儿童重症肺炎支原体肺炎并发胸腔积液的危险因素及预测标志物分析  

Risk factors for severe Mycoplasma pneumoniae pneumonia complicated with pleural effusion in children and analysis of predictive markers

作　　者：袁超 祁莹祥 YUAN Chao;QI Yingxiang(Department of Pediatrics,Fourth People's Hospital of Langfang City,Langfang,Hebei 065700,China;Operating Room,Fourth People's Hospital of Langfang City,Langfang,Hebei 065700,China)

机构地区：[1]廊坊市第四人民医院儿科,河北廊坊065700 [2]廊坊市第四人民医院手术室,河北廊坊065700

出　　处：《热带医学杂志》2024年第7期998-1002,1007,F0003,共7页Journal of Tropical Medicine

基　　金：河北省重点科技研究计划项目(20230381);廊坊市科学技术研究与发展计划(2023013025)。

摘　　要：目的探讨儿童重症肺炎支原体肺炎(SMPP)并发胸腔积液的危险因素及预测标志物,为临床早期诊断并及时干预提供依据。方法选取2018年1月-2023年10月廊坊市第四人民医院确诊的SMPP患儿121例。根据住院期间胸部彩色超声检查是否出现胸腔积液,将患儿分为并发胸腔积液组(n=53)和未并发胸腔积液组(n=68)。比较两组患儿临床资料及实验室检查指标[中性粒细胞百分比(NEUT%)、C反应蛋白(CRP)、降钙素原(PCT)、α1-酸性糖蛋白(α1⁃AG)、红细胞沉降率(ESR)、D-二聚体(D⁃D)、乳酸脱氢酶(LDH)、白蛋白(ALB)、血糖(Glu)],采用Pearson相关分析法分析预测指标与胸腔积液发生的相关性,采用多因素logistic回归分析影响胸腔积液发生的危险因素,采用受试者工作特征(ROC)曲线评估各指标的预测价值。结果并发胸腔积液组年龄、发热天数、住院天数、肺不张和肺外损害发生率、NEUT%、CRP、α1⁃AG、ESR、D⁃D、LDH、ALB、LDH/ALB、糖皮质激素使用率、阿奇霉素起效时间高于未并发胸腔积液组,24 h降钙素原清除率(24 h PCTc)低于未并发胸腔积液组,差异均有统计学意义(χ^(2)/t/Z=6.771、6.383、3.970、3.810、9.062、6.546、20.911、4.509、7.901、10.178、8.515、6.358、9.283、39.207、6.103、8.910,P均<0.05)。α1⁃AG、LDH/ALB、24 h PCTc为混杂因素校正后SMPP患儿发生胸腔积液的危险因素(P均<0.05)。α1⁃AG、LDH/ALB、24 h PCTc及以上指标协同预测SMPP患儿发生胸腔积液的曲线下面积(AUC)为0.853、0.759、0.668和0.912,协同预测的效能最高(Z=5.003、6.245、6.491,P均<0.05)。结论α1⁃AG、LDH/ALB、24 h PCTc水平可用于评估SMPP患儿发生胸腔积液的风险,3项指标协同预测的效能最高。Objective To investigate the risk factors for severe Mycoplasma pneumoniae pneumonia(SMPP)complicated with pleural effusion in children and predictive markers,and provide evidence for early clinical diagnosis and timely intervention.Methods A total of 121 children with SMPP diagnosed in the Fourth People's Hospital of Langfang City from January 2018 to October 2023 were selected.According to whether pleural effusion was detected by color ultrasound during hospitalization,the children were divided into pleural effusion group(53 cases,PE group)and without pleural effusion group(68 cases,NPE group).The clinical data and laboratory examination indexes[neutrophil percentage(NEUT%),C⁃reactive protein(CRP),procalcitonin(PCT),α1⁃acid glycoprottin(α1⁃AG),erythrocyte sedimentation rate(ESR),D⁃dimer(D⁃D),lactate dehydrogenase(LDH),albumin(ALB),blood glucose(Glu)]at admission were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between the prediction indexes and the occurrence of pleural effusion.Multivariate logistic regression was used to analyze the risk factors affecting the occurrence of pleural effusion,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value.Results Age,febrile days,hospitalization days,incidence of atelectasis and extrapulmonary damage,NEUT%,CRP,α1⁃AG,ESR,D⁃D,LDH,ALB,LDH/ALB,glucocorticoid use rate and azithromycin onset time in PE group were higher than those in NPE group,24 h PCTc was lower than NPE group,and the differences were statistically significant(χ^(2)/t/Z=6.771,6.383,3.970,3.810,9.062,6.546,20.911,4.509,7.901,10.178,8.515,6.358,9.283,39.207,6.103,8.910;all P<0.05)α1⁃AG,LDH/ALB and 24 h PCTc were risk factors for pleural effusion in SMPP children after confound⁃factor correction(all P<0.05).The area under the curve(AUC)ofα1⁃AG,LDH/ALB,24 h PCTc and the combination of above indicators were 0.853,0.759,0.668 and 0.912,respectively,in the collaborative prediction of pleural effusion in

关 键 词：重症肺炎支原体肺炎 胸腔积液 Α1-酸性糖蛋白 乳酸脱氢酶与白蛋白比值 24 h降钙素原清除率 儿童 

分 类 号：R725.6[医药卫生—儿科]