肺炎支原体肺炎患儿黏液栓塞的危险因素分析  

Analysis of risk factors of mucus embolism in children with Mycoplasma pneumoniae pneumonia

作　　者：陈琼华[1] 郑敬阳[1] 曾丽娥[1] 林春燕[1] 尤玉婷[1] 林洁如 林印涛[1] CHEN Qionghua;ZHENG Jingyang;ZENG Li′e;LIN Chunyan;YOU Yuting;LIN Jieru;LIN Yintao(Department of Respiratory Diseases,Quanzhou Municipal Children′s Hospital,Fujian Quanzhou 362000,China)

机构地区：[1]泉州市儿童医院呼吸科,福建泉州362000

出　　处：《中国妇幼健康研究》2022年第5期47-52,共6页Chinese Journal of Woman and Child Health Research

基　　金：泉州市卫生健康科研资助项目(泉卫办2019(3)号)。

摘　　要：目的探讨肺炎支原体肺炎(MPP)患儿发生黏液栓塞的危险因素。方法回顾性分析2019年1月至2020年12月在泉州市儿童医院呼吸科住院的214例MPP患儿的临床资料,根据影像学和支气管镜结果分为黏液栓塞组(98例)和对照组(116例),比较两组患儿的临床表现、实验室指标、影像学特征及支气管镜结果等情况,并分析发生黏液栓塞的危险因素,评估黏液栓塞的临界值。结果黏液栓塞组患儿年龄较大(t=-4.877),发热持续时间(Z=-7.908)和住院时间(Z=-10.273)均较长,热峰>40℃发生率较高(χ^(2)=68.628),胸腔积液发生率较高(χ^(2)=35.032),喘息发生率较低(χ^(2)=10.129),差异均有统计学意义(P<0.05)。此外,黏液栓塞较多发生在双下叶支气管,黏液栓塞组的中性粒细胞百分比(NE%)、C反应蛋白(CRP)、D二聚体(DDR)、乳酸脱氢酶(LDH)水平均较高(t值分别为-5.100、-9.368、-5.595、-8.577,P<0.05);白细胞计数(WBC)、血小板(PLT)水平均较低(t值分别为2.820、5.966,P<0.05)。受试者工作(ROC)曲线分析显示,MPP患儿年龄>4.28岁、热程>4.5天、CRP>19.71mg/L、LDH>348.5IU/L时,存在气道内黏液栓塞形成的可能。多因素分析显示,DDR(>0.58mg/L)、CRP(>19.71mg/L)、热峰(>40℃)、热程(>4.5天)均是导致MPP黏液栓塞的独立危险因素(P<0.05)。结论DDR、CRP、热程、热峰均是MPP形成黏液栓塞的独立危险因素,为早期识别MPP患儿发生气道黏液栓塞提供了依据。Objective To investigate risk factors of mucus plugs formation in children with Mycoplasma pneumoniae pneumonia(MPP).Methods The clinical data of 214children with MPP who admitted to Department of Respiratory Diseases,Quanzhou Mu-nicipal Children′s Hospital from January 2019to December 2020were retrospectively analyzed.The children were divided into mu-cus embolism group(n=98)and control group(n=116)according to results of CT imaging examination and bronchoscopic exami-nation.The clinical manifestations,laboratory indexes,CT characteristics and bronchoscopic results of the children were compared between the two groups.The risk factors of mucus embolism of the children were analyzed by Logistic regression analysis.The re-ceiver operating characteristic(ROC)curve was drawn out to evaluate the critical value of mucus embolism.Results Uni-variate anal-ysis showed that the children in the mucus embolism group were older(t=-4.877)and had longer fever duration(Z=-7.908),longer hospital stay(Z=-10.273),higher incidence of fever peak>40℃(χ^(2)=68.628),higher incidence of pleural effusion(χ^(2)=35.032),lower incidence of wheezing(χ^(2)=10.129),and the differences were statistically significant(all P<0.05).In addition,mu-cus embolism mostly occurred in bronchi of the two lower lobes.Neutrophil percentage(NE%),serum levels of C-reactive protein(CRP),D-dimer(DDR)and lactate dehydrogenase(LDH)were higher(t=-5.100,-9.368,-5.595and-8.577respectively,all P<0.05),while white blood cell count(WBC)and platelet count(PLT)were both lower in the mucus embolism group(t=2.820and 5.966respectively,both P<0.05).The ROC curve analysis showed that those children with MPP aged≥4.28years,fe-ver duration≥4.5days,CRP≥19.71mg/L,and LDH≥348.5U/L had more possibility to form intra-airway mucus plugs.The multi-factorial analysis showed DDR>0.58mg/L,CRP>19.71mg/L,fever peak>40℃,fever duration>4.5days were independent risk factors for mucus plugs formation in MPP(all P<0.05).Conclusion The serum levels of DDR and CRP,fever peak,fever

关 键 词：肺炎支原体肺炎 儿童 黏液栓塞 危险因素 

分 类 号：R179[医药卫生—妇幼卫生保健]