儿童重症肺炎支原体肺炎早期预测指标的研究  

Study on early prediction indexes of severe Mycoplasma pneumoniae pneumonia in children

作　　者：陈艳 姚欢迎 王盼 林健楠 王怡 CHEN Yan;YAO Huan-ying;WANG Pan;LIN Jian-nan;WANG Yi(Medical College of Shaoxing College of Arts and Sciences,Shaoxing,Zhejiang 312000,China;不详)

机构地区：[1]绍兴文理学院医学院,浙江绍兴312000 [2]绍兴市人民医院

出　　处：《中国妇幼保健》2024年第2期239-242,共4页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2023KY363)。

摘　　要：目的研究儿童重症肺炎支原体肺炎(MPP)的早期预测指标,为临床早期识别重症MPP提供实验依据。方法选取2022年2月一2023年2月在绍兴市人民医院住院治疗的117例MPP患儿,分为重症组(43例重症MPP患儿)和轻症组(74例轻症MPP患儿)。检测并对比两组的D-二聚体、C-反应蛋白(CRP)、白细胞计数(WBC)、乳酸脱氢酶(LDH)、中性粒细胞/淋巴细胞比值(NLR)、免疫球蛋白水平及肺实变发生率。采用多因素logistic回归分析法分析儿童发生重症MPP的风险因素,采用受试者工作特征曲线(ROC曲线)分析血清D-二聚体、CRP及LDH水平对重症MPP患儿的预测价值。结果重症组患儿D-二聚体、CRP、LDH、NLR水平及肺实变发生率均高于轻症组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示:D-二聚体(OR=9.629,95%CI:1.054~87.926)、CRP(OR=1.089,95%CI:1.007~1.178)、LDH(0R=1.040,95%CI:1.017~1.064)及肺实变发生率(OR=43.245,95%CI:5.466~342.155)是重症MPP的危险因素(均P<0.05)。D-二聚体+CRP+LDH诊断重症MPP的ROC曲线下面积为0.933(95%CI:0.879~0.987),D-二聚体+CRP+LDH+肺实变发生率4项联合检测的R0C曲线下面积为0.959(95%CI:0.918~1.000)。结论D-二聚体、CRP、NLR、LDH水平变化及肺实变发生率对早期预测重症MPP具有重要的参考价值,值得临床推广应用。Objective To study the early prediction indexes of severe Mycoplasma pneumoniae pneumonia(MPP)in children,and provide an experimental basis for early clinical identification of severe MPP.Methods A total of 117 children with MPP hospitalized in Shaoxing People's Hospital from February 2022 to February 2023 were selected,including 43 cases of severe MPP(severe group)and 74 cases of mild MPP(mild group).The levels of D-dimer,C-reactive protein(CRP),white blood cell count(WBC),lactic dehydrogenase(LDH),neutrophil/lymphocyte ratio(NLR),immune globulin,and the incidence rates of pulmonary consolidation were detected and compared between the two groups.Multivariate logistic regression analysis was used to analyze the risk factors of severe MPP in children,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum D-dimer,CRP,and LDH levels for severe MPP in children.Results The levels of D-dimer,CRP,LDH,NLR,and the incidence rate of pulmonary consolidation in severe group were statistically significantly higher than those in mild group(P<0.05).Multivariate logistic regression analysis showed that D-dimer(OR=9.629,95%CI:1.054-87.926),CRP(OR=1.089,95%CI:1.007-1.178),LDH(OR=1.040,95%CI:1.017-1.064),and incidence rate of pulmonary consolidation(OR=43.245,95%CI:5.466-342.155)were risk factors of severe MPP(P<0.05).The area under ROC curve of D-dimer+CRP+LDH in predicting severe MPP was 0.933(95%CI:0.879-0.987),the area under ROC curve of D-dimer+CRP+LDH+incidence rate of pulmonary consolidation in predicting severe MPP was 0.959(95%CI:0.918-1.000).Conclusion The changes of D-dimer,CRP,NLR,LDH levels and the incidence rate of pulmonary consolidation have important reference value for early prediction of severe MPP,which is worthy of clinical application.

关 键 词：重症肺炎支原体肺炎 C-反应蛋白 乳酸脱氢酶 中性粒细胞/淋巴细胞比值 肺实变 D-二聚体 

分 类 号：R725.6[医药卫生—儿科]