难治性肺炎支原体肺炎危险因素分析

Risk factors of refractory mycoplasma pneumoniae pneumonia in children

摘要:

目的 探讨难治性肺炎支原体肺炎（RMPP）的相关危险因素。方法 选取2016 年1 月—2016 年 12 月在大连市儿童医院呼吸科诊治的153 例普通肺炎支原体肺炎（GMPP）患儿和32 例RMPP 患儿的一般 资料、发热时间、实验室指标及影像学特点。绘制ROC 曲线分析各独立危险因素在RMPP 中的预测价值； 采用多因素Logistic 回归分析RMPP 发生的相关危险因素。结果 RMPP 组发热时间、乳酸脱氢酶（LDH）、 中性粒细胞百分比、C 反应蛋白（CRP）及降钙素原（PCT）水平高于GMPP 组（P <0.05）。RMPP 组肺部 浸润影≥ 2/3 肺、胸腔积液、肺实变、肺不张、合并感染及肺外并发症比例高于GMPP 组（P <0.05）。ROC 曲线分析显示，发热时间、LDH、中性粒细胞百分比、淋巴细胞百分比、CRP 及PCT 可鉴别RMPP 和 GMPP（P <0.05），其最佳分割点分别为10.5 d、342.5 IU/L、59.85%、25.55%、22.86 mg/L 及0.1 ng/ml。多因 素Logistic 回归分析提示，发热时间[Ol ^ R=6.939（95% CI：2.016，22.885）]、肺部浸润影≥ 2/3 肺[Ol ^ R=48.045（95% CI ：5.880，392.561）] 及LDH[Ol ^ R=10.075（95% CI ：2.770，36.640）] 是RMPP 发生的危险因素。结论 发 热时间、肺部浸润影≥ 2/3 肺，合并感染、肺外并发症、LDH 及CRP 水平升高有助于早期识别RMPP。发 热时间、肺部浸润影≥ 2/3 肺及LDH 是RMPP 发生的独立危险因素。

Abstract:

Objective To explore the risk factors of children with refractory mycoplasma pneumonia pneumonia (RMPP). Methods Clinical manifestations,laboratory indexes and image features of 153 children with general mycoplasma pneumoniae pneumonia (GMPP) and 32children with refractory mycoplasma pneumoniae pneumonia (RMPP) from January 2016 to December 2016 were retrospectively analyzed, and ROC curve was mapped to analyze the predictive value of independent risk factors in RMPP; stepwise logistic regression analysis was performed for risk factors of RMPP. Results Compared with 153 cases of general mycoplasma pneumoniae pneumonia (GMPP), durations of fever days were longer and LDH, the percentage of neutrophil, CRP, PCT levels were also higher in 32 cases of RMPP (P < 0.05). Lung infiltration (≥ 2/3), pleural effusion, pulmonary consolidations, lobar atelectasis, mixed with infection and extrapulmonary complications were higher (P < 0.05). ROC curve analysis showed that, fever duration, LDH, the percentage of neutrophil, CRP and PCT had good values for identification of children with RMPP and GMPP, and the best threshold point is 10.5 days,342.5 IU/L, 59.85%, 22.86mg/L and 0.1 ng/ml, respectively. Stepwise logistic regression analysis showed that fever days [Ol ^ R=6.939 (95% CI: 2.016, 22.885)], lung infiltration (≥ 2/3) [Ol ^ R=48.045 (95% CI: 5.880, 392.561)] and LDH [Ol ^ R=10.075 (95% CI: 2.770, 36.640)] were the independent risk factors of RMPP. Conclusions Fever duration, lung infiltration (≥ 2/3), mixed with infection and extrapulmonary complications, the levels of serum LDH and CRP are significantly increased, which is helpful for the early identification of RMPP. Fever duration, lung infiltration (≥ 2/3) and LDH were independent risk factors for RMPP.