Clinical characteristics and factors related to the severity of symptoms of children with mycoplasma pneumonia
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摘要:
目的 探讨小儿肺炎支原体肺炎临床特征、影响病情程度的因素,为小儿肺炎支原体肺炎临床早期诊断和病情程度评估提供依据。 方法 收集2016年3月~2018年3月医院儿科收治的156例肺炎支原体肺炎患儿的临床资料,记录患儿性别、年龄、临床特征、感染疾病类型、影像学表现、实验室检查等,根据小儿肺炎支原体肺炎重症标准和患儿病情程度分为小儿肺炎支原体肺炎重症组(62例)和小儿肺炎支原体肺炎轻症组(94例),对结果进行相关分析。 结果 156例支原体肺炎患儿中,年龄最小2月,最大14岁;142例发热患儿中,以不规则热或弛张热为主,其中以高热或超高热常见,103例患儿热程为1~7 d,39例患儿热程为8~14 d;咳嗽106例,多为阵咳及干咳;98例患儿查体闻及细湿啰音;148例患儿胸片检查示胸部有炎症表现。实验室检查情况比较,重症组患儿与轻症组在红细胞沉降率、白细胞介素6、C反应蛋白、降钙素原的差异具有统计学意义(P<0.05)。红细胞沉降率、白细胞介素6、C反应蛋白、降钙素原是小儿支原体肺炎病情加重的独立危险因素。 结论 小儿支原体肺炎以发热、咳嗽为主要临床表现,存在过度炎症反应,红细胞沉降率、白细胞介素6、C反应蛋白及降钙素原的升高程度是疾病加重的危险因素,可为临床预防及治疗提供参考。 Abstract:Objective To investigate the clinical features of mycoplasma pneumonia in children and to analyze factors that affect the severity of the disease, so as to provide the basis for the early diagnosis and evaluation of mycoplasma pneumonia. Methods The clinical data of 156 children with mycoplasma pneumonia admitted to our hospital from March 2014 to March 2016 were included. According to the severity of mycoplasma pneumonia in children, these cases were divided into severe group (n=62) and mild group (n=94). Relevant analysis of these data was performed. Results Of the 156 cases with mycoplasma pneumonia, the youngest was 2 months old and the eldest was 14 years old; among 142 cases with fever, the main symptoms were irregular heat and remittent fever, among which high fever and over-high fever were most common. The course of fever of 103 cases was 1 to 7 days, and that of 39 cases was 8 to 14 days; there were 106 cases with cough, mostly paroxysmal cough and dry cough, 98 cases with fine rales, and the chest X-ray findings of 148 cases showed chest inflammation. Significant differences in ESR, IL-6, CRP and PCT were found between severe group and mild group (P<0.05). ESR, IL-6, CRP and PCT were all independent risk factors for the exacerbation of mycoplasma pneumonia in children. Conclusions The main manifestations of mycoplasma pneumonia in children are fever and cough, and excessive inflammation might occur. The increase of ESR, IL-6, CRP and PCT are all risk factors for the exacerbation of mycoplasma pneumonia, thus able to be used for clinical prevention and treatment. -
表 1 肺炎支原体肺炎患儿的实验室检查情况(Mean±SD)
分组 n CRP(mg/L) IL-6(pg/L) PCT(μg/L) ESR(mm/H) 重症组 62 58.23±9.66 42.81±8.21 0.46±0.10 38±10.03 轻症组 94 10.11±2.06 9.17±2.23 0.09±0.03 25±9.78 t 1.81 1.65 1.97 1.83 P <0.05 <0.05 <0.05 <0.05 CRP: C反应蛋白; IL-6: 白细胞介素6; PCT: 降钙素原; ESR: 红细胞沉降率. 表 2 肺炎支原体肺炎患儿病情严重程度单因素分析
因素 β S.E. Wald χ2 P 性别 0.422 0.401 1.449 11.742 >0.05 年龄 0.734 0.346 16.21 13.64 <0.05 发热 0.733 0.581 3.965 1.039 >0.05 咳嗽 0.179 0.890 1.332 0.317 >0.05 CRP上升 1.428 0.721 8.032 4.002 <0.05 IL-6上升 0.972 1.087 4.062 2.718 <0.05 PCT上升 1.038 1.026 7.927 3.121 <0.05 ESR上升 1.295 0.737 8.723 3.462 <0.05 CRP: C反应蛋白; IL-6: 白细胞介素6; PCT: 降钙素原; ESR: 红细胞沉降率. 表 3 肺炎支原体肺炎患儿疾病程度危险因素Logistic分析
危险因素 OR P 95%CI 年龄 8.283 <0.05 4.026-15.278 CRP上升 5.162 <0.05 2.295-9.788 IL-6上升 6.336 <0.05 3.652-14.261 PCT上升 4.021 <0.05 2.102-8.761 ESR上升 8.462 <0.05 4.128-18.965 CRP: C反应蛋白; IL-6: 白细胞介素6; PCT: 降钙素原; ESR: 红细胞沉降率. -
[1] Biljana M, Atanaskovic-Markovic M, SnezanaRadic, et al. Mycoplasma pneumoniae as a causative agent of community-acquired pneumon in children:clinical features and laboratory diagnosis[J]. Ital J Pediatr, 2014,40(12): 104-9. [2] Kashyap S, Sarkar M. Mycoplasma pneumonia: Clinical features and management[J]. Lung India, 2010, 27(2): 75-85. [3] Guo WL, Wang J, Zhu LY, et al. Differentiation between mycoplasma and viral community-acquired pneumonia in children with lobe or multi foci infiltration: a retrospective case study[J]. BMJ Open, 2015, 5(1): e006766-72. [4] Patra PK, Thirunavukkarasu AB. Unusual complication of Mycoplasma pneumonia in a five-year-old child[J]. Australas Med J, 2013, 6(2): 73-4. [5] Saraya T, Kurai D, Nakagaki K, et al. Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications[J]. Front Microbiol, 2014, 5(8): 410-7. [6] Gao S, Wang L, Zhu W, et al. Mycoplasma pneumonia infection and asthma: A clinical study[J]. Pak J Med Sci, 2015, 31(3): 548-51. [7] 何谭娴. 小儿支原体肺炎治疗的研究进展[J]. 医学综述, 2014, 20(8): 1432-4. [8] 何兆坤, 张 云, 张 晓. 小儿肺炎支原体肺炎的临床诊治分析[J]. 当代医学, 2012, 18(13): 46-7. [9] 胡亚美, 江载芳. 诸福棠实用儿科学[M]. 7版. 北京: 人民卫生出版社, 2002: 1204-5. [10] Diaz MH, Winchell JM. The evolution of advanced molecular diagnostics for the detection and characterization of mycoplasma pneumoniae[J]. Front Microbiol, 2016, 7(11): 232-8. [11] 姜之炎, 王雪峰, 王立宁, 等. 中西医结合治疗小儿支原体肺炎多中心疗效评价研究[J]. 世界中医药, 2017, 12(3): 536-9. [12] Zhuo Z, Li F, Chen X, et al. Mycoplasma pneumonia combined with pulmonary infarction in a child[J]. Int J Clin Exp Med, 2015, 8(1): 1482-6. [13] 乔红梅, 庞焕香, 张云峰, 等. 肺炎支原体肺炎患儿IL-6、IL-10、TNF-α的变化[J]. 临床儿科杂志, 2012, 30(1): 59-61. [14] Chih-Yung C, Chih-Jung C, Kin-Sun K, et al. Impact of bacterial and viral coinfection on mycoplasmal pneumonia in childhood community-acquired pneumonia[J]. J Microbiol Immunol Infect, 2015, 48(1): 158-63. [15] Zobel K, Martus P, Pletz MW, et al. Interleukin 6, lipopolysaccharide-binding protein and interleukin 10 in the prediction of risk and etiologic patterns in patients with community-acquired pneumonia: results from the German competence network CAPNETZ[J]. BMC Pulm Med, 2012, 12(6): 143-51. [16] 李 莉. 浅析不同年龄段小儿支原体肺炎患者的临床表现[J]. 当代医药论丛, 2017, 15(01): 35-6. [17] 郝婷婷. 血清IL-6, TNF-α水平在小儿难治性支原体肺炎中变化及临床意义[D]. 延安: 延安大学, 2017. [18] 陈志敏. 肺炎支原体肺炎再认识——从发病机制到临床治疗的探讨[J]. 中国实用儿科杂志, 2012, 27(4): 253-7. [19] 刘 慧. 住院患儿难治性肺炎支原体肺炎相关因素研究[D]. 贵州: 遵义医学院, 2012. [20] Patrick M. Meyer sauteur,Wendy W.J.unger.infection with and carriage of mycoplasma pneumoniae in children[J]. Front Microbiol, 2016, 21(7): 329-35. [21] 王宇军, 阮为勇, 冯伟伟, 等. 小儿支原体肺炎早期诊断临床分析[J]. 现代医学, 2016, 44(10): 1332-5. [22] 贺登科. 小儿重症支原体肺炎临床高危因素分析[J]. 现代实用医学, 2014, 26(7): 859-60. [23] Youn YS, Lee KY, Hwang JY, et al. Difference of clinical features in childhood Mycoplasma pneumoniae pneumonia[J]. BMC Pediatr, 2010, 10(3): 48-54. [24] 沈 科, 鲁央南, 叶 峰. 儿童重症支原体肺炎临床特征及危险因素分析[J]. 中国医院统计, 2015, 30(2): 6309-10. [25] 王程毅, 王世彪, 刘光华, 等. 重症肺炎支原体肺炎患儿临床特征与儿童危重病例评分的相关性分析[J]. 中国循证儿科杂志, 2016, 11(4): 280-4.
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