摘要
目的 分析儿童难治性肺炎支原体肺炎(RMPP)的危险因素及预测价值。方法 选取162例肺炎支原体肺炎(MPP)患儿,其中将44例RMPP患儿作为RMPP组,其余118例普通肺炎支原体肺炎(GMPP)患儿作为GMPP组。比较两组患儿临床资料(年龄、性别、发热持续时间、咳嗽持续时间、肺外表现、胸部影像学资料及血清学指标),并分析RMPP的危险因素及受试者工作特征(ROC)曲线。结果 RMPP组患儿年龄(5.73±2.96)岁大于GMPP组的(4.56±2.07)岁,发热持续时间(7.16±1.77)d长于GMPP组的(3.55±2.23)d,肺外表现占比43.18%、C反应蛋白(CRP)(37.37±10.21)mg/L、降钙素原(PCT)(0.23±0.16)ng/ml、乳酸脱氢酶(LDH)(444.84±138.67)U/L、影像学表现肺内高密度实变影以及胸腔积液占比54.55%均高于GMPP组的16.95%、(8.25±3.18)mg/L、(0.11±0.10)ng/ml、(283.34±67.58)U/L、10.17%(P<0.05)。两组患儿性别、咳嗽持续时间、白细胞计数水平比较差异无统计学意义(P>0.05)。将是否发展为RMPP作为二分类因变量(发生=1,未发生=0),经过Logistic回归分析,年龄大、发热持续时间长、LDH水平高均为RMPP的危险因素(P<0.05)。年龄、发热持续时间、LDH对RMPP诊断的ROC曲线分析显示,其中LDH的ROC曲线下面积(AUC)最大,为0.948,临界值为312 U/L(敏感性为0.977,特异性为0.805);其次是发热持续时间AUC为0.900,临界值为5.50 d(敏感性为0.932,特异性为0.780);年龄AUC为0.617,临界值为4.50岁(敏感性为0.682,特异性为0.576)。结论 RMPP临床特征多表现为发热持续时间长、肺部病变重、合并其他脏器损伤、炎性指标高等,发病年龄大、发热持续时间长、LDH水平高可作为预测发展为RMPP的指标。
Objective To analyze the risk factors and predictive value of refractory mycoplasma pneumoniae pneumonia(RMPP)in children.Methods 162 child patients with mycoplasma pneumoniae pneumonia(MPP)were included in this study,in which 44 child patients with RMPP were selected as the RMPP group,and the other 118 child patients with general mycoplasma pneumonia(GMPP)were selected as the GMPP group.The clinical data(age,gender,duration of fever,duration of cough,extrapulmonary manifestations,chest imaging data and serological indicators)was compared between the two groups,and risk factors and receiver operating characteristic(ROC)curves were analyzed for RMPP.Results The age of(5.73±2.96)years in RMPP group was older than that of(4.56±2.07)years in GMPP group;the duration of fever of(7.16±1.77)d in RMPP group was longer than that of(3.55±2.23)d in GMPP group;In RMPP group,the extrapulmonary manifestation accounted for 43.18%,C-reactive protein(CRP)was(37.37±10.21)mg/L,provocalcitonin(PCT)was(0.23±0.16)ng/ml,lactate dehydrogenase(LDH)was(444.84±138.67)U/L,and the imaging manifestations of lung hyperdensity and pleural effusion accounted for 54.55%,which were higher than those of 16.95%,(8.25±3.18)mg/L,(0.11±0.10)ng/ml,(283.34±67.58)U/L and 10.17%(P<0.05)in GMPP group(P<0.05).There was no statistically significant difference between the two groups in terms of gender,duration of cough and white blood cell count(P>0.05).The development of RMPP was taken as a binary dependent variable(occurrence=1,non-occurrence=0).Logistic regression analysis showed that old age,long duration of fever and high LDH were all risk factors for RMPP(P<0.05).The ROC curve analysis of age,fever duration,and LDH for the diagnosis of RMPP showed that the area under the ROC curve(AUC)for LDH was the largest at 0.948,with a critical value of 312 U/L(sensitivity of 0.977,specificity of 0.805);followed by fever duration,with an AUC of 0.900,with a critical value of 5.50 d(sensitivity of 0.932 and specificity of 0.780);then age,with an AUC of 0.617,with a critical value of 4.50 years(sensitivity of 0.682 and specificity of 0.576).Conclusion RMPP is often manifested as a long duration of fever,combined with organ damage,high inflammatory indicators,and severe lung lesions.Older age of onset,long duration of fever,and high LDH level can be used as indicators for predicting the development of RMPP.
作者
杨海军
YANG Hai-jun(Department of Pediatrics,Liaoning Provincial People's Hospital,Shenyang 110016,China)
出处
《中国现代药物应用》
2024年第1期1-5,共5页
Chinese Journal of Modern Drug Application
关键词
难治性支原体肺炎
炎性因子
预测价值
儿童
Refractory mycoplasma pneumoniae pneumonia
Inflammatory factors
Predictive factors
Children
