气道黏液栓形成的肺炎支原体肺炎患儿的预后分析

Prognostic judgment of children with Mycoplasma pneumoniae pneumonia associated with airway mucous plug formation

摘要:

目的 探讨气道黏液栓形成的肺炎支原体肺炎(MPP)患儿吸收缓慢者的临床特征及治疗不足, 为判断预后及指导治疗提供依据。方法 回顾性分析2012年5月至2014年5月收治的67例纤维支气管镜下表现为气道黏液栓形成的MPP患儿的病例资料, 根据复查影像学是否恢复正常, 分为肺炎吸收缓慢组(n=30)和对照组(n=37)。比较两组临床表现、实验室指标、影像学结果及治疗的差异, 对有显著差异的指标行受试者工作特征曲线(ROC曲线)分析。结果 肺炎吸收缓慢组外周血中性细胞比例(N)、C反应蛋白(CRP)、乳酸脱氢酶、纤维蛋白原(FIB)、IgM水平及胸腔积液发生率均高于对照组(P<0.05), 总热程、首次应用阿奇霉素及纤维支气管镜治疗时间均长于对照组(P<0.05)。ROC曲线分析结果显示总热程≥11.5 d、N≥70.7%、CRP≥57 mg/L、FIB≥4.7 g/L、首次行纤维支气管镜治疗时间≥13.5 d时, 敏感度均大于0.643, 特异度均高于0.727。结论 黏液栓形成的MPP患儿总热程、N、CRP、FIB及首次行纤维支气管镜治疗时间对提示肺炎吸收时间超过2个月均有一定的诊断价值。

Abstract:

Objective To investigate the clinical characteristics and treatment defects in slow-to-recover children with Mycoplasma pneumoniae pneumonia (MPP) associated with airway mucous plug formation, and to provide a basis for prognostic judgment and therapeutic guidance. Methods A retrospective analysis was performed on the clinical data of 67 children with MPP who were admitted between May 2012 and May 2014 and showed airway mucous plug formation in fiberoptic bronchoscope examinations. Based on the results of re-examinations using imaging methods, all patients were classified into a slow-to-recover group (n=30) and a control group (n=37). Comparisons of clinical outcomes, laboratory indices, imaging findings, and treatment methods were performed between the two groups. The receiver operating characteristic (ROC) curves were drawn to analyze the indices with significant differences. Results The percentage of neutrophils, levels of C-reactive protein (CRP), lactic dehydrogenase (LDH), fibrinogen (FIB), and IgM in peripheral blood, and incidence of pleural effusion were significantly higher in the slow-to-recover group than in the control group (P<0.05). The fever duration and treatment time of azithromycin and fiberoptic bronchoscope for the first time were significantly longer in the slow-to-recover group than in the control group (P<0.05). The results of ROC curve analysis showed that the optimal cut-off points of fever duration, percentage of neutrophils, levels of CRP and FIB, and treatment time of fiberoptic bronchoscope for the first time were 11.5 days, 70.7%, 57 mg/L, 4.7 g/L, and 13.5 days, respectively, with sensitivity and specificity higher than 0.643 and 0.727. Conclusions The fever duration, percentage of neutrophils, level of CRP, level of FIB, and treatment time of fiberoptic bronchoscope for the first time can predict a recovery time longer than two months in children with MPP associated with mucous plug formation.