麻疹患儿合并重症肺炎的危险因素分析  

Analysis of risk factors in children with measles and severe pneumonia

作　　者：郝晶 曾静霞 HAO Jing;ZENG Jing-xia(Emergency Department,Children’s Hospital of Nanjing Medical University,Nanjing,China 210008)

机构地区：[1]南京医科大学附属儿童医院急诊科

出　　处：《中国病原生物学杂志》2019年第11期1346-1350,共5页Journal of Pathogen Biology

摘　　要：目的研究麻疹患儿合并重症肺炎的危险因素,分析不同指标预测重症肺炎的价值。方法回顾性分析本院2016年12月-2018年6月收治70例麻疹患儿的临床资料,分成重症肺炎组13例,非重症肺炎组57例,采用单因素及多因素Logistic回归分析合并重症肺炎的危险因素,并将血清CRP、白蛋白及CRP/白蛋白比值对重症肺炎患儿进行受试者工作曲线(Receiver operating characteristic curves,ROC)分析。结果重症肺炎组患儿病后出疹时间,住院时间,合并喉炎,脓毒症,急性呼吸窘迫综合征比例,血CRP水平较非重症肺炎组增高,血淋巴细胞比例及白蛋白水平低于非重症肺炎组。多因素Logistic回归分析提示合并脓毒症,血清CRP增高,白蛋白降低是麻疹患儿并发重症肺炎的独立危险因素。ROC曲线分析提示CRP、白蛋白及CRP/白蛋白的曲线下面积(area under the curve,AUC)分别为0.749、0.823和0.797,CRP取24.5 mg/L为截点,灵敏度和特异度为62.9%、70.6%;白蛋白取33.5 g/L为截点,灵敏度和特异度为73.3%、80.0%;CRP/白蛋白取0.385为截点,灵敏度和特异度为79.2%、74.0%。病原学检查:病毒共计检出12株,其中呼吸道合胞病毒5株,副流感病毒5株,腺病毒2株。病原菌共计检出31株,其中革兰阳性菌9株,革兰阴性菌22株。结论合并脓毒症、血CRP增高,白蛋白降低的麻疹患儿合并重症肺炎风险增加。CRP、白蛋白和CRP/白蛋白比值对合并重症肺炎患儿的评估预测有一定价值。Objective To explore the risk factors for measles and severe pneumonia in children and to evaluate the role of different indicators in predicting the development of severe pneumonia.Methods Clinical data on 70 children with measles seen at the Children’s Hospital of Nanjing Medical University from December 2016 to June 2018 were retrospectively analyzed.Children were divided into those with severe pneumonia(13 patients)and those without severe pneumonia(57 patients)depending on whether or not they had severe pneumonia.Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors for measles and severe pneumonia.Serum CRP,albumin levels,and the CRP/albumin ratio were analyzed with ROC curves to explore their predictive value.Results The timing of a rash after illness was later,the duration of hospitalization was longer,the incidence of laryngitis,sepsis,and ARDS was higher,and serum CRP levels were and the percentage of blood lymphocytes and serum albumin levels were lower in pediatric patients with severe pneumonia.Multivariate logistic regression analysis indicated that having sepsis,increased CRP levels,and decreased albumin levels were the major risk factors for measles and severe pneumonia.ROC curves indicated the area under the curve was 0.749 for CRP,0.823 for albumin,and 0.797 for the CRP/albumin ratio(P<0.05).When the cut-off for CRP was 24.5 mg/L,its sensitivity and specificity were 62.9%and 70.6%,respectively.When the cut-off for albumin was 33.5 g/L,its sensitivity and specificity were 73.3%and 80.0%,respectively.When the cut-off for the CRP/albumin ratio was 0.385,its sensitivity and specificity were 79.2%and 74.0%,respectively.Pathogenic examination:A total of 12 strains of viruses were detected,including 5 respiratory syncytial viruses,5 parainfluenza viruses,and 2 adenoviruses.A total of 31 strains of pathogenic bacteria were detected,including 9 strains of Gram-positive bacteria and 22 strains of Gram-negative bacteria.Conclusion Having sepsis,increased

关 键 词：麻疹 重症肺炎 危险因素 治疗 儿童 

分 类 号：R511.1[医药卫生—内科学]