儿童重症肺炎支原体肺炎危险因素的Meta分析  

Risk Factors for Severe Mycoplasma Pneumoniae Pneumonia in Children:a Meta-analysis

作　　者：杨硕[1] 刘新颖 王慧哲 李焕敏 李新民[1] YANG Shuo;LIU Xinying;WANG Huizhe;LI Huanmin;LI Xinmin(Department of Pediatrics,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300000,China)

机构地区：[1]天津中医药大学第一附属医院儿科国家针灸中医临床医学研究中心,天津市300000

出　　处：《中国全科医学》2024年第14期1750-1760,共11页Chinese General Practice

基　　金：国家自然科学基金资助项目(82104931);天津市科技计划项目(21JCZDJC01130)。

摘　　要：背景近年来,儿童肺炎支原体肺炎的发病率持续上升,重症肺炎支原体肺炎的发病人数也相应升高,引起了临床医师的广泛关注。了解与重症肺炎支原体肺炎相关的危险因素,以判断患儿病情的严重程度、预防重症发生和减少后遗症,一直是研究的热点。虽然已经有许多关于重症肺炎支原体肺炎危险因素的研究,但这些研究在时间和地理区域上存在差异,因此需要进行系统综述及分析以对其进行全面了解。目的系统评价重症肺炎支原体肺炎的危险因素。方法计算机检索中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普网(VIP)、中国生物医学文献数据库(CBM)、独秀学术搜索数据库(Duxiu)、中华医学期刊全文数据库(Yiigle)、Cochrane Library、PubMed、Embase、Web of Science、Science Direct和BioMed Central,检索涉及儿童重症肺炎支原体肺炎危险因素的相关研究,检索时限均从建库至2023年8月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 14.0和RevMan 5.4软件进行Meta分析。结果共纳入22个研究,均为回顾性病例对照研究,包括4531例患儿。Meta分析结果显示,C反应蛋白(CRP)(OR=1.92,95%CI=1.72~2.15,P<0.00001)、红细胞沉降率(ESR)(OR=2.61,95%CI=2.12~3.22,P<0.00001)、降钙素原(PCT)(OR=2.60,95%CI=1.43~4.75,P=0.002)、D-二聚体(OR=4.36,95%CI=2.93~6.50,P<0.00001)、白细胞计数(WBC)(OR=1.98,95%CI=1.66~2.36,P<0.00001)、肺下叶病变(OR=5.70,95%CI=3.48~9.35,P<0.00001)、肺大片状病变(OR=6.37,95%CI=4.09~9.92,P<0.00001)、高肺炎支原体抗体滴度(OR=2.83,95%CI=1.78~4.49,P<0.0001)、乳酸脱氢酶(LDH)(OR=1.03,95%CI=1.00~1.05,P=0.05)、发热时间(OR=8.33,95%CI=3.38~20.56,P<0.00001)是儿童重症肺炎支原体肺炎的影响因素。结论炎性标志物(CRP、ESR、PCT、LDH、WBC)的升高、出现影像学特征性改变(大片状实变、下叶病变)、高肺炎支原体抗体滴度、D-二聚体�Background In recent years,the incidence of Mycoplasma pneumoniae pneumonia in children has continued to rise,with a corresponding increase in the number of severe Mycoplasma pneumoniae pneumonia,attracting widespread attention from clinical physicians.Understanding the risk factors associated with severe Mycoplasma pneumoniae pneumonia with the aim to determine the severity of the condition in affected children,prevent the occurrence of severe cases,and reduce sequelae has been a focal point in research.Although numerous studies have been conducted on the risk factors of severe Mycoplasma pneumoniae pneumonia,variations in time and geographical regions of the studies necessitate a systematic review and analysis for a comprehensive understanding.Objective To systematically review the risk factors for severe Mycoplasma pneumoniae pneumonia.Methods CNKI,Wanfang Data,VIP,CBM,Duxiu,Yiigle,Cochrane Library,PubMed,Embase,Web of Science,Science Direct,and BioMed Central were searched for studies related to risk factors of severe Mycoplasma pneumoniae pneumonia in children from inception to August 2023.Two investigators independently screened literature,extracted data,and assessed the bias risk of included studies.Meta-analysis was performed using Stata 14.0 and RevMan 5.4 software.Results A total of 22 retrospective case-control studies involving 4531 childre were included.Metaanalysis showed that C-reactive protein(CRP)(OR=1.92,95%CI=1.72-2.15,P<0.00001),erythrocyte sedimentation rate(ESR)(OR=2.61,95%CI=2.12-3.22),(P<0.00001),procalcitonin(PCT)(OR=2.60,95%CI=1.43-4.75,P=0.002),D-dimer(OR=4.36,95%CI=2.93-6.50,P<0.00001),white blood cell count(WBC)(OR=1.98,95%CI=1.66-2.36,P<0.00001),lower lobe lesions(OR=5.70,95%CI=3.48-9.35,P<0.00001),large patchy lesions(OR=6.37,95%CI=4.09-9.92,P<0.00001),high Mycoplasma pneumoniae antibody titers(OR=2.83,95%CI=1.78-4.49,P<0.0001),lactate dehydrogenase(LDH)(OR=1.03,95%CI=1.00-1.05,P=0.05),and duration of fever(OR=8.33,95%CI=3.38-20.56,P<0.00001)were positively correlated with severe My

关 键 词：肺炎 支原体 儿童 危险因素 META分析 

分 类 号：R563.1[医药卫生—呼吸系统]