摘要
目的探讨儿童侵袭性肺炎链球菌病(IPD)伴坏死性肺炎(NP)临床特点、耐药性和预后不良相关因素。方法选取2018年6月—2022年6月西安交通大学第一附属医院IPD伴NP患儿158例(观察组),以同期92例肺炎支原体感染NP患儿作为对照组。比较2个组患儿临床特征和实验室相关指标检测结果。对肺炎链球菌进行体外药物敏感性试验。根据预后情况将IPD伴NP患儿分为预后不良组(26例)和预后良好组(132例)。采用多因素Logistic回归分析筛选IPD伴NP患儿预后不良的影响因素,并构建预测IPD伴NP患儿预后不良的列线图模型。采用受试者工作特征(ROC)曲线评价列线图模型的预测效能。结果观察组发热时间、气促发生率和C反应蛋白(CRP)、白细胞(WBC)计数、中性粒细胞绝对数(NEUT#)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)水平,以及胸腔积液乳酸脱氢酶(LDH)、WBC计数、葡萄糖水平均显著高于对照组(P<0.05)。肺炎链球菌对万古霉素、左氧氟沙星和利奈唑胺较敏感,对红霉素、克林霉素的敏感率较低。CRP>161.75 mg·L^(-1)、WBC计数>20.24×10^(9)/L、NEUT#>0.86×10^(9)/L、PCT>2.98μg·L^(-1)、血钠<2.24 mmol·L^(-1)、血钙<136.35 mmol·L^(-1)与IPD伴NP患儿预后不良有关(P<0.05)。结论IPD伴NP患儿发热时间长,易发生气促,感染菌株对万古霉素、左氧氟沙星和利奈唑胺较敏感。高水平CRP、WBC、NEUT#、PCT和低水平血钠、血钙与IPD伴NP患儿预后不良有关。
Objective To investigate the clinical characteristics,drug resistance and poor prognosis factors for invasive pneumococcal disease(IPD)with necrotizing pneumonia(NP).Methods A total of 158 children with IPD with NP from the First Affiliated Hospital of Xi'an Jiao Tong University from June 2018 to June 2022 were enrolled as observation group,and 92 mycoplasma pneumoniae patients with NP were enrolled as control group.The clinical manifestations and laboratory indexes were compared.In vitro drug susceptibility test was performed.The observation group was classified into poor prognosis group(26 cases)and good prognosis group(132 cases)according to whether there was poor prognosis.Multivariate Logistic regression analysis was used to screen the influencing factors of poor prognosis in children with IPD and NP,and the prediction model of nomographic chart was constructed and evaluated.Receiver operating characteristic(ROC)curve was used to evaluate the prediction efficiency of the nomographic chart prediction model.Results In the observation group,fever time,breathless incidence rate,C-reactive protein(CRP),white blood cell(WBC)count,the absolute value of neutrophils(NEUT#),tumor necrosis factor-alpha(TNF-α),procalcitonin(PCT)levels and pleural effusion lactate dehydrogenase(LDH),WBC count and glucose level were higher than those in control group(P<0.05).Streptococcus pneumoniae was more sensitive to vancomycin,levofloxacin and linezolid,but less sensitive to erythromycin and clindamycin.CRP>161.75 mg·L^(-1),WBC count>20.24×10^(9)/L,NEUT#>0.86×10^(9)/L,PCT>2.98μg·L^(-1),blood sodium<2.24 mmol·L^(-1)and blood calcium<136.35 mmol·L^(-1)were associated with poor prognosis in children with IPD and NP(P<0.05).Conclusions The children with IPD and NP have a long fever time and are prone to breathless.The infected isolates are sensitive to vancomycin,levofloxacin and linezolid.High levels of CRP,WBC count,NEUT#,PCT and low levels of blood sodium and blood calcium are associated with poor prognosis in children with IPD and NP.
作者
马晨
张祎
李芳
王静
陈葳
MA Chen;ZHANG Yi;LI Fang;WANG Jing;CHEN Wei(Department of Clinical Laboratory,the First Affiliated Hospital of Xi'an Jiao Tong University,Xi'an 710061,Shaanxi,China)
出处
《检验医学》
CAS
2024年第3期265-271,共7页
Laboratory Medicine
关键词
侵袭性肺炎链球菌病
坏死性肺炎
临床特点
耐药性
预后
Invasive pneumococcal disease
Necrotizing pneumonia
Clinical characteristic
Drug resistance
Prognosis
