儿童大叶性肺炎支气管黏液栓形成危险因素及预测效能分析

Risk factors of bronchial mucus thrombus formation in children with lobar pneumonia and their predictive efficacy

目的探讨儿童大叶性肺炎支气管黏液栓形成的危险因素并分析上述因素的预测效能,旨在为早期识别预后不良人群及防治工作提供更多参考。方法回顾性纳入2021年7月至2023年5月驻马店市中心医院诊治儿童大叶性肺炎患儿共78例,根据是否形成支气管黏液栓分为形成组(19例)和未形成组(59例),采用单因素和多因素分析法分析儿童大叶性肺炎支气管黏液栓形成的独立危险因素,并进一步评估上述独立危险因素用于儿童大叶性肺炎支气管黏液栓形成的风险预测临床效能。结果单因素分析结果显示,年龄、发热时间、中性粒细胞百分比、C反应蛋白水平、降钙素原水平、D-二聚体水平、乳酸脱氢酶水平、CD4^(+)与CD8^(+)T淋巴细胞计数比值、合并细菌感染情况及合并EB病毒感染情况均可能与儿童大叶性肺炎支气管黏液栓形成有关(P<0.05);多因素分析结果显示,高乳酸脱氢酶和高CD4^(+)与CD8^(+)T淋巴细胞计数比值均是儿童大叶性肺炎支气管黏液栓形成独立危险因素(P<0.05);ROC曲线分析结果显示,乳酸脱氢酶和CD4^(+)与CD8^(+)T淋巴细胞计数比值均可用于儿童大叶性肺炎支气管黏液栓形成风险预测,同时二者联合预测效能优于单一使用(P<0.05)。结论儿童大叶性肺炎支气管黏液栓形成与乳酸脱氢酶和CD4^(+)与CD8^(+)T淋巴细胞计数比值独立相关;而两者联合可更准确地预测儿童大叶性肺炎支气管黏液栓形成的风险。

【Objective】To investigate the risk factors of bronchial mucus thrombus formation in children with lobar pneumonia and their predictive efficacy,in order to provide more reference for early identification of poor prognosis population and prevention and treatment.【Methods】Seventy-eight children with lobar pneumonia were retrospectively chosen in the period from July 2021 to May 2023.All patients were divided into formation group(19 cases)and non-formation group(59 cases)according to bronchial mucus thrombus formation or not.The independent risk factors for bronchial mucus thrombus formation in children with lobar pneumonia were evaluated by univariate and multivariate methods.The clinical efficacy of these independent risk factors in predicting the risk of bronchial mucus thrombus formation in children with lobar pneumonia were further evaluated.【Results】The results of univariate analysis showed that age,fever duration,neutrophil percentage,C-reactive protein level,procalcitonin level,D-dimer level,lactate dehydrogenase level,CD4^(+)and CD8^(+)T lymphocyte count ratio,bacterial infection and Epstein-Barr virus infection may be related to the formation of bronchial mucus thrombus in children with lobar pneumonia(P<0.05).Multivariate analysis of logistic regression model showed that high lactate dehydrogenase and high CD4^(+)to CD8^(+)T lymphocyte count ratio were independent risk factors for bronchial mucus thrombus formation in children with lobar pneumonia(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that both lactate dehydrogenase and CD4^(+)to CD8^(+)T lymphocyte count ratio could be used to predict the risk of bronchial mucus thrombus formation in children with lobar pneumonia,and the combined efficacy of both was better than that of single use(P<0.05).【Conclusion】The formation of bronchial mucus thrombus in children with lobar pneumonia was independently correlated with lactate dehydrogenase and CD4^(+)to CD8^(+)T lymphocyte count ratio.The combination of the two methods can more accurately predict the risk of bronchial mucus thrombus formation in children with lobar pneumonia.