| 摘要: |
| ［摘要］ 目的 探讨儿童重症肺炎支原体肺炎（SMPP）发生的危险因素，为临床医师早期诊断和治疗SMPP提供参考。方法 回顾性分析2023年4月至2024年6月在广西壮族自治区人民医院儿科住院，支气管肺泡灌洗液（BALF）肺炎支原体（MP）DNA检测阳性的399例肺炎支原体肺炎（MPP）患儿的临床资料，根据病情分为重症组（230例）和轻症组（169例）。比较两组间实验室指标、BALF中MP-DNA载量和MP耐药基因23S rRNA的A2063G基因位点突变阳性率差异，分析影响SMPP发生的危险因素。结果 重症组患儿中性粒细胞百分比（NEU%）、中性粒细胞/淋巴细胞比值（NLR）、C反应蛋白（CRP）、降钙素原（PCT）、白介素-6（IL-6）、乳酸脱氢酶（LDH）、D-二聚体（D-D）水平和A2063G基因位点突变阳性率高于轻症组，淋巴细胞百分比（LYM%）、白蛋白（ALB）水平低于轻症组，差异有统计学意义(P<0.05)。多因素logistic回归分析显示，CRP［OR（95%CI）：1.085（1.051～1.120）］、LDH［OR（95%CI）：1.031（1.022～1.040）］、D-D［OR（95%CI）：40.359（9.417～172.975）］水平升高和A2063G基因位点突变阳性［OR（95%CI）：2.677（1.372～5.222）］是发生SMPP的独立危险因素(P<0.05)。ROC曲线分析显示，CRP（AUC=0.761）、LDH（AUC=0.809）、D-D（AUC=0.817）对于SMPP具有中等诊断价值。结论 SMPP患儿炎症指标明显升高，CRP、LDH、D-D水平升高和MP耐药基因23S rRNA的A2063G基因位点突变是SMPP发生的危险因素，对SMPP诊断具有参考价值。 |
| 关键词: 重症肺炎支原体肺炎 儿童 危险因素 支气管肺泡灌洗液 炎症指标 基因突变 |
| DOI：10.3969/j.issn.1674-3806.2024.11.07 |
| 分类号:R 725.6 |
| 基金项目:南宁市青秀区科技计划项目（编号：2019031）；广西卫生健康委自筹经费科研课题（编号：Z20201325） |
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| Analysis on risk factors of severe Mycoplasma pneumoniae pneumonia in children |
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YANG Caiqiong, ZHANG Min, ZHANG Diwen, WANG Suili, LU Yanlian, WEN Xiaoling, CHEN Junyu, WEN Zhihong
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Department of Pediatrics, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To explore the risk factors of severe Mycoplasma pneumoniae pneumonia(SMPP) in children, and to provide reference for early diagnosis and treatment of SMPP for clinicians. Methods The clinical data of 399 pediatric patients with Mycoplasma pneumoniae pneumonia(MPP) who were admitted to Department of Pediatrics, the People′s Hospital of Guangxi Zhuang Autonomous Region from April 2023 to June 2024 and tested positive for Mycoplasma pneumoniae(MP) DNA by using bronchoalveolar lavage fluid(BALF) were retrospectively analyzed. The pediatric patients were divided into severe group(230 cases) and mild group(169 cases) according to disease condition. The differences in laboratory indicators, MP-DNA loads in BALF and positive rate of mutation in MP drug-resistant gene 23S rRNA locus(A2063G) were compared between the two groups. The risk factors affecting the occurrence of SMPP were analyzed. Results The levels of percentage of neutrophils(NEU%), neutrophil-to-lymphocyte ratio(NLR), C-reactive protein(CRP), procalcitonin(PCT), interleukin-6(IL-6), lactate dehydrogenase(LDH), D-dimer(D-D) and positive rate of mutation in MP drug-resistant gene 23S rRNA locus(A2063G) in the pediatric patients of the severe group were higher than those in the pediatric patients of the mild group, and the levels of percentage of lymphocytes(LYM%) and albumin(ALB) in the pediatric patients of the severe group were lower than those in the pediatric patients of the mild group, and differences were significant(P<0.05). The results of multivariate logistic regression analysis showed that the elevated levels of CRP［OR(95%CI): 1.085(1.051-1.120)］, LDH［OR(95%CI): 1.031(1.022-1.040)］, and D-D［OR(95%CI): 40.359(9.417-172.975)］, as well as the mutation in MP drug-resistant gene 23S rRNA locus(A2063G)［OR(95%CI): 2.677(1.372-5.222)］ were independent risk factors for SMPP(P<0.05), and the results of receiver operating characteristic(ROC) curve analysis showed that CRP(AUC=0.761), LDH(AUC=0.809), and D-D(AUC=0.817) had moderate diagnostic value for SMPP. Conclusion The inflammatory indicators of SMPP pediatric patients are significantly elevated, and the elevated levels of CRP, LDH and D-D, as well as the mutation in MP drug-resistant gene locus(A2063G) are risk factors for SMPP, which have reference value for the diagnosis of SMPP. |
| Key words: Severe Mycoplasma pneumoniae pneumonia(SMPP) Children Risk factors Bronchoalveolar lavage fluid(BALF) Inflammatory indicators Genetic mutation |
