Liu Jin-rong, Peng Yun, Yang Hai-ming, Li Hui-min, Zhao Shun-ying, Jiang Zai-fang
Respiratory and Infectious Diseases Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2012 Dec;50(12):915-8.
To investigate clinical characteristics and predictive factors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children so as to recognize and treat the disease earlier.
The data including febrile time, inflammatory markers (WBC, neutrophil, CRP) and radiological features of 213 children hospitalized with Mycoplasma pneumoniae pneumonia (MPP) (72 with refractory MPP and 141 with mild MPP were retrospectively analyzed). The primary diagnostic criteria of refractory MPP: the patient's condition still deteriorates after treatment with macrolides for more than 5 days. The independent variables which had significant difference in univariate analysis was analyzed by multivariate logistic regression analysis. The predictive criteria of RMPP were further applied in 100 other patients prospectively. Kappa test was used to evaluate the accuracy rate.
Refractory MPP patients: febrile time was more than 10 days, white blood cell (WBC) count was (3.8 - 18.5)×10(9)/L in peripheral blood routine test, CRP was 38 mg/L - > 160 mg/L, large lobar consolidation with high density (> 2/3 pulmonary lobe, CT value 40 - 50 HU, without air bronchogram). Mild MPP patients: febrile time was less than 10 days, CRP was often less than 40 mg/L. Independent risk factors for RMPP were febrile time, CRP, large consolidation area with high density in lungs with or without pleural effusion (OR = 1.586, P = 0.017; OR = 4.344, P = 0.001; OR = 2.660, P = 0.012), CT value 40 - 50 HU which were demonstrated by logistic regression analysis. The specificity, sensitivity and Youden index for this diagnostic test were respectively 0.96, 0.94 and 0.90 at a CRP cut off of 40 mg/L. The sensitivity, specificity, and Kappa value for the above criteria to diagnose RMPP were respectively 0.96, 0.94 and 0.9.
The predictive factors for RMPP are febrile time (> 10 days), CRP (> 40 mg/L), large lobar consolidation with high density (> 2/3 pulmonary lobe, CT value > 40 HU with or without pleural effusion) for the purpose of treating earlier.
探讨儿童难治性支原体肺炎（RMPP）的临床特征及预测因素，以便更早地认识和治疗该疾病。
回顾性分析213例住院的支原体肺炎（MPP）患儿（72例为难治性MPP，141例为轻症MPP）的发热时间、炎症指标（白细胞、中性粒细胞、C反应蛋白）及影像学特征。难治性MPP的主要诊断标准：使用大环内酯类药物治疗5天以上病情仍恶化。对单因素分析中有显著差异的自变量进行多因素logistic回归分析。将RMPP的预测标准前瞻性应用于另外100例患者。采用Kappa检验评估准确率。
难治性MPP患者：发热时间超过10天，外周血常规白细胞（WBC）计数为（3.8 - 18.5）×10⁹/L，C反应蛋白为38mg/L - >160mg/L，大叶实变且密度高（>2/3肺叶，CT值40 - 50HU，无空气支气管征）。轻症MPP患者：发热时间少于10天，C反应蛋白常小于40mg/L。RMPP的独立危险因素为发热时间、C反应蛋白、肺部大叶实变且密度高伴或不伴胸腔积液（比值比=1.586，P = 0.017；比值比=4.344，P = 0.001；比值比=2.660，P = 0.01），logistic回归分析显示CT值40 - 50HU。当C反应蛋白截断值为40mg/L时，该诊断试验的特异性、敏感性和约登指数分别为0.96、0.94和0.90。上述标准诊断RMPP的敏感性、特异性和Kappa值分别为0.96、0.94和0.9。
RMPP的预测因素为发热时间（>10天）、C反应蛋白（>40mg/L）、大叶实变且密度高（>2/3肺叶，CT值>40HU伴或不伴胸腔积液），以便更早地进行治疗。
