不同病原感染肺炎患儿发生气道黏液高分泌状态的危险因素分析  

Clinical characteristics and risk factors for bronchoscopic airway mucus hypersecretion in childhood pneumonia infected by different pathogens

作　　者：蔡江瑜 晏春愉 王晓晴 罗征秀[1] 罗健[1] 李渠北[1] 刘恩梅[1] 邓昱[1] Cai Jiangyu;Yan Chunyu;Wang Xiaoqing;Luo Zhengxiu;Luo Jian;Li Qubei;Liu Enmei;Deng Yu(Department of Respiratory Medicine,Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,National International Science and Technology Cooperation Base for Major Diseases of Child Development,Chongqing Key Laboratory of Child Infection and Immunity,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院呼吸科、国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿童发育重大疾病国家国际科技合作基地、儿童感染免疫重庆市重点实验室,重庆400014

出　　处：《中华儿科杂志》2023年第8期719-725,共7页Chinese Journal of Pediatrics

基　　金：国家重点研发计划(2022YFC2704900);重庆市自然科学基金(cstc2019jcyj-msxmX0858);重庆市人力资源和社会保障局留学人员回国创业创新支持计划(cx2019068);重庆市教育委员会科学技术研究计划(KJQN202000431);重庆市科卫联合医学科研项目(2020FYYX086);重庆医科大学未来医学青年创新团队支持计划。

摘　　要：目的探讨不同病原感染的肺炎患儿发生气道黏液高分泌状态的危险因素。方法回顾性队列研究。收集2019年1月至2021年12月在重庆医科大学附属儿童医院呼吸科因肺炎支原体肺炎(MPP)、呼吸道合胞病毒(RSV)肺炎、腺病毒肺炎住院并行支气管镜检查的968例患儿临床资料。对支气管镜下黏液分泌情况进行评分,并分为气道黏液高分泌组和非高分泌组,分别比较3种病原感染肺炎患儿两组的人口学特征、临床特征、实验室检查、疾病严重度,分析其发生气道黏液高分泌状态的危险因素。应用χ2检验、Mann-Whithey U检验、Fisher确切概率法分析组间差异,多因素Logistic回归分析影响因素。结果968例患儿中男559例、女409例,就诊年龄4.0(1.4,6.0)岁。642例MPP患儿中高分泌组185例、非高分泌组457例;201例RSV肺炎患儿中高分泌组41例、非高分泌组160例;125例腺病毒肺炎患儿中高分泌组39例、非高分泌组86例。MPP、RSV、腺病毒3种病原感染的肺炎患儿高分泌组就诊年龄均大于非高分泌组[6.0(4.0,7.0)比5.0(3.0,7.0)岁、1.5(0.5,3.6)比0.8(0.4,1.6)岁、2.0(1.2,4.5)比1.3(0.8,2.0)岁,U=35295.00、2492.00、1101.00,均P<0.05]。多因素Logistic回归分析显示,外周血白细胞计数升高(OR=3.30,95%CI 1.51~7.93,P=0.004)、中性粒细胞比例升高(OR=2.24,95%CI 1.16~4.33,P=0.016)、淋巴细胞计数降低(OR=3.22,95%CI 1.66~6.31,P<0.001)、血清白蛋白降低(OR=2.00,95%CI 1.01~3.98,P=0.047)的MPP患儿发生气道黏液高分泌的风险增加;外周血嗜酸粒细胞升高(OR=3.04,95%CI 1.02~8.93,P=0.043)的RSV肺炎患儿发生气道黏液高分泌的风险增加,气道黏液高分泌与重症肺炎相关(OR=2.46,95%CI 1.03~6.15,P=0.047);年龄较大(OR=1.02,95%CI 1.00~1.04,P=0.026)、肺部听诊闻及啰音、哮鸣音或痰鸣音(OR=3.65,95%CI 1.22~12.64,P=0.028)的腺病毒肺炎患儿发生气道黏液高分泌的风险均增加。MPP患儿中高分泌组支气管肺泡灌洗�ObjectiveTo investigate the risk factors for airway mucus hypersecretion in childhood pneumonia infected by different pathogens.MethodA retrospective cohort included 968 children who were hospitalized for Mycoplasma pneumoniae pneumonia(MPP),respiratory syncytial virus(RSV)pneumonia,adenovirus pneumonia and underwent bronchoscopy in Respiratory Department of Children′s Hospital of Chongqing Medical University from January 2019 to December 2021 was conducted.The children were divided into two groups distinguished by airway mucus secretion according to the airway mucus hypersecretion score which were scored according to the mucus secretion under the bronchoscope.The demographic characteristics,clinical characteristics,laboratory tests and disease severity of the two groups were compared.And the risk factors for the development of airway mucus hypersecretion in two groups were analyzed.Chi square test,Mann-WhitheyU test and Fisher exact test were used to analyze the differences between the two groups,and multivariate Logistic regression was used to analyze the influencing factors.ResultThere were 559 males and 409 females in the 968 children,with an age of 4.0(1.4,6.0)years.Among the 642 children with MPP,185 cases were in the hypersecretion group and 457 cases were in the non-hypersecretion group.There were 41 cases in the hypersecretion group and 160 cases in the non-hypersecretion group of 201 children with RSV pneumonia.In the 125 children with adenovirus pneumonia,there were 39 cases in the hypersecretion group and 86 cases in the non-hypersecretion group.In these children,the age of children in the hypersecretion group was older than that in the non-hypersecretion group(6.0(4.0,7.0)vs.5.0(3.0,7.0)years old,1.5(0.5,3.6)vs.0.8(0.4,1.6)years old,2.0(1.2,4.5)vs.1.3(0.8,2.0)years old,U=35295.00,2492.00,1101.00,all P<0.05).Through multivariate Logistic regression analysis it found that increased risk of airway mucus hypersecretion was present in childhood MPP with increase in peripheral blood white blood cell coun

关 键 词：肺炎 支原体 呼吸道合胞病毒 腺病毒 人 呼吸道感染 黏液 

分 类 号：R725.6[医药卫生—儿科]