中国循证儿科杂志 ›› 2021, Vol. 16 ›› Issue (3): 229-232.

• 论著 • 上一篇    下一篇

儿童肺炎支原体肺炎合并黏液栓的病例对照研究

彭力, 钟礼立, 黄振, 黎燕, 张兵   

  1. 湖南省人民医院(湖南师范大学附属第一医院)儿童医学中心儿童呼吸病学湖南省重点实验室  长沙,410005
  • 收稿日期:2021-03-31 修回日期:2021-06-25 出版日期:2021-06-25 发布日期:2021-06-25
  • 通讯作者: 钟礼立

Mycoplasma pneumoniae pneumonia with mucous plug in children: A case-control study

PENG Li, ZHONG Lili, HUANG Zhen,LI Yan,ZHANG Bing   

  • Received:2021-03-31 Revised:2021-06-25 Online:2021-06-25 Published:2021-06-25
  • Contact: ZHONG Lili

摘要: 背景:部分儿童难治性肺炎支原体肺炎(MPP)合并黏液栓,可导致炎性狭窄或闭塞。 目的:探讨儿童肺炎支原体肺炎(MPP)合并黏液栓的影响因素。 设计:病例对照研究。 方法:纳入2018 年 6月至2020年6 月在湖南省人民医院儿童医学中心住院、符合MPP诊断且行纤维支气管镜检查的患儿,根据首次纤维支气管镜下是否观察到黏液栓分为无黏液栓组和黏液栓组。从病历系统中截取患儿的一般资料、实验室检查结果、影像学报告、治疗情况等,比较两组临床特征。 主要观察指标:MPP患儿合并黏液栓的相关因素。 结果:390例患儿进入本文分析,男 218 例、女 172 例,无黏液栓组287例、黏液栓组103例。与无黏液栓组相比,黏液栓组的平均发病年龄大,热程和住院时间长,发生肺实变、肺外并发症、使用激素的比例高,CPIS评分高,血淋巴细胞计数低,CRP、LDH、ALT和D-二聚体、MP-DNA(log10)高,使用糖皮质激素治疗的比例高,起病至使用大环内酯类药物、纤维支气管镜灌洗、全身糖皮质激素时间均长,行≥2次支气管肺泡灌洗治疗的比例高,住院时间长,差异均有统计学意义。Logistics回归分析显示,MP-DNA拷贝数(OR=4.35, 95%CI:1.66~11.38,P=0.003)、起病至使用糖皮质激素类药物时间(OR=3.70, 95%CI:1.42~9.64,P=0.007)与 MPP黏液栓形成有相关性。 结论:MPP患儿如发热时间长,炎症感染指标、MP-DNA载量及CPIS临床评分高,应及早使用糖皮质激素并进行肺泡灌洗治疗,以防止黏液栓的形成。

关键词: 肺炎支原体肺炎, 黏液栓塞, 儿童

Abstract: Background: Some children with refractory mycoplasma pneumoniae pneumonia (MPP) are complicated with mucus thrombus which can lead to inflammatory stenosis or occlusion. Objective: To investigate the factors affecting MPP with mucous plug in children. DesignCase-control study. Methods: Children with MPP who were hospitalized with bronchoalveolar lavage from June 2018 to June 2020 were included in the study. According to the fact whether mucous plug could be observed under fiberoptic bronchoscope for the first time, they were divided into non mucous plug group and mucous plug group. The general information, laboratory examination results, imaging reports and treatment of the children were intercepted from the medical record system and compared between the two groups. Main outcome measures: Related factors of mucus thrombus in children with MPP. Results: A total of 390 cases were included in this analysis, including 218 males and 172 females, with 287 cases in non mucous plug group and 103 cases in mucous plug group. Compared with the non mucous plug group, the mucous plug group had higher average age of onset, longer duration of fever and hospital stay, higher proportion of pulmonary consolidation, extrapulmonary complications, higher CPIS score, lower blood lymphocyte count, higher levels of CRP, LDH, ALT, D-dimer and MP-DNA (log10), and higher proportion of glucocorticoid treatment. The time from the onset to the use of macrolides, glucocorticoids and bronchofiberscope lavage was longer, and the proportion of patients who received bronchoalveolar lavage more than twice was higher. The differences between two groups were statistically significant. Logistic regression analysis showed that MP-DNA copy number (OR=4.35, 95% CI: 1.66-11.38, P=0.003) and the time from onset to glucocorticoid use (OR=3.70, 95% CI: 1.42-9.64, P=0.007) were associated with the formation of MPP mucus thrombus. Conclusion: MPP children have longer duration of fever, higher inflammatory infection index, and higher MP-DNA load and CPIS clinical score. Glucocorticoid and bronchoalveolar lavage should be used as early as possible to prevent the formation of mucous plug.

Key words: Mycoplasma pneumonia pneumonia, Mucous plug, Children