重症肺炎支原体肺炎患儿CRP、LDH等实验室指标的预警价值及支气管镜下特点

Early warning value and bronchoscopic characteristics of experimental indicators such as CRP and LDH in severe Mycoplasma pneumoniae

目的探讨重症肺炎支原体肺炎(SMPP)患儿实验室指标的预警价值及支气管镜下临床特点,为早期诊断SMPP提供参考。方法收集2023年1—12月在安徽医科大学附属宿州医院住院的80例肺炎支原体肺炎患儿的临床资料,按照病情轻重分为重症组和普通组,每组各40例患儿。比较2组一般情况、实验室指标、支气管镜下特点的差异,并行统计分析。结果2组中性粒细胞比例、降钙素原(PCT)差异无统计学意义(P>0.05),而重症组白细胞(WBC)、C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、D-二聚体(D-D)均高于普通组(P<0.05)。多因素logistic回归分析显示,WBC、CRP、LDH、D-D为SMPP的独立影响因素(P<0.05)。ROC曲线分析显示,CRP、LDH、D-D对SMPP的诊断有较高的预测价值(P<0.05),最佳阈值分别为19.42 mg/L、361.00 IU/L、1.075 mg/L。重症组行支气管镜比例、镜下黏液栓痰及灌洗液中性粒细胞比例均高于普通组(P<0.05)。结论CRP、LDH、D-D为SMPP的独立影响因素,当CRP>19.42 mg/L、LDH>361.00 IU/L、D-D>1.075 mg/L时有助于早期识别SMPP。SMPP镜下发生黏液栓比例高,需积极行支气管镜治疗,同时灌洗液外观较浑浊、中性粒细胞比例高,可进一步评估病情。

Objective To explore the early warning value of experimental indicators for severe Mycoplasma pneumoniae pneumonia(SMPP)and the clinical characteristics under bronchoscopy,and provide reference for early diagnosis of SMPP.Methods The case data of children with Mycoplasma pneumoniae pneumonia(MPP)admitted to Suzhou Hospital Affiliated to Anhui Medical University from January to December 2023 was collected.According to the severity of the condition,they were divided into a severe group and a common group,with 40 cases randomly selected from each group.The differences in general conditions,experimental indicators,and bronchoscopy characteristics between the two groups were compared for statistical analysis.Results There was no statistically significant difference in the proportion of neutrophils and procalcitonin(PCT)between the two groups(P>0.05),while the severe group had higher levels of white blood cells(WBC),C-reactive protein(CRP),lactate dehydrogenase(LDH),and D-dimer(D-D)than the normal group(P<0.05).Multivariate logistic regression analysis showed that WBC,CRP,LDH,and D-D were independent risk factors for SMPP(P<0.05).ROC curve analysis showed that CRP,LDH,and D-D have high predictive value for the diagnosis of SMPP(P<0.05),with the optimal thresholds of 19.42 mg/L,361.00 IU/L,and 1.075 mg/L,respectively.The proportion of bronchoscopy,mucus emboli under bronchoscopy,and neutrophil count in lavage fluid in the severe group were higher than those in the normal group(P<0.05).Conclusion CRP,LDH,and D-D are independent risk factors for SMPP.When CRP>19.42 mg/L,LDH>361.00 IU/L,and D-D>1.075 mg/L,it is helpful for early identification of SMPP.The proportion of mucus embolism under SMPP endoscopy is high,and active bronchoscopy treatment is needed.At the same time,the appearance of the lavage fluid is cloudy and the proportion of neutrophils is high,which can further evaluate the condition.