学龄前期儿童难治性肺炎支原体肺炎临床特征及危险因素分析  

Clinical characteristics and risk factors of refractory mycoplasma pneumoniae pneumonia in pre-school children

作　　者：梅淑芬[1,2] 张园园 周云连[3] 陈志敏[3] MEI Shufen;ZHANG Yuanyuan;ZHOU Yunlian(Department of Pediatrics,Red Cross Hospital of Hangzhou,Hangzhou 310003,China)

机构地区：[1]杭州市红十字会医院儿科,310003 [2]浙江大学 [3]浙江大学医学院附属儿童医院呼吸科

出　　处：《浙江医学》2018年第11期1202-1205,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生重点科技计划项目(2018268955);浙江省中医药科技计划项目(2018ZA092)

摘　　要：目的分析学龄前期儿童难治性肺炎支原体肺炎(RMPP)的临床特征及危险因素,寻找RMPP的预测指标。方法将189例临床诊断为肺炎支原体肺炎(MPP)的学龄前期患儿,根据病情分为普通肺炎支原体肺炎(GMPP)组135例与RMPP组54例,分析并比较两组患儿的临床资料、实验室检查结果、影像学表现及并发症等,总结RMPP的临床特征及发病的危险因素。结果与GMPP组比较,RMPP组发热时间、住院时间更长,肺外并发症发生率更高,肺部影像学表现更严重,吸氧、入住ICU治疗的比例更高,差异均有统计学意义(均P<0.05)。在实验室指标方面,RMPP组外周血中性粒细胞百分比、C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)以及血清细胞因子IL-6、IL-10、IFN-γ等指标均明显高于GMPP组(均P<0.05)。ROC曲线分析显示,学龄前期MPP患儿中性粒细胞百分比≥64.6%、CRP≥19.5mg/L、PCT≥0.13ng/ml、LDH≥474.5IU/L、IL-6≥20.65pg/ml、IL-10≥5.25pg/ml对鉴别RMPP与GMPP具有重要价值。结论 RMPP患儿的临床表现、肺部影像学表现、实验室检查结果等均较GMPP严重;而中性粒细胞百分比、CRP、PCT、LDH、IL-6、IL-10是学龄前期儿童RMPP的重要预测指标。Objective To analyze the clinical characteristics of refractory mycoplasma pneumoniae pneumonia（RMPP） in pre-school children and its risk factors. Methods Clinical data of 189 pre-school children with mycoplasma pneumoniae pneumonia（MPP）admitted in our monhospital between January 2012 and December 2016 were retrospectively analyzed. Among 189 patients, there were 54 cases of RMPP and 135 cases of general MPP（GMPP）. The clinical characteristics, laboratory tests and imaging findings were compared between the RMPP and GMPP groups; and the risk factors of RMPP were analyzed. Results Compared to GMPP group, patients in RMPP group had more severe clinical symptoms, longer duration of fever, more serious radiological findings, higher incidence of extra-pulmonary complications and longer length of hospital stay, and the patients needed oxygen and ICU therapy more often（P 0.05）. Meanwhile, the percentage of neutrophils（N%）, C-reactive protein（CRP）, procalcitonin（PCT）, lactic dehydrogenase（LDH）, IL-6, IL-10 and IFN-γ levels in RMPP group were significantly higher than those in GMPP group（P〈0.05）. ROC curve analysis showed that N%≥64.6%, CRP≥19.5 mg/L,PCT ≥0.13 ng/ml, LDH ≥474.5 IU/L, IL-6 ≥20.65 pg/ml and IL-10 ≥5.25 pg/ml were of value in differentiating RMPP from GMPP.Conclusion N%, CRP, PCT, LDH, IL-6 and IL-10 can be used to differentiate RMPP from GMPP in pre-school children.

关 键 词：肺炎支原体肺炎 难治性 学龄前期儿童 危险因素 

分 类 号：R725.6[医药卫生—儿科]