重症肺炎支原体肺炎所致塑型性支气管炎患儿多次支气管镜灌洗治疗的预测指标研究  

A clinical study of preditors of multiple bronchoscopic lavage therapy in children with plastic bronchitis due to severe Mycoplasma pneumoniae pneumonia

作　　者：姚慧生[1] 刘立云[1] 李淼[1] 韩晓华[1] Yao Huisheng;Liu Liyun;Li Miao;Han Xiaohua(Department of Pediatric Respiratory Medicine,Shengjing Hospital of China Medical University,Shenyang110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿呼吸内科,沈阳110004

出　　处：《国际儿科学杂志》2024年第12期849-853,共5页International Journal of Pediatrics

摘　　要：目的分析儿童重症肺炎支原体肺炎(severe Mycoplasma pneumoniae pneumonia,SMPP)所致塑型性支气管炎(plastic bronchitis,PB)需多次支气管镜灌洗治疗的临床特点。方法回顾性分析2017年1月至2019年12月于中国医科大学附属盛京医院小儿呼吸内科收治的SMPP所致PB患儿的临床资料。根据支气管镜灌洗治疗的次数,分为多次组(≥2次)和单次组,比较2组患儿在临床表现、实验室检查、影像学特点等方面的差异,将2组间差异有统计学意义的指标进行多因素Logistic回归分析,绘制受试者工作特征曲线,分析儿童SMPP所致PB需多次支气管镜灌洗治疗的预测指标。结果共收集68例SMPP所致PB患儿,其中多次组24例,单次组44例。与单次组比较,多次组热程长[(14.46±3.68)d比(11.14±2.64)d,t=4.302],住院时间长[(16.83±5.40)d比(11.00±3.19)d,t=4.848],外周血中性粒细胞比例高[(74.67±11.06)%比(63.02±14.46)%,t=3.431],IL-6水平增高[69.98(24.79,119.90)pg/mol比31.10(17.29,54.86)pg/mol,Z=-2.336],乳酸脱氢酶水平升高[(683.08±248.39)U/L比(495.86±170.88)U/L,t=3.292],D-二聚体升高[2168.50(1244.25,3227.75)μg/L比915.50(479.00,2017.75)μg/L,Z=-3.536],差异均具有统计学意义(均P<0.05)。Logistic回归分析显示中性粒细胞百分比、乳酸脱氢酶和D-二聚体3个独立因素可作为预测SMPP所致PB需多次支气管镜灌洗治疗的有价值指标,临界值分别为74.35%、629.5 U/L和963ug/L。结论儿童SMPP所致PB病情重,经积极抗感染及支气管镜灌洗等对症支持治疗,大多预后良好。当儿童SMPP所致PB患儿中性粒细胞比例>74.35%、乳酸脱氢酶>629.5 U/L、D-二聚体>963μg/L时,应注意可能需多次支气管镜灌洗治疗。Objective To analyze the clinical characteristics of children with severe Mycoplasma pneumoniae pneumonia(SMPP)induced plastic bronchitis(PB)requiring multiple bronchoscopic lavage treatments.Methods The clinical data related to children with SMPP causing PB admitted to the Department of Pediatric Respiratory Medicine,Shengjing Hospital of China Medical University,from January 2017 to December 2019 was retrospectively analyzed.According to the number of bronchoscopic lavage treatment,the children were divided into the multiple group(≥2 times)and the single group,and the differences between the two groups of children in terms of clinical manifestations,laboratory tests,and imaging characteristics were compared,and the indicators with statistically significant differences between the two groups were subjected to multifactorial Logistic regression analysis to draw the receiver operating characteristic curve of the subjects.Analysis of predictors of the need for multiple bronchoscopic lavage treatment for PB due to SMPP in children was conducted.Results A total of 68 children with PB due to SMPP were collected,including 24 cases in the multiple group and 44 cases in the single group.Compared with the single group,the multiple group had a longer fever duration[(14.46±3.68)d vs.(11.14±2.64)d,t=4.302],longer hospital stay[(16.83±5.40)d vs.(11.00±3.19)d,t=4.848],a higher proportion of peripheral blood neutrophils[(74.67±11.06)%vs.(63.02±14.46)%,t=3.431],increased IL-6 levels[69.98(24.79,119.90)pg/mol vs.31.10(17.29,54.86)pg/mol,Z=-2.336],elevated lactate dehydrogenase levels[(683.08±248.39)U/L vs.(495.86±170.88)U/L,t=3.292],and increased D-dimer[2168.50(1244.25,3227.75)μg/L vs.915.50(479.00,2017.75)μg/L,Z=-3.536],and the differences were statistically significant(all P<0.05).Logistic regression analysis revealed that three independent factors,neutrophil percentage,lactate dehydrogenase and D-dimer,could be valuable predictors of the need for multiple bronchoscopic lavage treatments for PB due to SMPP,with cri

关 键 词：重症肺炎支原体肺炎 塑型性支气管炎 支气管镜 

分 类 号：R72[医药卫生—儿科]