儿童难治性肺炎支原体肺炎的危险因素及其预测效能  

Risk factors of children with refractory mycoplasma pneumoniae pneumonia and their predictive value

作　　者：穆世茵 邹映雪[1] 郭永盛[1] 于玫[1] 黄冰 MU Shiyin;ZOU Yingxue;GUO Yongsheng;YU Mei;HUANG Bing(Department of Respiratory,Tianjin Children's Hospital,Tianjin 300074,China)

机构地区：[1]天津市儿童医院,天津大学儿童医院马场院区呼吸科,天津市儿童出生缺陷防治重点实验室,天津300074

出　　处：《山东医药》2024年第23期11-15,共5页Shandong Medical Journal

基　　金：天津市卫生健康科技项目(TJWJ2022QN081);天津市卫健委重点学科专项课题(TJWJ2022XK038);天津市医学重点学科(专科)建设项目(TJYXZDXK-040A)。

摘　　要：目的分析儿童难治性肺炎支原体肺炎(RMPP)的危险因素,并探讨其预测价值。方法选择肺炎支原体肺炎(MPP)患儿244例,根据是否发展为RMPP,将其分为RMPP组47例及普通肺炎支原体肺炎(GMPP)组197例。比较两组的人口统计学信息(性别、年龄),临床表现及体征(热峰、热程、低氧血症、呼吸音减低、合并肺外并发症及塑形性支气管炎),入院24 h内首次实验室指标[血清circ_0054633、白细胞计数(WBC)、中性粒细胞计数(NE)、中性粒细胞与淋巴细胞比值(NLR)、血小板计数(PLT)、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素6(IL-6)、乳酸脱氢酶(LDH)、铁蛋白(FER)、红细胞沉降速率(ESR)、丙氨酸氨基转移酶(ALT)、肌酸激酶同工酶(CK-MB)、D-二聚体(D-D)],影像学特征(肺不张、胸腔积液)。将两组比较差异有统计学意义的因素进行多因素Logistic回归分析,绘制危险因素预测MPP进展为RMPP的受试者工作特征(ROC)曲线,分析其预测价值。结果两组性别、年龄、热峰及WBC、NE、PLT、CRP、PCT、ESR、ALT、CK-MB水平比较差异均无统计学意义(P均>0.05);RMPP组热程长于GMPP组,低氧血症、呼吸音减低、合并肺外并发症、塑形性支气管炎及肺不张、胸腔积液的比例均高于GMPP组,血清circ_0054633、NLR、IL-6、LDH、FER、D-D水平均高于GMPP组(P均<0.05)。多因素Logistic回归分析结果显示,热程(OR=1.499,95%CI:1.243~1.808)、低氧血症(OR=10.638,95%CI:2.747~41.203)、合并肺外并发症(OR=2.948,95%CI:1.174~7.404)、血清circ_0054633(OR=6.283,95%CI:2.729~14.465)、血清IL-6(OR=1.018,95%CI:1.004~1.032)、肺不张(OR=3.157,95%CI:1.246~8.000)均是MPP进展为RMPP的独立影响因素(P均<0.05)。ROC曲线分析结果显示,热程、血清circ_0054633、血清IL-6预测RMPP的临界值分别为9.50 d、3.12、25.98 pg/mL,此时预测RMPP的敏感度分别为76.6%、80.9%、66.0%,特异度分别为73.0%、69.4%、63.8%,曲线下面积分别为0.768、0.802、0.67Objective To analyze the risk factors of refractory mycoplasma pneumoniae pneumonia(RMPP)in chil⁃dren,and to explore their predictive value.Methods Totally 244 children with mycoplasma pneumoniae pneumonia(MPP)were selected.The children were divided into the RMPP group(n=65)and the general mycoplasma pneumoniae pneumonia(GMPP)group(n=197)based on whether they had RMPP.We compared the demographic information(gen⁃der,age),clinical manifestations,and signs(heat peak,heat duration,hypoxemia,decreased auscultatory respiratory sounds in the lungs,concomitant extrapulmonary complications,and plastic bronchitis),primary laboratory indicators within 24 hours of admission[serum circ_0054633,white blood cell count(WBC),neutrophil count(NE),neutrophil/lymphocyte ratio(NLR),platelet count(PLT),C-reactive protein(CRP),procalcitonin(PCT),interleukin 6(IL-6),lactate dehydrogenase(LDH),ferritin(FER),erythrocyte sedimentation rate(ESR),alanine aminotransferase(ALT),creatine kinase-MB(CK-MB),and D-dimer(D-D)],imaging features(atelectasis,pleural effusion).The statistically different data were included in the multivariate Logistic regression model to analyze the influencing factors of RMPP.The predictive value was analyzed by receiver operating characteristic(ROC)curve.Results There were no statistically sig⁃nificant differences in gender,age,heat peak,WBC,NE,PLT,CRP,PCT,ESR,ALT,or CK-MB levels between the two groups(all P>0.05).The duration of fever in the RMPP group was longer than that in the GMPP group.Hypoxemia,decreased respiratory sounds,extrapulmonary complications,plastic bronchitis,atelectasis,and the proportion of pleural effusion were all higher in the RMPP group than those in the GMPP group,and the serum circ-0054633,NLR,IL-6,LDH,FER,and D-D levels were all higher than those in the GMPP group(all P<0.05).The results of multivariate Lo⁃gistic regression analysis showed that fever duration(OR=1.499,95%CI:1.243-1.808),hypoxemia(OR=10.638,95%CI:2.747-41.203),concomitant extrapulmonary complications(OR=2.948,95%CI:1.

关 键 词：难治性肺炎支原体肺炎 circ_0054633 热程 白细胞介素6 儿童 

分 类 号：R725.6[医药卫生—儿科]