420例肺炎支原体肺炎患儿中医证型分布及相关危险因素分析

Distribution of Traditional Chinese Medicine Syndromes and Related Risk Factors in Children with Mycoplasma Pneumoniae Pneumonia:An Analysis of 420 Cases

【目的】探讨肺炎支原体肺炎(MPP)患儿中医证型分布规律及其相关危险因素。【方法】收集广州中医药大学第一附属医院收治的420例MPP患儿的临床资料,包括性别、年龄、既往呼吸道疾病病史、中医证型、MPP分型、咳嗽时长、发热时长、发热峰值、实验室指标[C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)]以及是否合并感染等;运用SPSS 26.0软件进行数据统计,分析MPP患儿的中医证型分布规律及其与各项临床资料的相关性,探讨基于中医证型的不同MPP分型的相关危险因素。【结果】(1)420例MPP患儿中,轻型283例(67.4%),难治型76例(18.1%),重型61例(14.5%);风热闭肺证152例(36.2%),痰热闭肺证141例(33.6%),湿热闭肺证77例(18.3%),毒热闭肺证25例(6.0%),肺脾气虚证16例(3.8%),阴虚肺热证9例(2.1%);单纯肺炎支原体感染295例(70.2%),混合感染125例(29.8%)。(2)不同中医证型MPP患儿在年龄分层、就诊季节方面比较,差异均有统计学意义(P<0.01),而在性别、既往有无呼吸道病史、是否合并感染方面比较,差异均无统计学意义(P>0.05)。(3)不同MPP分型在就诊季节、既往有无呼吸道病史、是否合并感染比较,差异均有统计学意义(P<0.05),而在性别及年龄分层方面比较,差异均无统计学意义(P>0.05)。(4)不同中医证型的CRP、PCT等实验室指标及咳嗽时长、发热时长、热峰等症状表现比较,差异均有统计学意义(P<0.05或P<0.01)。(5)不同MPP分型的PCT、LDH等实验室指标及咳嗽时长、发热时长、峰值等症状表现比较,差异均有统计学意义(P<0.05或P<0.05)。(6)多因素Logistic回归分析结果提示:CRP≥10.5 mg/L和风热闭肺证是轻症MPP的独立危险因素(P<0.05或P<0.01);发热≥7 d、咳嗽≥12 d和痰热闭肺证是难治性MPP的独立危险因素(P<0.05或P<0.01);咳嗽≥12 d、混合感染、毒热闭肺证是重症MPP的独立危险因素(P<0.01)。【结论】该研究发现,MPP分型以轻型为主,中医证型以风热闭肺证居多。难治型MPP和湿热闭肺证在秋季的比例显著增高,可能与地域及运气特点相关;CRP水平及热峰升高可能与痰热闭肺证、毒热闭肺证相关,临床上应注意及早使用清热化痰或清热解毒类药物;既往呼吸道疾病病史与混合感染患儿更易发展为重型MPP,临床上需加以警惕;风热闭肺证、痰热闭肺证和毒热闭肺证分别是轻型MPP、难治型MPP和重型MPP的独立危险因素,临证需及时施治,以防止MPP由轻型向难治或重型发展。

Objective To investigate the distribution of traditional Chinese medicine(TCM)syndromes and related risk factors in children with mycoplasma pneumoniae pneumonia(MPP).Methods The clinical data of 420 children with MPP admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected.The clinical data included gender,age,history of respiratory tract diseases,TCM syndromes,MPP classification,cough duration,fever duration,fever peak value,laboratory indicators of C-reactive protein(CRP),procalcitonin(PCT)and lactate dehydrogenase(LDH),and the complication of infection.SPSS 26.0 software was used for data statistics,and then the distribution of TCM syndromes in children with MPP and its correlation with various clinical data,as well as the related risk factors of MPP with different classification and various TCM syndromes were explored.Results(1)Among the 420 children with MPP,there were 283 cases(67.4%)of mild MPP,76 cases(18.1%)of refractory MPP,and 61 cases(14.5%)of severe MPP.For the distribution of TCM syndromes,there were 152 cases(36.2%)of wind-heat obstructing the lung syndrome,141 cases(33.6%)of phlegm-heat obstructing the lung syndrome,77 cases(18.3%)of damp-heat obstructing the lung syndrome,25 cases(6.0%)of toxin-heat obstructing the lung syndrome,16 cases(3.8%)of lung-spleen qi deficiency syndrome,and 9 cases(2.1%)of yin deficiency and lung heat syndrome.For the classification of infection,there were 295 cases(70.2%)of simple mycoplasma pneumoniae(MP)infection and 125 cases(29.8%)of mixed infection.(2)There were statistically significant differences in age stratification and visit season among MPP children with different TCM syndromes(P<0.01),while no significant differences were shown in the gender,history of respiratory tract diseases,and the complication of infection(P>0.05).(3)There were statistically significant differences in the visit season,history of respiratory tract diseases,and the complication of infection among the children with various MPP types(P<0.05),while no significant differences were shown in the gender and age stratification(P>0.05).(4)There were statistically significant differences in laboratory indicators of CRP and PCT and in the symptoms of cough duration,fever duration and fever peak among MPP children with different TCM syndromes(P<0.05 or P<0.01).(5)Significant differences were presented in laboratory indicators of PCT and LDH and in the symptoms of cough duration,fever duration and fever peak value among the children with different MPP types(P<0.05 or P<0.01).(6)Multivariate logistic regression analysis showed that CRP level≥10.5 mg/L and wind-heat obstructing the lung syndrome were the independent risk factors for mild MPP(P<0.05 or P<0.01);fever duration≥7 days,cough duration≥12 days and phlegm-heat obstructing the lung syndrome were the independent risk factors for refractory MPP(P<0.05 or P<0.01);cough duration≥12 days,mixed infection and toxin-heat obstructing the lung syndrome were the independent risk factors for severe MPP(P<0.01).Conclusion The results indicated that the classification MPP in children is predominated by mild MPP,and their TCM syndrome types is predominated by wind-heat obstructing the lung syndrome.The proportions of refractory MPP and damp-heat obstructing the lung syndrome increase significantly in autumn,which may be related to the characteristics of regional environment and circuit qi.The increase of CRP level and fever peak may be related to phlegm-heat obstructing the lung syndrome and toxin-heat obstructing the lung syndrome.In clinic,attention should be paid to the early use of heat-clearing and phlegm-resolving drugs or heat-clearing and toxin-removing drugs;children with the history of respiratory tract diseases and mixed infections are more likely to develop into severe MPP,and the physicians should be alert clinically.Wind-heat obstructing the lung syndrome,phlegmheat obstructing the lung syndrome and toxin-heat obstructing the lung syndrome are the independent risk factor separately for mild MPP,refractory MPP and severe MPP,which requires timely intervention to prevent mild MPP from developing into refractory MPP or severe MPP in clinic.