儿童重症肺炎支原体肺炎的危险因素探讨

张博; 朱玉林; 熊玉红; 秦文刚; 陈雅娜; 赵亚; 陈名武

doi:10.16766/j.cnki.issn.1674-4152.003574

儿童重症肺炎支原体肺炎的危险因素探讨

doi: 10.16766/j.cnki.issn.1674-4152.003574

张博¹,
朱玉林³,
熊玉红²,
秦文刚¹,
陈雅娜²,
赵亚²,
陈名武^{1, 2, ,}

1.
安徽医科大学附属省立医院儿科，安徽合肥 230001
2.
中国科学技术大学附属第一医院儿科，安徽合肥 230001
3.
安徽医科大学第一附属医院儿科，安徽合肥 230001

基金项目:

安徽省重点研究与开发计划项目 201904a07020042

详细信息

通讯作者:
陈名武，E-mail: chenmingwu01@163.com

中图分类号: R375.2 R725.6
计量
- 文章访问数: 37
- HTML全文浏览量: 12
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-02-09
- 网络出版日期: 2024-09-05

Exploration of risk factors for severe Mycoplasma pneumoniae pneumonia in children

1.
Department of Pediatrics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China

摘要

摘要: 目的探究儿童重症肺炎支原体肺炎(SMPP)的高危因素，分析C反应蛋白(CRP)、D-二聚体(D-D)、乳酸脱氢酶(LDH)对SMPP的诊断价值。方法回顾性分析2023年6—11月在中国科学技术大学附属第一医院住院治疗的320例肺炎支原体肺炎患儿的临床资料，根据病情严重程度分为普通肺炎支原体肺炎(GMPP，85例)和SMPP(235例)。行单因素分析，将差异有统计学意义的因素纳入多因素logistic回归分析。绘制ROC曲线分析实验室指标对SMPP的诊断价值。结果 SMPP组发热时间和咳嗽时间长于GMPP组，CRP、血小板、血小板容积、纤维蛋白原、D-D、纤维蛋白原降解产物、谷丙转氨酶、血清总胆红素、γ-谷氨酰转肽酶、LDH均高于GMPP组(P＜0.05)。多因素logistic回归分析显示，CRP、D-D和LDH升高是SMPP发生的独立危险因素，OR(95% CI)分别为1.049(1.008~1.092)、18.674(4.184~83.336)和1.007(1.001~1.013)。ROC曲线分析显示，D-D和LDH的临界值设定为0.69 μg/mL和291.45 U/L时，识别SMPP的灵敏度和特异度分别为51.5%和91.8%、63.0%和69.4%。结论 CRP、D-D及LDH水平升高是SMPP发生的独立危险因素，其中D-D和LDH对SMPP的诊断具有重要的临床价值。
- 肺炎支原体 /
- 重症 /
- 临床特征 /
- 危险因素 /
- 儿童
Abstract: Objective To explore the high-risk factors of severe Mycoplasma pneumoniae pneumonia (SMPP) in children, and analyze the diagnostic value of C-reactive protein (CRP), D-dimer(D-D), and lactate dehydrogenase (LDH) in SMPP. Methods Retrospective analysis of clinical data of 320 children with Mycoplasma pneumoniae pneumonia admitted to the First Affiliated Hospital of the University of Science and Technology of China from June 2023 to November 2023. According to the severity of the condition, they were divided into 85 cases of general Mycoplasma pneumoniae pneumonia (GMPP) and 235 cases of SMPP. Two groups were subjected to univariate analysis, and factors with statistical differences were included in multivariate logistic regression analysis. Draw ROC curves were performed to analyze the diagnostic value of laboratory indicators for SMPP. Results The SMPP group had a longer fever and cough times than the GMPP group, and CRP, platelets, platelet volume, fibrinogen, D-D, fibrinolytic products, alanine aminotransferase, serum total bilirubin, γ-Glutamyl transpeptidase, and LDH were higher in the GMPP group than those in the GMPP group (P < 0.05). Multivariate logistic regression analysis showed that CRP, D-D, and LDH were independent risk factors for the occurrence of SMPP, with OR (95% CI) of 1.049 (1.008-1.092), 18.674 (4.184-83.336), and 1.007 (1.001-1.013). ROC curve analysis showed that when the critical values of D-D and LDH were set at 0.69 μg/mL and 291.45 U/L, the sensitivity and specificity for identifying SMPP were 51.5% and 91.8%, 63.0% and 69.4%, respectively. Conclusion Elevated levels of CRP, D-D, and LDH are independent risk factors for the occurrence of SMPP, among which D-D and LDH have important clinical value in the diagnosis of SMPP.
- Mycoplasma pneumoniae /
- Severe illness /
- Clinical features /
- Risk factors /
- Children

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图 1 不同指标诊断SMPP的ROC曲线

Figure 1. ROC curves for various indicators in the diagnosis of SMPP

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表 1 2组肺炎支原体肺炎患儿临床特征比较

Table 1. Comparison of clinical characteristics between two groups of children with Mycoplasma pneumoniae pneumonia

项目	GMPP组(n=85)	SMPP组(n=235)	统计量	P值
年龄[M(P₂₅, P₇₅), 岁]	6.00(4.00，7.00)	6.00(4.00，8.00)	-1.337^a	0.181
性别[例(%)]			4.002^b	0.045
男	48(56.5)	103(43.8)
女	37(43.5)	132(56.2)
发热时间[M(P₂₅, P₇₅), d]	5.00(3.00，5.50)	7.00(6.00，10.00)	-10.609^a	＜0.001
咳嗽时间[M(P₂₅, P₇₅), d]	5.00(4.00，7.00)	7.00(5.00，10.00)	-5.227^a	＜0.001
肺部喘鸣音[例(%)]	7(8.2)	23(9.8)	0.177^b	0.674
肺部湿啰音[例(%)]	35(41.2)	118(50.2)	2.043^b	0.153
恶心呕吐[例(%)]	11(12.9)	49(20.9)	2.564^b	0.109
腹痛或腹泻[例(%)]	14(16.5)	27(11.5)	1.387^b	0.239
糖皮质激素[例(%)]	37(43.5)	145(61.7)	8.405^b	0.004
住院时间[M(P₂₅, P₇₅), d]	6.00(5.00，7.00)	6.00(5.00，8.00)	-0.673^a	0.501
总费用[M(P₂₅, P₇₅), 元]	3 742.57(2 622.40，4 287.08)	3 933.87(2 896.12，4 828.32)	-2.373^a	0.018
注：^a为Z值，^b为χ²值。

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表 2 2组肺炎支原体肺炎患儿实验室指标比较[M(P₂₅, P₇₅)]

Table 2. Comparison of laboratory indexes between two groups of children with Mycoplasma pneumoniae pneumonia[M(P₂₅, P₇₅)]

项目	GMPP组(n=85)	SMPP组(n=235)	Z值	P值
CRP(mg/L)	7.10(3.05，12.08)	9.88(4.29，22.95)	-3.248	0.001
WBC(×10⁹/L)	7.08(5.44，9.45)	7.64(5.80，9.94)	-1.045	0.296
ANC(×10⁹/L)	4.41(3.25，6.12)	4.75(3.39，6.54)	-1.112	0.266
PLT(×10⁹/L)	292.00(235.50，359.00)	319.00(249.00，388.00)	-2.137	0.033
PCT(%)	0.27(0.23，0.34)	0.30(0.24，0.36)	-2.370	0.018
FIB(g/L)	3.79(3.28，4.37)	4.06(3.43，4.74)	-2.584	0.010
D-D(μg/mL)	0.40(0.31，0.53)	0.70(0.41，1.20)	-7.116	＜0.001
FDP(μg/mL)	2.50(2.50，2.52)	2.54(2.50，3.65)	-5.227	＜0.001
ALT(U/L)	16.00(14.00，19.00)	18.00(15.00，24.00)	-3.560	＜0.001
TBIL(μmol/L)	5.90(4.50，7.75)	6.90(5.30，8.60)	-2.827	0.005
γ-GT(IU/L)	11.00(10.00，12.90)	12.00(10.00，14.90)	-3.188	0.001
ALP(IU/L)	141.80(122.65，168.85)	136.30(115.10，160.00)	-1.687	0.092
Cr(μmol/L)	30.40(27.60，34.85)	32.00(27.00，39.50)	-1.672	0.095
CK-MB(IU/L)	8.78(5.94，12.73)	9.45(6.04，13.28)	-0.664	0.507
LDH(U/L)	271.10(239.80，311.05)	310.20(267.70，380.80)	-5.650	＜0.001

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表 3 单因素及多因素二元logistic回归分析

Table 3. Univariate and multivariate binary logistic regression analysis

变量	单因素分析		多因素分析
变量	OR(95% CI)	P值	OR(95% CI)	P值
年龄	1.063(0.967~1.168)	0.204	-	-
性别为男	0.601(0.365~0.992)	0.046	0.691(0.371~1.286)	0.243
CRP(mg/L)	1.057(1.028~1.086)	<0.001	1.049 (1.008~1.092)	0.018
WBC(×10⁹/L)	1.049(0.970~1.134)	0.230	-	-
ANC(×10⁹/L)	1.070(0.973~1.178)	0.163	-	-
PLT(×10⁹/L)	1.000(1.000~1.006)	0.025	1.007(0.997~1.016)	0.166
PCT(%)	60.668(2.219~1 658.412)	0.015	1.379(0.000~51 688.041)	0.952
FIB(g/L)	1.403(1.065~1.848)	0.016	0.884(0.547~1.429)	0.616
D-D(μg/mL)	35.344(10.116~123.483)	<0.001	18.674(4.184~83.336)	<0.001
FDP(g/L)	1.325(1.049~1.672)	0.018	0.951(0.764~1.183)	0.652
ALT(U/L)	1.096(1.040~1.155)	0.001	1.064(0.996~1.137)	0.064
TBIL(μmol/L)	1.109(1.006~1.223)	0.037	0.990(0.878~1.117)	0.874
γ-GT(IU/L)	1.145(1.052~1.245)	0.002	1.004(0.901~1.117)	0.949
ALP(IU/L)	0.994(0.987~1.000)	0.038	0.999(0.990~1.007)	0.719
Cr(μmol/L)	1.034(1.000~1.070)	0.048	1.060(1.010~1.113)	0.018
CK-MB(IU/L)	1.020(0.974~1.067)	0.402	-	-
LDH(U/L)	1.013(1.008~1.018)	<0.001	1.007(1.001~1.013)	0.016
注：“-”为未纳入分析。

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表 4 SMPP患者独立相关因素的预测值

Table 4. Predicted values of independent related factors in SMPP patients

项目	AUC (95% CI)	临界值	灵敏度 (%)	特异度 (%)	P值
CRP(mg/L)	0.619(0.556~0.682)	18.31	32.3	94.1	0.001
D-D(μg/mL)	0.760(0.709~0.812)	0.69	51.5	91.8	＜0.001
LDH(U/L)	0.707(0.648~0.766)	291.45	63.0	69.4	＜0.001
Cr(μmol/L)	0.561(0.496~0.626)	38.8	26.4	95.3	0.095
CRP+D-D+LDH	0.793(0.744~0.841)	0.79	57.0	95.3	＜0.001

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