儿童肺炎支原体肺炎合并栓塞的危险因素及临床特征分析：一项回顾性研究。
Analysis of the risk factors and clinical features of Mycoplasma pneumoniae pneumonia with embolism in children: a retrospective study.
机构信息
Clinical School of Paediatrics, Tianjin Medical University, Tianjin, China.
Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.
出版信息
Ital J Pediatr. 2022 Aug 20;48(1):153. doi: 10.1186/s13052-022-01344-0.
BACKGROUND
Mycoplasma pneumoniae pneumonia (MPP) is a prevalent disease in community-acquired pneumonia among children. However, in addition to respiratory manifestations, it may also develop extra-pulmonary complications. Embolism is one of the uncommon extra-respiratory manifestations prone to severe sequelae and even death. This study aims to analyze the clinical features of MPP with embolism in children, and explore the associated risk factors of embolism in MPP patients.
METHODS
A retrospective case-control analysis was performed on 48 children with MPP admitted to our hospital wards between January 2010 and December 2021. Embolism group comprised children with embolism by CTA or MRA results, whereas the non-embolism group comprised children with clinical suspicion of embolism but negative diagnostic imaging support. The clinical features, laboratory findings and imaging were analyzed to explore the risk factors for embolism in children with MPP.
RESULTS
A total of 48 children with MPP were enrolled in the study (16 cases and 32 controls). In the embolism group, 10 patients (62.5%) had pulmonary embolism, 3 patients (18.75%) presented ventricle embolism, 2 patients (12.5%) presented cerebral and carotid artery embolism, one patient (6.25%) had a cerebral embolism, limb, and spleen, respectively. The univariate analysis revealed the maximum body temperature (Tmax), CRP, D-dimer (closest to CTA/MRA), the percentage of neutrophils (N%), pulmonary consolidation (⩾ 2/3 lobe), pleural effusion and atelectasis have significant differences between the embolism group and non-embolism group (P < 0.05). Multivariate logistic regression analysis showed that D-dimer (closest to CTA/MRA) > 3.55 mg/L [OR = 1.255 (95% CI: 1.025-1.537), P < 0.05], pulmonary consolidation (⩾ 2/3 lobe) [OR = 8.050 (95% CI: 1.341-48.327), P < 0.05], and pleural effusion [OR = 25.321 (95% CI: 2.738-234.205), P < 0.01] were independent risk factors for embolism in children with MPP.
CONCLUSION
In conclusion, MPP with embolism patients have more D-dimer values and severe radiologic manifestations.
背景
肺炎支原体肺炎（MPP）是儿童社区获得性肺炎中常见的疾病。然而，除了呼吸道表现外，它还可能发展为肺外并发症。栓塞是一种罕见的肺外表现，容易导致严重的后遗症，甚至死亡。本研究旨在分析儿童 MPP 合并栓塞的临床特征，并探讨 MPP 患者栓塞的相关危险因素。
方法
对 2010 年 1 月至 2021 年 12 月我院病房收治的 48 例 MPP 患儿进行回顾性病例对照分析。栓塞组为 CTA 或 MRA 结果提示栓塞的患儿，而非栓塞组为临床怀疑栓塞但无诊断性影像学支持的患儿。分析临床特征、实验室检查和影像学结果，探讨儿童 MPP 栓塞的危险因素。
结果
共纳入 48 例 MPP 患儿（16 例栓塞组和 32 例非栓塞组）。栓塞组 10 例（62.5%）患儿为肺栓塞，3 例（18.75%）患儿为心室栓塞，2 例（12.5%）患儿为脑和颈动脉栓塞，1 例（6.25%）患儿为脑、肢体和脾脏分别栓塞。单因素分析显示，栓塞组与非栓塞组最大体温（Tmax）、CRP、D-二聚体（最接近 CTA/MRA）、中性粒细胞百分比（N%）、肺实变（≥2/3 叶）、胸腔积液和肺不张有显著差异（P<0.05）。多因素 logistic 回归分析显示，D-二聚体（最接近 CTA/MRA）>3.55mg/L[比值比（OR）=1.255（95%可信区间：1.025-1.537），P<0.05]、肺实变（≥2/3 叶）[OR=8.050（95%可信区间：1.341-48.327），P<0.05]和胸腔积液[OR=25.321（95%可信区间：2.738-234.205），P<0.01]是儿童 MPP 栓塞的独立危险因素。
结论
综上所述，合并栓塞的 MPP 患儿 D-二聚体值较高，影像学表现较重。
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