儿童重症肺炎支原体肺炎的临床表型分析  

Clinical phenotyping of severe Mycoplasma pneumoniae pneumonia in children

作　　者：王亨 徐玮涵 刘金荣[1] 彭芸[2] 彭晓霞[3] 温潇慧 唐晓蕾[1] 徐慧[1] 刘辉[1] 申月琳[1] 张晓艳[1] 杨海明[1] 彭亚光[3] 李惠民[1] 赵顺英[1] Wang Heng;Xu Weihan;Liu Jinrong;Peng Yun;Peng Xiaoxia;Wen Xiaohui;Tang Xiaolei;Xu Hui;Liu Hui;Shen Yuelin;Zhang Xiaoyan;Yang Haiming;Peng Yaguang;Li Huimin;Zhao Shunying(DepartmentⅡof Respiratory Center,National Clinical Research Center for Respiratory Diseases,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Radiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Center for Clinical and Epidemiology and Evidence-Based Medicine,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院呼吸中心临床部二病区,北京100045 [2]国家儿童医学中心、首都医科大学附属北京儿童医院放射科,北京100045 [3]国家儿童医学中心、首都医科大学附属北京儿童医院临床流行病与循证医学中心,北京100045

出　　处：《中华儿科杂志》2024年第7期669-675,共7页Chinese Journal of Pediatrics

基　　金：国家呼吸系统疾病临床医学研究中心呼吸专项(HXZX-202103);北京市医院管理中心重点医学专业发展“扬帆”计划(ZYLX202118)。

摘　　要：目的总结临床和影像学等不同表现的儿童重症肺炎支原体肺炎(MPP)的临床表型。方法回顾性队列研究。纳入2016年1月至2023年10月在首都医科大学附属北京儿童医院呼吸中心临床部二病区住院的505例MPP患儿的临床、影像学和实验室数据等资料。根据是否遗留下气道闭塞分为重症和非重症组,分析组间的临床和影像学特征;根据重症组影像学表现为单个肺叶≥2/3的肺实变(大叶实变)的患儿是否发生肺组织坏死分为肺组织坏死亚型及肺组织未坏死亚型,比较两个亚型的临床表现、支气管镜下表现和全血C反应蛋白(CRP)等炎症指标。组间比较采用独立样本t检验、非参数检验或χ^(2)检验。对两个亚型的CRP等炎症指标进行单因素受试者工作特征(ROC)曲线分析。结果505例MPP患儿中,男254例、女251例,起病年龄(8.2±2.9)岁。重症组233例,其中影像学表现为大叶实变206例,弥漫性细支气管炎27例;非重症组272例,影像学表现均有斑片、云絮影或单个肺叶<2/3的不均匀实变或局限性细支气管炎。206例大叶实变患儿中,肺组织坏死亚型88例、肺组织未坏死亚型118例;持续高热206例(100.0%),支气管镜下存在炎性分泌物阻塞和塑形性支气管炎203例(98.5%)。88例肺组织坏死亚型中呼吸困难42例(47.7%),合并中-大量胸腔积液39例(44.3%),病程中明确合并肺栓塞35例(39.8%),另有34例(38.6%)高度可疑,支气管镜下可见气道较为广泛的黏膜坏死46例(52.3%);肺组织坏死亚型的全血CRP水平高于肺组织未坏死亚型[131.5(91.0,180.0)比25.5(12.0,43.1)mg/L,U=334.00,P<0.001],称为"肺实变-不张-坏死型"。118例肺组织未坏死亚型中呼吸困难27例(22.9%),中-大量胸腔积液0例,支气管镜下可见塑形性支气管炎65例(55.1%),可见气道黏膜少量坏死32例(27.1%),称为"肺实变-不张型"。ROC曲线分析示病程第6~10天的全血CRP 67.5 mg/L对于在大叶实变患儿中识别出"Objective To investigate and summarize pediatric patients with severe Mycoplasma pneumoniae pneumonia(MPP)presenting with varied clinical and chest imaging features in order to guide the individualized treatment.Methods This was a retrospective cohort study.Medical records of clinical,imaging and laboratory data of 505 patients with MPP who were admitted to the DepartmentⅡof Respirology Center,Beijing Children′s Hospital,Capital Medical University from January 2016 to October 2023 and met the enrollment criteria were included.They were divided into severe group and non-severe group according to whether lower airway obliterans was developed.The clinical and chest imaging features of the two groups were analyzed.Those severe cases with single lobe≥2/3 consolidation(lobar consolidation)were further divided into subtype lung-necrosis and subtype non-lung-necrosis based on whether lung necrosis was developed.Comparison on the clinical manifestations,bronchoscopic findings,whole blood C-reactive protein(CRP)and other inflammatory indicators between the two subtypes was performed.Comparisons between two groups were achieved using independent-sample t-test,nonparametric test or chi-square test.Univariate receiver operating characteristic(ROC)curve analyses were performed on the indicators such as CRP of the two subtypes.Results Of the 505 cases,254 were male and 251 were female.The age of the onset was(8.2±2.9)years.There were 233 severe cases,among whom 206 were with lobar consolidation and 27 with diffuse bronchiolitis.The other 272 belonged to non-severe cases,with patchy,cloudy infiltrations or single lobe<2/3 uneven consolidation or localized bronchiolitis.Of the 206 cases(88.4%)severe cases with lobar consolidation,88 harbored subtype lung-necrosis and 118 harbored subtype non-lung-necrosis.All 206 cases(100.0%)presented with persistent high fever,among whom 203 cases(98.5%)presented with inflammatory secretion obstruction and plastic bronchitis under bronchoscopy.Of those 88 cases with subtype lung-necrosis

关 键 词：儿童 肺炎支原体肺炎 重症 表型 下气道闭塞 

分 类 号：R725.6[医药卫生—儿科]