肿瘤坏死因子-α与支原体抗体滴度对肺炎支原体肺炎患儿肝功能损伤的诊断价值及其危险因素分析  

Analysis the diagnostic value of tumor necrosis factor-α and Mycoplasma antibody titersin liver function impairment in children with Mycoplasma pneumoniae pneumonia and its risk factors

作　　者：廖龙跃 简清勇 蒋玲 胡云 LIAO Longyue;JIAN Qingyong;JIANG Ling;HU Yun(Department of Pediatrics,Xinyu People's Hospital,Xinyu,Jiangxi,338000,China)

机构地区：[1]新余市人民医院儿科,江西新余338000

出　　处：《当代医学》2024年第17期83-88,共6页Contemporary Medicine

摘　　要：目的分析肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)与支原体抗体滴度对肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)患儿肝功能损伤的诊断价值及其发生肝功能损伤的危险因素。方法回顾性分析2021年2月至2022年4月新余市人民医院收治的80例MPP患儿的临床资料,根据是否发生肝功能损伤分为观察组(发生肝功能损伤,n=22)与对照组(未发生肝功能损伤,n=58)。采用单因素及多因素Logistic回归分析MPP患儿发生肝功能损伤的影响因素,并通过绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)分析TNF-α、支原体抗体滴度对MPP患儿肝功能损伤的诊断价值。结果两组年龄、性别、肺不张、胸腔积液情况比较差异无统计学意义;两组TNF-α水平、支原体抗体滴度、肺实变、乳酸脱氢酶(lactate dehydrogenase,LDH)水平、C反应蛋白(C-reactive protein,CRP)水平、维生素A水平、大环内酯类抗生素使用时间、联用抗菌药物种类、糖皮质激素使用情况比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,TNF-α水平较高、支原体抗体滴度(>1∶640)、肺实变、LDH(≥120 U/L)、CRP(≥5 mg/L)、维生素A(<0.20 mg/L)、大环内酯类抗生素使用时间(≥7 d)、联用抗菌药物种类(≥2种)是MPP患儿发生肝功能损伤的独立危险因素(P<0.05),而使用糖皮质激素是MPP患儿发生肝功能损伤的保护因素(P<0.05)。TNF-α诊断MPP患儿发生肝功能损伤的AUC为0.761(95%CI:0.653~0.849),灵敏度为68.18%,特异度为74.14%,截断值为>27.81 ng/L;支原体抗体滴度诊断MPP患儿发生肝功能损伤的AUC为0.718(95%CI:0.607~0.813),灵敏度为63.64%,特异度为75.86%,截断值为>1∶640,均具有一定诊断价值。结论TNF-α水平较高、支原体抗体滴度(>1∶640)、肺实变、LDH(≥120 U/L)、CRP(≥5 mg/L)、维生素A(<0.20 mg/L)、大环内酯类抗生素使用时间(≥7 d)、联用抗菌药物种类(≥2种)是�Objective To analyze the diagnostic value of tumor necrosis factor-α(TNF-α)and Mycoplasma titer in liver function impairment in children with Mycoplasma pneumoniae pneumonia(MPP)and the risk factors of liver function impairment in children.Methods The clinical data of 80 children with MPP admitted to Xinyu People's Hospital from February 2021 to April 2022 were retrospectively analyzed,and they were divided into the observation group(with liver function impairment,n=22)and the control group(without liver function impairment,n=58)according to whether they had liver function impairment.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of liver function impairment in children with MPP,receiver operating characteristic curve(ROC)was drawn to analyzethe diagnostic value of TNF-αand mycoplasma antibody titer for liver function impairment in children with MPP.Results There were no significant differences in age,sex,atelectasis and pleural effusion between the two groups;there were significant differences in TNF-αlevel,mycoplasma antibody titer,lung consolidation,lactate dehydrogenase(LDH)level,C-reactive protein(CRP)level,vitamin A level,macrolide antibiotics use time,types of combined antibiotics,and glucocorticoid use between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that high TNF-αlevel,mycoplasma antibody titer(>1∶640),lung consolidation,LDH(≥120 U/L),CRP(≥5 mg/L),vitamin A(<0.20 mg/L),macrolide antibiotic use time(≥7 d)and combination of antibiotics(≥2 kinds)were independent risk factors for liver function impairment in MPP children(P<0.05),while glucocorticoid use was protective factor for liver function impairment in MPP children(P<0.05).The AUC of TNF-αin the diagnosis of liver function impairment in children with MPP was 0.761(95%CI:0.653-0.849),the sensitivity was 68.18%,the specificity was 74.14%,and the cutoff value was>27.81 ng/L;the AUC of mycoplasma antibody titer in the diagnosis of liver func

关 键 词：肺炎支原体肺炎 肝功能损伤 相关因素 支原体抗体滴度 肿瘤坏死因子-Α 

分 类 号：R725.6[医药卫生—儿科]