,AST,ALT LDH CK and D-Dimer and incidence rates of pulmonary atelectasis and pleural effusion were higher,the levels of PLT and lymphocytes were lower,and the differences were statistically significant(P<0.05).The receiver operating characteristic(ROC)curve analysis results showed that the highest body temperature,NEUT,PCT,IL-6,AST and LDH could serve as the predictive indicators for PB occurrence in RMPP(P<0.05).The multivariate logistic regression analysis results showed that the highest body temperature>39.8℃,NEUT>72.9%,IL-6>26.65 pg/mL,AST>49.5 U/L and pulmonary atelectasis were the risk factors of PB occurrence in RMPP.Conclusion Should pay attention to the risk factors of PB occurrence in children patients with RMPP and take necessary preventive measures to improve their prognosis.