The Clinical Characteristics and Predictors of Refractory Mycoplasma pneumoniae Pneumonia in Children.
The Clinical Characteristics and Predictors of Refractory Mycoplasma pneumoniae Pneumonia in Children.
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儿童难治性肺炎支原体肺炎的临床特征及预测因素。
DOI：
10.1371/journal.pone.0156465
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Chen Z
中科院分区：
文献类型：
--
作者：
Zhang Y;Zhou Y;Li S;Yang D;Wu X;Chen Z
目的分析难治性肺炎支原体肺炎（RMPP）的临床特点，探讨预测RMPP的相关因素。方法对2011年1月1日至2014年12月31日在我院住院治疗的634例肺炎支原体肺炎患儿进行回顾性分析。比较RMPP组与普通肺炎支原体肺炎（GMPP）组的临床特征、实验室资料、影像学表现，并分析相关因素的预测价值。结果RMPP患者的中位年龄（n = 145）明显大于GMPP患者（n = 489） （P<0.01）。RMPP组表现更严重，肺外并发症发生率更高，影像学表现更严重，需氧次数更多，抗生素使用时间更长，重症监护时间更长（P<0.05）。RMPP组c反应蛋白（CRP）、乳酸脱氢酶（LDH）、免疫球蛋白A （IgM）、白细胞介素(IL)-6、IL-10、干扰素γ (IFN-γ)水平及中性粒细胞、CD8+比例显著高于GMPP组（P<0.05）；而前白蛋白（PAB）水平低于GMPP组（P<0.01）。在ROC曲线分析中，中性粒细胞、CRP、LDH、PAB、IL-6、IL-10和IFN-γ的百分比可用于区分RMPP与GMPP患者。多元logistic回归分析显示，CRP≥16.5mg/L、LDH≥417IU/L、IL-6≥14.75pg/ml是RMPP的显著预测因子。结论CRP≥16.5mg/L、LDH≥417IU/L、IL-6≥14.75pg/ml可能是儿童RMPP的重要预测指标，有助于早期识别RMPP。
Objective To analyze the clinical characteristics of refracory Mycoplasma pneumoniae pneumonia (RMPP), and explore the related factors predicting RMPP. Methods Retrospective analysis was performed on 634 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in our hospital between January 1, 2011 and December 31, 2014. The clinical features, laboratory data, radiological findings between the RMPP group and the general Mycoplasma pneumoniae pneumonia (GMPP) group were compared and the predictive values of related factors were analyzed. Results The median age of the RMPP patients (n = 145) was much older than that of the GMPP patients (n = 489) (P<0.01). We also found more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings in RMPP group, which needed oxygen more often, longer antibiotics administration and intensive care (P<0.05). Meanwhile, the levels of C-reactive protein (CRP), lactic dehydrogenase (LDH), immunoglobulin A (IgM), interleukin (IL)-6, IL-10, interferon gamma (IFN-γ) and the percentage of neutrophils, CD8+ in RMPP group were significantly higher than those in GMPP group (P<0.05); while the levels of prealbumin (PAB) were lower than that in GMPP group (P<0.01). In ROC curve analysis, the percentage of neutrophil, CRP, LDH, PAB, IL-6, IL-10 and IFN-γ were useful for differentiating patients with RMPP from those with GMPP. Multiple logistic regression analysis showed that the CRP≥16.5mg/L, LDH ≥417IU/L and IL-6 ≥14.75pg/ml were significant predictors regarding to RMPP. Conclusions CRP≥16.5mg/L, LDH ≥417IU/L and IL-6 ≥14.75pg/ml might be the significant predictors of RMPP in children, which can aid in early recognition of RMPP.