The Level of D-Dimer Is Positively Correlated With the Severity of Mycoplasma pneumoniae Pneumonia in Children.
The Level of D-Dimer Is Positively Correlated With the Severity of Mycoplasma pneumoniae Pneumonia in Children.
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D-二聚体水平与儿童肺炎支原体肺炎严重程度呈正相关
DOI：
10.3389/fcimb.2021.687391
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发表时间：
2021
影响因子：
5.7
通讯作者：
Zhang Y
中科院分区：
文献类型：
--
作者：
Zheng Y;Hua L;Zhao Q;Li M;Huang M;Zhou Y;Wang Y;Chen Z;Zhang Y
肺炎支原体肺炎（MPP）是儿童的一种重要疾病。研究表明，部分MPP患儿，尤其是伴有血栓并发症的患儿，其D - 二聚体水平升高。然而，MPP与D - 二聚体之间的潜在关联仍不明确。在本研究中，我们旨在探究血浆D - 二聚体水平与MPP患者临床特征之间的关系。
我们对2017年1月1日至2019年12月31日期间在我院住院治疗的356例MPP患者进行回顾性分析。根据D - 二聚体峰值，将患者分为三组：正常组（D - 二聚体<0.55mg/L）、轻 - 中度升高组（D - 二聚体0.55 - 5.5mg/L）和重度升高组（D - 二聚体>5.5mg/L）。比较不同组患者的人口统计学和临床信息、影像学检查结果、实验室数据及治疗情况。
正常组有106例患者，轻 - 中度升高组有204例患者，重度升高组有46例患者。与正常组相比，升高组患者的临床和影像学表现更严重，发热时间、住院时间和抗生素治疗时间更长，肺外并发症、难治性MPP（RMPP）、重症MPP（SMPP）的发生率更高（P<0.01）。同时，我们发现随着D - 二聚体升高，中性粒细胞百分比（N%）、CD8 +淋巴细胞百分比（CD8 +%）、C反应蛋白（CRP）、乳酸脱氢酶（LDH）、白细胞介素（IL） - 6、IL - 10和干扰素 - γ（IFN - γ）呈上升趋势，而淋巴细胞百分比（L%）和前白蛋白（PAB）呈下降趋势（P<0.01）。此外，重度升高组中需要吸氧治疗、使用糖皮质激素、进行支气管镜检查、使用免疫球蛋白、胸腔穿刺或入住重症监护病房（ICU）的患者比例显著高于其他两组（P<0.01）。相关性分析显示，N%、L%、CRP、LDH、IL - 10、发热时间、住院时间和抗生素治疗时间与D - 二聚体水平密切相关。
D - 二聚体水平较高的MPP患者临床表现更严重，需要更长的治疗时间，这可能与肺炎支原体感染后肺部炎症的严重程度密切相关。
Objective Mycoplasma pneumoniae pneumonia (MPP) is an important disease in children. Studies have demonstrated that the levels of D-dimer are elevated in some children with MPP, especially those with thrombotic complications. However, the potential association between MPP and D-dimer remains unclear. In our study, we sought to explore the relationship between the levels of plasma D-dimer and clinical characteristics of MPP patients. Methods Retrospective analysis was conducted on 356 patients who were hospitalized in our hospital for MPP between January 1, 2017, and December 31, 2019. According to the peak value of D-dimer, patients were divided into three groups: the normal group (D-dimer<0.55 mg/L), the mild-moderately elevated group (D-dimer 0.55–5.5 mg/L) and the severely elevated group (D-dimer >5.5 mg/L). The demographic and clinical information, radiological findings, laboratory data, and treatments of patients were compared among different groups. Results 106 patients were in the normal group, 204 patients were in the mild-moderately elevated group, and 46 patients were in the severely elevated group. More severe clinical and radiographic manifestations, longer length of fever, hospital stay and antibiotic therapy duration, higher incidences of extra-pulmonary complications, refractory MPP (RMPP), severe MPP (SMPP) were found in the elevated group, when compared with the normal group (P<0.01). Meanwhile, we found that the percentage of neutrophil (N%) and CD8 + lymphocyte (CD8 +%), C-reactive protein (CRP), lactate dehydrogenase (LDH), interleukin (IL)-6, IL-10, and interferon-gamma (IFN-γ) trended higher with increasing D-dimer, whereas the percentage of lymphocyte (L%) and prealbumin (PAB) trended lower (P<0.01). In addition, the proportions of patients requiring oxygen therapy, glucocorticoid, bronchoscopy, immunoglobulin use, thoracentesis, or ICU admission were significantly higher in the severely elevated group than those in the other two groups (P<0.01). Correlation analysis showed that N%, L%, CRP, LDH, IL-10, length of fever, length of stay, and length of antibiotic therapy had strong correlations with the level of D-dimer. Conclusions MPP patients with higher levels of D-dimer had more severe clinical manifestations and needed longer duration of treatment, which might be closely related to the severity of lung inflammation after MP infection.