儿童难治性肺炎支原体肺炎的临床特征和炎症性因子研究  

Clinical characteristics and related inflammatory factors of refractory Mycoplasma pneumoniae pneumonia in children

作　　者：张丽娉 王金菊[1] 郝贵亮 Zhang Liping;Wang Jinju;Hao Guiliang(Department of Respiratory Medicine,Women and Children's Hospital Affiliated to Qingdao University,Qingdao 266000,China;Department of Clinical Laboratory,Women and Children's Hospital Affiliated to Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属妇女儿童医院呼吸科,266000 [2]青岛大学附属妇女儿童医院检验科,266000

出　　处：《中国小儿急救医学》2025年第4期273-278,共6页Chinese Pediatric Emergency Medicine

基　　金：青岛市科技惠民项目(21-1-4-rkjk-18-nsh)。

摘　　要：目的分析儿童难治性肺炎支原体肺炎(RMPP)的临床特征及炎症性因子特点,探讨RMPP的早期预测方法。方法选取2022年1月至2023年12月于青岛市妇女儿童医院呼吸科住院且行电子支气管镜肺泡灌洗的肺炎支原体肺炎患儿为研究对象,根据病情分为RMPP组和普通肺炎支原体肺炎(GMPP)组。比较两组的临床特征、炎症性因子差异,通过多因素Logistic回归分析发生RMPP的危险因素,并绘制受试者工作特征(ROC)曲线评价其预测价值。结果共纳入232例患儿,男108例,女124例,RMPP组114例,GMPP组118例。与GMPP组比较,RMPP组患儿年龄更低,发热时间、住院时间更长,血C-反应蛋白、D-二聚体、乳酸脱氢酶(LDH)和影像学胸腔积液比例更高;RMPP组支气管肺泡灌洗液(BALF)中细胞因子干扰素(IFN)-α、IFN-γ、白细胞介素(IL)-2、IL-5、IL-6、IL-1β、IL-10、IL-17水平更高;差异均有统计学意义(均P<0.05)。多因素分析显示,住院时间、发热时间长,血D-二聚体、LDH及BALF中IL-5、IL-6、IL-17、IL-1β、IFN-α升高为RMPP的独立危险因素(均P<0.05)。住院时间、发热时间、D-二聚体、LDH、IL-5、IL-6、IL-17、IL-1β的ROC曲线下面积依次为0.669、0.857、0.606、0.811、0.686、0.890、0.647、0.691(均P<0.05)。其中,发热时间、LDH、IL-6的诊断预测价值较高;发热时间最佳临界值为6.5 d,灵敏度97.40%,特异度64.90%;LDH最佳临界值为420.77 U/L,灵敏度64.90%,特异度89.50%;IL-6最佳临界值为293.04 pg/mL,灵敏度91.2%,特异度82.5%。结论RMPP患儿发热时间长、炎症指标高,肺炎支原体肺炎患儿发热时间>6.5 d、血LDH>420.77 U/L、BALF中IL-6>293.04 pg/mL有助于早期识别RMPP。Objective To analyze the clinical features and inflammatory factors of refractory Mycoplasma pneumoniae pneumonia(RMPP)in children,and to explore the early prediction methods of RMPP.Methods Children with Mycoplasma pneumoniae who were hospitalized in the Respiratory Department of Qingdao Women and Children's Hospital from January 2022 to December 2023 and underwent electronic bronchoscopic lavage were selected as the study objects.They were divided into RMPP group and GMPP group according to the severity of illness.Clinical features and inflammatory factors between the two groups were compared,and the risk factors of RMPP were analyzed by multivariate Logistic regression model.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive values.Results A total of 232 children were included,including 114 cases in RMPP group and 118 cases in GMPP group.Compared with GMPP group,children in RMPP group were younger,had longer fever time and hospitalization time,and had higher levels of blood C-reactive protein,D-dimer,and lactate dehydrogenase(LDH),as well as higher proportion of pleural effusion observed in imaging.The cytokine levels of interferon(IFN)-α,IFN-γ,interleukin(IL)-2,IL-5,IL-6,IL-1β,IL-10 and IL-17 in bronchoalveolar lavage fluid(BALF)were higher in RMPP group.The differences were statistically significant(all P<0.05).Multivariate Logistic analysis showed that longer hospitalization time and fever time,increased levels of D-dimer and LDH in plasma,increased IL-5,IL-6,IL-17,IL-1βand IFN-αin BALF were independent risk factors for RMPP(all P<0.05).The area under ROC curve of hospitalization time,fever time,D-dimer,LDH,IL-5,IL-6,IL-17 and IL-1βwere 0.669,0.857,0.606,0.811,0.686,0.890,0.647 and 0.691,respectively(all P<0.05).Among these,the diagnostic value of fever time,LDH and IL-6 was higher.The optimum critical value of fever time was 6.5 days,with a sensitivity of 97.40%and a specificity of 64.90%.The optimum critical value of LDH was 420.77U/L,with a sensitivity of 64.90%and a

关 键 词：肺炎支原体 难治性肺炎支原体肺炎 儿童 支气管肺泡灌洗液 细胞因子 

分 类 号：R725.6[医药卫生—儿科]