儿童难治性肺炎支原体肺炎早期预警指标

Early warning indicators of children with refractory mycoplasma pneumoniae pneumonia

目的探讨儿童难治性肺炎支原体肺炎(RMPP)的早期预警指标,特别纳入了外周血CXC趋化因子配体9(CXCL9)的检测,为临床早期识别RMPP并及早干预提供依据。方法选择2021年8月至2022年4月就诊于首都儿科研究所附属儿童医院呼吸内科且临床诊断为肺炎支原体肺炎(MPP)的128例患儿为研究对象,其中RMPP患儿45例(RMPP组),非RMPP患儿83例(对照组)。比较两组患儿的一般资料、临床症状、体征、实验室检查及肺内外并发症等。采用酶联免疫吸附试验(ELISA)检测两组患儿血清CXCL9水平。应用二元Logistic回归分析筛选RMPP发生的影响因素。采用Spearman相关性检验分析血清CXCL9与发热时间、中性粒细胞比例、C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、D-二聚体、血清白细胞介素-6(IL-6)及干扰素-(IFN-)水平、肺内并发症及肺外并发症的相关性。结果RMPP组患儿发热时间[12(11,15)dvs.10(8,11)d]和住院时间[9(6,11)dvs.6(4,7)d]均显著长于对照组患儿,差异有显著统计学意义(Z=-5.929、P<0.001,Z=-5.949、P<0.001);肺内(48.9%vs.14.5%)及肺外(71.1%vs.33.7%)并发症发生率显著高于对照组,差异有显著统计学意义(χ^(2)=17.734、P<0.001,χ^(2)=16.369、P<0.001)。RMPP组患儿中性粒细胞比例(t=2.339、P=0.021)、CRP(Z=-4.564、P<0.001)、D-二聚体(Z=-6.024、P<0.001)、LDH(Z=-5.535、P<0.001)、CXCL9(Z=-2.181、P=0.029)、IL-6(Z=-4.2、P<0.001)和IFN-(Z=-3.729、P<0.001)水平均高于对照组,差异均有统计学意义。二元Logistic回归分析显示,发热时间(OR=1.818、95%CI:1.363~2.425、P<0.001)、CXCL9水平(OR=1.002、95%CI:1.000~1.004、P=0.04)均为RMPP的影响因素。外周血CXCL9水平与CRP(r=0.179、P=0.044)、LDH(r=0.262、P=0.003)和血清IL-6(r=0.279、P=0.001)水平呈正相关,与血清IFN-水平呈显著正相关(r=0.441、P<0.001)。结论RMPP患儿发热时间、外周血CRP、D-二聚体、LDH、IL-6、IFN-及血清CXCL9水平显著升高,且发热时间、血清CXCL9水平为RMPP的影响因素,以上指标均可成为RMPP的良好预警指标,为临床诊治提供依据。

Objective To explore the early warning indicators of refractory mycoplasma pneumoniae pneumonia(RMPP)in children,which especially included the detection of CXC chemokine ligand 9(CXCL9)in peripheral blood,and to provide basis for early clinical identification of RMPP and early intervention.MethodsTotal of 128 children diagnosed with mycoplasma pneumoniae pneumonia(MPP)in the respiratory department of Children's Hospital Affiliated to the Capital Institute of Pediatrics from August 2021 to April 2022 were selected.Among them,45 cases were diagnosed with RMPP(RMPP group)and 83 cases without RMPP were set as control group.The general data,clinical symptoms,signs,laboratory tests and internal and external pulmonary complications were compared between the two groups,respectively.Serum chemokine CXCL9 levels were detected by enzyme-linked immunosorbent assay(ELISA).The independentrisk factors of RMPP were analyzed by Binary Logistic regression,while the correlation between CXCL9and fever duration,neutrophil ratio,C-reactive protein(CRP),lactate dehydrogenase(LDH),D-dimer,seruminterleukin-6(IL-6)and interferon-(IFN-)levels,intrapulmonary and extrapulmonary complications wereanalyzed by Spearman correlation test.Results The fever duration[12(11,15)d vs.10(8,11)d]and hospitalduration[9(6,11)d vs.6(4,7)d]in RMPP group were significantly longer than those of control group,withsignificant differences(Z=-5.929,P<0.001;Z=-5.949,P<0.001).The incidence of intrapulmonary(48.9%vs.14.5%)and extrapulmonary complications(71.1%vs.33.7%)were both significantly higher thanthose of control group,with significant differences(x=17.734,P<0.001;χ^(2)=16.369,P<0.001).Theneutrophil ratio(t=2.339,P=0.021),CRP(Z=-4.564,P<0.001),D-dimer(Z=-6.024,P<0.001),LDH(Z=-5.535,P<0.001),CXCL9(Z=-2.181,P=0.029),IL-6(Z=-4.2,P<0.001)and IFN-(Z=-3.729,P<0.001)levels in RMPP group were significantly higher than those of control group,all with significantdifferences.Binary Logistic regression analysis showed that fever duration(OR=1.818,95%CI:1.363-2.425,P<0.001)and CXCL9 level(OR=1.002,95%CI:1.000-1.004,P=0.04)were both influencing factors forRMPP.CXCL9 level in peripheral blood was positively correlated with CRP(r=0.179,P=0.044),LDH(r=0.262,P=0.003)and IL-6(r=0.279,P=0.001),which was positively correlated with IFN-level(r=0.441,P<0.001).Conclusions Fever duration,peripheral blood CRP,D-dimer,LDH,IL-6,IFN-and serumCXCL9 levels of children with RMPP increased significantly,and fever duration and serum CXCL9 levelare infuencing factors for RMPP.All the above indicators could be early warning indicators of RMPP,andprovide basis for clinical diagnosis and treatment.