摘要
目的探讨难治性肺炎支原体肺炎的表现特征和判断指标。方法（1）将应用大环内酯类药物治疗至少5d，临床和影像学表现仍恶化的肺炎支原体肺炎定义为难治性病例，以此为初步诊断标准，将213例肺炎支原体肺炎患儿分为一般病例141例，难治性病例72例，回顾分析两组患儿在临床表现、外周血白细胞总数、中性粒细胞百分比、C反应蛋白（CRP）、胸部影像学等方面的差别，对难治性肺炎支原体肺炎的表现进行多因素Logistic回归分析等，总结出难治性肺炎支原体肺炎的判断指标；（2）在100例肺炎支原体肺炎患儿中前瞻性应用这些指标，进行Kappa检验，验证其准确性。结果按照初步诊断标准定义的难治性病例组患儿发热时间均大于10d，外周血白细胞（3．8～18．5）×10^9/L，发病5—10d时，CRP均大于38mg／L，最高者〉160mg／L，肺CT均表现为密度均匀的肺叶实变，累及范围均超过2／3肺叶，所有病变区内未见支气管充气征，CT值为40～50HU，仅1例无胸腔积液；一般病例组发热时间常小于10d，CRP常小于40mg／L。对两组病例进行Logistic逐步回归分析，发现年龄、性别、外周血白细胞、中性粒细胞百分比差异无统计学意义，发热超过10d、CRP升高、影像表现为肺部高密度均匀实变影（范围超过2／3肺叶，CT值大于40HU）为预测难治性肺炎支原体肺炎的判断指标（分别为OR=1．586，P=0．017；OR=4．344，P=0．001：OR=2．660，P=0．012）。当CRP为40mg／L临界值时诊断难治性肺炎支原体肺炎的试验评价时敏感度为0．96，特异度为0．94。对上述指标在100例肺炎支原体肺炎患儿进行验证，Kappa值为0．9。结论对于肺炎支原体肺炎患儿发热持续10d以上、CRP大于40mg／L、肺部高密度均匀一致实变阴影（超过2／3肺叶，CT值大于40HU，伴或不伴有胸腔积液），可视为难治性肺炎支原体肺炎。
Objective To investigate clinical characteristics and predictive factors of refractory Mycoplasrna pneumoniae pneumonia （RMPP） in children so as to recognize and treat the disease earlier. Method The data including febrile time, inflammatory markers （WBC, neutrophil, CRP） and radiological features of 213 children hospitalized with Mycoplasma pneumoniae pneumonia （MPP） （72 with refractory MPP and 141 with mild MPP were retrospectively analyzed）. The primary diagnostic criteria of refractory MPP： the patient＇s condition still deteriorates after treatment with macrolides for more than 5 days. The independent variables which had significant difference in univariate analysis was analyzed by multivariate logistic regression analysis. The predictive criteria of RMPP were further applied in 100 other patients prospectively. Kappa test was used to evaluate the accuracy rate. Result Refractory MPP patients：febrile time was more than 10 days ,white blood cell （WBC） count was （3.8 -18.5 ）×10^9/L in peripheral blood routine test, CRP was 38 mg/L - 〉 160 mg/L,large lobar consolidation with high density （ 〉 2/3 puhnonary lobe,CT value 40 -50 HU,without air bronehogram）. Mild MPP patients： febrile time was less than 10 days, CRP was often less than 40 mg/L. Independent risk factors for RMPP were febrile time, CRP, largeconsolidation area with high density in lungs with or without pleural effusion （ OR = 1. 586, P = 0. 017 ; OR = 4. 344 ,P = 0. 001 ; OR = 2. 660, P = 0. 012 ）, CT value 40 - 50 HU which were demonstrated by logistic regression analysis. The specificity, sensitivity and Youden index for this diagnostic test were respectively 0. 96, 0. 94 and 0. 90 at a CRP cut off of 40 mg/L. The sensitivity, specificity, and Kappa value for the above criteria to diagnose RMPP were respectively 0. 96, 0. 94 and 0. 9. Conclusion The predictive factors for RMPP are febrile time （ 〉 10 days ）, CRP （ 〉 40 mg/L ）, large lobar consolidation with high density （ 〉 2/3 pulmonary lobe, CT value 〉 40 HU with or without pleural effusion） for the purpose of treating earlier.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2012年第12期915-918,共4页
Chinese Journal of Pediatrics
关键词
肺炎
支原体
C反应蛋白
放射摄影术
胸部
Pneumonia Mycoplasma
C-Reactive protein
Radiography Thoracic
