[儿童难治性肺炎支原体肺炎的临床特征]
[Clinical characteristics of refractory Mycoplasma pneumoniae pneumonia in children].
作者信息
Xu Jiang-Jiang, Shu Lin-Hua
机构信息
Department of Infection Control, Shanghai Children's Hospital/Shanghai Jiao Tong University, Shanghai 200062, China.
出版信息
Zhongguo Dang Dai Er Ke Za Zhi. 2018 Jan;20(1):37-42. doi: 10.7499/j.issn.1008-8830.2018.01.008.
OBJECTIVE
To provide a basis for early diagnosis and treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children by comparing the clinical characteristics of RMPP and general Mycoplasma pneumoniae pneumonia (MPP).
METHODS
Children with MPP hospitalized between October 2015 and December 2016 were selected as study subjects. According to the diagnostic criteria, children were divided into RMPP group (n=152) and MPP group (n=551). The differences between the two groups in the basic situation, clinical manifestations, infection parameters and myocardial enzymes were compared.
RESULTS
There were no significant differences in gender and age between the RMPP and MPP groups (P>0.05). The peak temperature in the RMPP group was significantly higher than that in the MPP group on the first day of admission (P<0.01). The percentage of children with augmentation in the RMPP group was lower than that in the MPP group (P=0.009). The percentage of neutrophils [Ne(%)] and serum procalcitonin (PCT) levels in the RMPP group were both higher than those in the MPP group (P<0.05), while the percentage of lymphocytes was significantly lower in the RMPP group (P<0.05). The serum levels of aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) in the RMPP group were also higher than those in the MPP group (P<0.05). Binary logistic regression analysis showed that the peak temperature and LDH were closely related to RMPP in children (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of the peak temperature and LDH for the diagnosis of RMPP was 0.647 and 0.637 respectively. In children ≤2 years old, when the threshold value of LDH was 400 U/L, the diagnostic sensitivity was 52.63% and the specificity was 54.84%. In children above 2 years old, when the threshold value of LDH was 335 U/L, the diagnostic sensitivity was 69.92% and the specificity was 51.55%.
CONCLUSIONS
The children with RMPP have a high fever in the early stage. Meanwhile there are abnormal laboratory test results in these children. Elevated serum LDH levels have a high clinical value of early diagnosis of RMPP, especially in children above 2 years.
目的
通过比较难治性支原体肺炎（RMPP）与普通支原体肺炎（MPP）的临床特征，为儿童RMPP的早期诊断和治疗提供依据。
方法
选取2015年10月至2016年12月住院的MPP患儿作为研究对象。根据诊断标准，将患儿分为RMPP组（n = 152）和MPP组（n = 551）。比较两组患儿的基本情况、临床表现、感染参数及心肌酶的差异。
结果
RMPP组与MPP组在性别和年龄方面差异无统计学意义（P > 0.05）。RMPP组入院首日的体温峰值显著高于MPP组（P < 0.01）。RMPP组肺部实变患儿的比例低于MPP组（P = 0.009）。RMPP组中性粒细胞百分比[Ne(%)]及血清降钙素原（PCT）水平均高于MPP组（P < 0.05），而淋巴细胞百分比则显著低于MPP组（P < 0.05）。RMPP组血清天冬氨酸转氨酶（AST）及乳酸脱氢酶（LDH）水平也高于MPP组（P < 0.05）。二元logistic回归分析显示，体温峰值及LDH与儿童RMPP密切相关（P < 0.05）。受试者工作特征（ROC）曲线分析显示，体温峰值及LDH诊断RMPP的曲线下面积（AUC）分别为0.647和0.637。在≤2岁儿童中，当LDH阈值为400 U/L时，诊断敏感性为52.63%，特异性为54.84%。在＞2岁儿童中，当LDH阈值为335 U/L时，诊断敏感性为69.92%，特异性为51.55%。
结论
RMPP患儿早期有高热表现，同时实验室检查结果异常。血清LDH水平升高对RMPP的早期诊断具有较高临床价值，尤其在＞2岁儿童中。
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