儿童肺炎支原体肺炎合并气道黏液栓的临床特点及危险因素分析  

Clinical characteristics and risk factors of Mycoplasma pneumoniae pneumonia with airway mucus plugs in children

作　　者：石苗苗[1] 王玉[1] 杨泽玉[1] 梁磊[1] SHI Miaomiao;WANG Yu;YANG Zeyu;LIANG Lei(The Third Respiratory Department of Children′s Hospital Affiliated of Anhui Medical University, Hefei 230051, China)

机构地区：[1]安徽医科大学附属省儿童医院呼吸三科,合肥230051

出　　处：《新疆医科大学学报》2020年第9期1213-1217,共5页Journal of Xinjiang Medical University

基　　金：安徽医科大学科学研究基金(2019xkj181);安徽省卫生计生委科研计划项目(2017ek009)。

摘　　要：目的了解儿童肺炎支原体肺炎(MPP)合并支气管黏液栓临床特点,探讨其气道黏液栓形成的危险因素。方法回顾性调查2018年1月-2019年11月安徽医科大学附属省儿童医院呼吸三科收治的行电子支气管镜检查及术中行灌洗治疗的165例MPP患儿的临床资料,根据患儿电子气管镜检查气道有无黏液栓形成,分为黏液栓组(79例)和对照组(86例)。对MPP患儿气道黏液栓形成的危险因素先进行单因素分析,对单因素结果有统计学差异的可能危险因素纳入多因素Logistic回归分析。结果研究显示MPP支气管镜下表现黏膜充血水肿、纵行皱襞、颗粒状凸起、滤泡增生、糜烂坏死及管腔开口处炎性狭窄。黏液栓组79例均可见一个及以上支气管亚段黏液栓阻塞,经1~5次灌洗后支气管黏液栓清除,灌洗效果不佳者需使用异物钳或细胞刷清除黏液栓。单因素分析结果显示黏液栓组年龄、住院费用、住院天数、热程、白细胞(WBC)、C反应蛋白(CRP)、D-二聚体、乳酸脱氢酶(LDH)、混合感染、合并胸腔积液、肺不张及电子支气管镜灌洗治疗次数均高于对照组,差异有统计学意义(P均<0.05)。多因素Logistic回归分析显示年龄≥6岁(χ^2=5.900,P=0.015)、D-二聚体≥0.9 mg/L(χ^2=6.780,P=0.009)、肺不张(χ^2=5.140,P=0.023)是MPP患儿气道黏液栓形成的独立危险因素。结论当MPP患儿年龄≥6岁,D-二聚体≥0.9 mg/L,影像学出现肺不张时,有气道内黏液栓形成的可能;MPP患儿气道黏液栓形成导致患儿住院时间延长,增加患儿家庭经济负担。Objective To investigate the clinical characteristics of bronchial mucus plugs and the risk factors of airway mucus plugs in patients with Mycoplasma pneumoniae pneumonia(MPP).Methods A retrospective analysis of clinical data of 165 patients with MPP treated by electronic bronchoscopy and intraoperative lavage in the Third Respiratory Department of Children′s Hospital Affiliated to Anhui Medical University from January 2018 to November 2019 was conducted.According to the tracheal results of electronic bronchoscopy,they were divided into two groups,mucus suppository group(79 cases)and control group(86 cases).The risk factors of airway mucus plug formation in children with MPP were analyzed by single factor analysis,and the possible risk factors with statistical difference in single factor results were included in Logistic regression analysis.Results The bronchoscopic manifestation of patients with MPP showed hyperemia and edema of mucosa,longitudinal folds,granular bulge,follicular hyperplasia,mucosal erosion and necrosis and inflammatory stenosis of lumen.In the mucus plugs group showed that one or more subsegmental mucus thrombus were blocked.After 1-5 times of lavage,the mucus plugs was removed.In case of serious blockage,the mucus plugs should be removed by brush or foreign body forceps.Univariate analysis showed that the age,hospitalization cost,hospitalization days,total heat course,WBC,CRP,D-dimer,LDH,mixed infection,pleural effusion,atelectasis ratio and the number of times of electronic bronchoscopy in mucus plugs group were significantly higher than those in the control group with statistical significance(P<0.05).Multivariate logistic regression analysis showed that age≥6 year-old(χ^2=5.900,P=0.015),D-dimer≥0.9 mg/L(χ^2=6.780,P=0.009),atelectasis(χ^2=5.140,P=0.023)were an independent risk factors for airway mucus formation in patients with MPP.Conclusion When the age of patients with MPP≥6 year-old,D-dimer≥0.9 mg/L,and imaging findings show atelectasis,there is a possibility of the formation

关 键 词：肺炎支原体肺炎 气道黏液栓 电子支气管镜 儿童 危险因素 

分 类 号：R725.6[医药卫生—儿科]