血清分泌型磷脂酶A2与肺炎支原体肺炎患儿疾病严重程度的关系  

Relationship between serum secreted phospholipase A2 and disease severity in children with Mycoplasma pneumoniae pneumonia

作　　者：丁妞[1] 陈艳萍[1] 吴碧琛[1] 罗淑娟[1] Ding Niu;Chen Yanping;Wu Bichen;Luo Shujuan(Department of Respiratory Medicine,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院呼吸内科,长沙410007

出　　处：《中国医药》2022年第2期204-208,共5页China Medicine

基　　金：湖南省科技创新计划项目(2017SK50705);湖南省卫生和计划生育委员会科研课题(132015-128)。

摘　　要：目的探讨血清分泌型磷脂酶A2(sPLA2)与肺炎支原体肺炎(MPP)患儿疾病严重程度的关系。方法回顾性分析2018年2月至2021年2月湖南省儿童医院收治的256例MPP患儿的病历资料,根据患儿疾病程度分为重症组(136例)和轻症组(120例)。比较2组患儿的实验室检查指标,采用多因素Logistic回归模型分析影响MPP患儿疾病严重程度的危险因素,采用受试者工作特征(ROC)曲线评价各指标对MPP患儿疾病严重程度的判断价值。结果重症组sPLA2、白细胞计数、红细胞沉降率、纤维蛋白原、乳酸脱氢酶(LDH)、血小板计数(PLT)、中性粒细胞计数(NEU)、C反应蛋白(CRP)水平均高于轻症组,差异均有统计学意义(均P<0.001)。多因素Logistic回归分析结果显示sPLA2、LDH、PLT、NEU、CRP均为重症MPP的独立危险因素(均P<0.05)。ROC曲线分析结果显示,sPLA2预测重症MPP的曲线下面积为0.892(95%置信区间:0.831~0.907,P<0.001),截断值为35.39μg/L,敏感度为81.9%,特异度为88.2%。恢复期气管、支气管内膜炎症患儿血清sPLA2水平低于亚支气管狭窄、通气不良及闭塞患儿[(33±6)μg/L比(47±10)μg/L],差异有统计学意义(P<0.001)。结论血清sPLA2水平可作为判断MPP患儿病情严重程度及预后的指标之一,sPLA2水平越高,患儿病情越重,预后越差。Objective To investigate the relationship between serum secreted phospholipase A2(sPLA2) and disease severity in children with Mycoplasma pneumoniae pneumonia(MPP). Methods The medical data of 256 children with MPP admitted to Hunan Children′s Hospital from February 2018 to February 2021 were retrospectively analyzed. According to their disease severities, they were divided into severe group(136 cases) and mild group(120 cases). The laboratory indexes of the two groups were compared. Multivariate Logistic regression model was used to analyze the risk factors affecting diseases severity in patients with MPP. The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of the indexes in diseases severity in patients with MPP. Results The levels of sPLA2, white blood cell count, erythrocyte sedimentation rate, fibrinogen, lactate dehydrogenase(LDH), platelet count(PLT), neutrophil count(NEU) and C-reactive protein(CRP) in the severe group were higher than those in the mild group, and the differences were statistically significant(all P<0.001). Multivariate Logistic regression analysis showed that sPLA2, LDH, PLT, NEU and CRP were independent risk factors of severe MPP(all P<0.001). The ROC curve analysis showed that the area under the curve of sPLA2 in predicting severe MPP was 0.892(95% confidence interval: 0.831-0.907, P<0.001), the cut-off value was 35.39 μg/L, the sensitivity was 81.9% and the specificity was 88.2%. The level of serum sPLA2 in children with intimal inflammation of trachea and bronchus during convalescence was lower than that in children with subbronchial stenosis, malventilation and occlusion[(33±6)μg/L vs(47±10)μg/L](P<0.001). Conclusion Serum sPLA2 level can be used as one of indicators to determine the disease severity and prognosis in children with MPP, the higher the level of sPLA2, the worse the condition and prognosis.

关 键 词：肺炎支原体肺炎 血清分泌型磷脂酶A2 疾病严重程度 

分 类 号：R725.6[医药卫生—儿科]