儿童难治性肺炎支原体肺炎的早期临床特点及相关危险因素

Early clinical characteristics and related risk factors of refractory Mycoplasma pneumoniaepneumonia in children

目的分析总结儿童难治性肺炎支原体肺炎(refractory Mycoplasma pneumoniae pneumonia,RMPP)的早期临床特征,并探讨其相关危险因素。方法回顾性分析2020—2023年在武汉儿童医院重症医学科住院的518例肺炎支原体肺炎患儿的临床资料,根据病情严重程度和治疗情况,将其分为RMPP组(127例)和普通组(391例),比较2组患儿临床特征和相关实验室指标的差异,logistic回归筛选出难治性肺炎支原体肺炎的相关危险因素。结果2组患儿性别、体质量、发病季节及个人或家族过敏史比较,差异无统计学意义(P>0.05),按照年龄分组,婴幼儿组(<3岁)RMPP发病率(18.92%)低于学龄前组(3~6岁,47.88%)和学龄组(>6岁,33.20%)(P<0.05),学龄前组与学龄组比较,差异无统计学意义。RMPP组患儿发生高热的概率、发热持续时间、大环内酯类药物使用时间均高于普通组(P<0.05),2组患儿气促、腹泻、惊厥、皮疹的发生率比较,差异有统计学意义(P<0.05)。RMPP组患儿白细胞计数、C反应蛋白、降钙素原、乳酸、尿素氮、丙氨酸转氨酶、D-二聚体、白细胞介素-6水平均高于普通组,差异有统计学意义(P<0.001)。普通组患儿有308例患儿完成支原体DNA检测,支原体耐药位点阳性率为57.47%(177/308),明显低于RMPP组(76.38%,97/127),差异有统计学意义(P<0.001)。RMPP组患儿合并细菌病毒混合感染率(59.84%)高于普通组(P<0.001)。RMPP组患儿肺实变、肺不张、胸腔积液的病例数均高于普通组(P<0.001)。多因素logistic回归分析显示,发热持续时间、细菌合并病毒感染、支原体耐药基因位点阳性与RMPP的发生具有独立相关性。结论RMPP以3岁以上儿童为主,多发于秋冬季,其早期临床症状并不典型,患儿如使用大环内酯类药物后发热持续不退、存在细菌合并病毒感染或出现肺外并发症(腹泻、惊厥、皮疹),临床医生需高度警惕RMPP的发生,建议尽早完善支原体耐药基因位点检测,有助于早期识别RMPP。

Objective To analyze and summarize the early clinical characteristics of refractory Mycoplasma pneumoniae pneumonia(RMPP)in children,and to explore its related risk factors.Methods A retrospective analysis was conducted on the clinical data of 518 patients with Mycoplasma pneumoniae pneumonia(MPP)admitted to the Department of Critical Care Medicine of Wuhan Children′s Hospital from January 2020 to December 2023.According to the severity of the disease and treatment outcomes,the patients were divided into the RMPP group(n=127)and the general group(n=391).The differences in clinical features and laboratory indexes between the two groups were compared,and the risk factors of RMPP were screened out by logistic regression analysis.Results There were no significant differences in gender,weight,onset season,and personal or family allergy history between the two groups(P>0.05).When categorized by age,the incidence of RMPP in the infant group(<3 years old,18.92%)was lower than that in the preschool group(3-6 years old,47.88%)and school-age group(>6 years old,33.20%)(P<0.05),with no significant difference between the preschool group and school-age group.The probability of high fever,duration of fever,and duration of macrolide medication use in the RMPP group were significantly higher than those in the general group(P<0.05).The incidences of shortness of breath,diarrhea,convulsions,and rash in the two groups of children were also significantly different(P<0.05).There was a significant difference in white blood cell count,C-reactive protein,procalcitonin,lactate,blood urea nitrogen,alanine transaminase,D-dimer,interleukin-6 in the RMPP group were higher than Mycoplasma pneumoniae DNA testing, the positive rate of Mycoplasma pneumoniae resistance sites was 57.47% (177/308),which was significantly lower than that of the RMPP group (76.38%, 97/127) (P<0.001). The rate of bacterial and viral coinfectionin the RMPP group (59.84%) was significantly higher than that in the general group (P<0.001). The number of cases ofpulmonary consolidation, atelectasis, and pleural effusion in the RMPP group was significantly higher than those in the generalgroup (P<0.001). Multivariate logistic regression analysis showed that the duration of fever, bacterial co-viral infection, andpositive Mycoplasma pneumoniae resistance gene loci were independent risk factors for RMPP. Conclusions RMPP is morecommon in children over 3 years old and tends to occur in autumn and winter, and its early clinical symptoms are not typical.Clinical doctors should be highly vigilant about the occurrence of RMPP in patients who have prolonged fever despite macrolidetreatment, bacterial and viral co-infections, or develop extrapulmonary complications (diarrhea, convulsions, rash). It isrecommended that Mycoplasma pneumoniae resistance gene loci testing be performed as soon as possible, which can help toidentify RMPP in the early stage.