儿童难治性肺炎支原体肺炎早期识别的多中心前瞻性研究  

A multicenter prospective study on early identification of refractory Mycoplasma pneumoniae pneumonia in children

作　　者：徐丹[1] 章爱莲 郑吉善[3] 叶明伟 郦凡[5] 钱根才 施红波 金小红[8] 黄烈平 梅建刚 梅国花 徐震[12] 傅红[13] 林建军[14] 叶洪舟[15] 郑燕 华玲玲[3] 杨敏 童江民 陈玲玲[8] 张园园[1] 杨德华[1] 周云连[1] 李慧文 蓝引乐[1] 徐玉兰 冯金燕[10] 陈幸[12] 龚敏[16] 陈志敏[1] 王颖硕[1] Xu Dan;Zhang Ailian;Zheng Jishan;Ye Mingwei;Li Fan;Qian Gencai;Shi Hongbo;Jin Xiaohong;Huang Lieping;Mei Jiangang;Mei Guohua;Xu Zhen;Fu Hong;Lin Jianjun;Ye Hongzhou;Zheng Yan;Hua Lingling;Yang Min;Tong Jiangmin;Chen Lingling;Zhang Yuanyuan;Yang Dehua;Zhou Yunlian;Li Huiwen;Lan Yinle;Xu Yulan;Feng Jinyan;Chen Xing;Gong Min;Chen Zhimin;Wang Yingshuo(Department of Pulmonology,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China;Department of Pediatrics,the Second Hospital of Jiaxing,Jiaxing 314001,China;Department of Pediatrics,Ningbo Women and Children's Hospital,Ningbo 315012,China;Department of Pediatrics,Sanmen People's Hospital,Taizhou 317199,China;Department of Pediatrics,Shaoxing Second Hospital,Shaoxing 312099,China;Department of Pediatrics,Changxing Maternal and Child Health Care Hospital,Huzhou 313199,China;Department of Pediatrics,Ningbo Medical Center Lihuili Hospital,Ningbo 315048,China;Department of Pediatrics,Taizhou Hospital of Zhejiang Province,Taizhou 317099,China;Department of Pediatrics,Zhoushan Women and Children's Hospital,Zhoushan 316004,China;Department of Pediatrics,Cixi Maternal and Child Health Care Hospital,Ningbo 315331,China;Department of Pediatrics,Quzhou Maternal and Child Health Care Hospital,Quzhou 324003,China;Department of Pediatrics,Huzhou Central Hospital,Huzhou 313099,China;Department of Pediatrics,Shengsi People's Hospital,Zhoushan 202450,China;Department of Pediatrics,Lishui City People's Hospital,Lishui 323050,China;Department of Pediatrics,the First People's Hospital of Huzhou,Huzhou 313099,China;Department of Pediatrics,People's Hospital of Quzhou,Quzhou 324002,China)

机构地区：[1]浙江大学医学院附属儿童医院呼吸内科,国家儿童健康与疾病临床医学研究中心,杭州310052 [2]嘉兴市第二医院儿科,嘉兴314001 [3]宁波市妇女儿童医院儿科,宁波315012 [4]三门县人民医院儿科,台州317199 [5]绍兴第二医院儿科,绍兴312099 [6]长兴县妇幼保健院儿科,湖州313199 [7]宁波市医疗中心李惠利医院儿科,宁波315048 [8]浙江省台州医院儿科,台州317099 [9]舟山市妇女儿童医院儿科,舟山316004 [10]慈溪市妇幼保健院儿科,宁波315331 [11]衢州市妇幼保健院儿科,衢州324003 [12]湖州市中心医院儿科,湖州313099 [13]嵊泗县人民医院儿科,舟山202450 [14]丽水市人民医院儿科,丽水323050 [15]湖州市第一人民医院儿科,湖州313099 [16]衢州市人民医院儿科,衢州324002

出　　处：《中华儿科杂志》2024年第4期317-322,共6页Chinese Journal of Pediatrics

基　　金：国家儿童健康与疾病临床医学研究中心自主设计项目重点项目(G20B0003);浙江省教育厅一般科研项目(Y202249224)。

摘　　要：目的探索早期预测儿童难治性肺炎支原体肺炎(RMPP)的方法。方法前瞻性多中心研究,收集2019年5月1日至2020年1月31日在浙江13家医院就诊的1428例发热>48~<120 h患儿的临床资料,采集咽拭子检测肺炎支原体DNA,检测阳性者行胸部X线片、血常规、C反应蛋白、乳酸脱氢酶(LDH)和前降钙素等检测。根据随访时病情发展情况,将患儿分为RMPP组和普通肺炎支原体肺炎(GMPP)组。组间比较采用Mann-Whitney U检验。Logistic回归分析影响RMPP的相关因素,建立RMPP预报概率π的回归模型,受试者工作特征曲线分析预测RMPP的诊断价值。结果1428例患儿中男801例、女627例,年龄4.3(2.7,6.3)岁,肺炎支原体DNA阳性534例(37.4%),其中446例(83.5%)诊断为肺炎支原体肺炎。446例肺炎支原体肺炎患儿中男251例、女195例,就诊年龄5.2(3.3,6.9)岁。大环内酯类抗菌药物耐药性变异位点检测阳性410例(91.9%)。RMPP组55例、GMPP组391例。RMPP组第1次就诊前的峰值体温与乳酸脱氢酶(LDH)水平均高于GMPP组[39.6(39.1,40.0)比39.2(38.9,39.7)℃、333(279,392)比311(259,359)U/L,均P<0.05]。Logistic回归示RMPP的预报概率π=exp[-29.7+0.667×最高体温(℃)+0.004×LDH(U/L)]/{1+exp[-29.7+0.667×最高体温(℃)+0.004×LDH(U/L)]},截断值为0.12,预报一致性为0.89,灵敏度0.89,特异度0.67。预报概率π的受试者工作特性曲线下面积为0.682(95%CI 0.593~0.771,P<0.01)。结论发热>48~<120 h的肺炎支原体肺炎患儿,可根据首次就诊前的最高体温和LDH水平计算RMPP的预报概率,以期达到早期预测RMPP的目的。Objective To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia(RMPP)in early stage.Methods The prospective multicenter study was conducted in Zhejiang,China from May 1st,2019 to January 31st,2020.A total of 1428 patients with fever>48 hours to<120 hours were studied.Their clinical data and oral pharyngeal swab samples were collected;Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected.Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests,including chest X-ray,complete blood count,C-reactive protein,lactate dehydrogenase(LDH),and procalcitonin.According to the occurrence of RMPP,the patients were divided into two groups,RMPP group and general Mycoplasma pneumoniae pneumonia(GMPP)group.Measurement data between the 2 groups were compared using Mann-Whitney U test.Logistic regression analyses were used to examine the associations between clinical data and RMPP.Receiver operating characteristic(ROC)curves were used to analyse the power of the markers for predicting RMPP.Results A total of 1428 patients finished the study,with 801 boys and 627 girls,aged 4.3(2.7,6.3)years.Mycoplasma pneumoniae DNA was positive in 534 cases(37.4%),of whom 446 cases(83.5%)were diagnosed with Mycoplasma pneumoniae pneumonia,including 251 boys and 195 girls,aged 5.2(3.3,6.9)years.Macrolides-resistant variation was positive in 410 cases(91.9%).Fifty-five cases were with RMPP,391 cases with GMPP.The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients(39.6(39.1,40.0)vs.39.2(38.9,39.7)℃,333(279,392)vs.311(259,359)U/L,both P<0.05).Logistic regression showed the prediction probabilityπ=exp(-29.7+0.667×Peak body temperature(℃)+0.004×LDH(U/L))/(1+exp(-29.7+0.667×Peak body temperature(℃)+0.004×LDH(U/L))),the cut-off value to predict RMPP was 0.12,with a consensus of probability forecast of 0.89,sensitivity of 0.89,and specificity of 0.67;and the area under ROC curve was 0.682(95%CI 0.593-0.771,P<0.01).Con

关 键 词：支原体 肺炎 肺炎 预测 儿童 

分 类 号：R725.6[医药卫生—儿科]