儿童大环内酯类耐药重症肺炎支原体肺炎的临床特征及危险因素分析

doi:10.12372/jcp.2024.24e0026

摘要/Abstract

摘要：

目的探讨大环内酯类耐药重症肺炎支原体肺炎（SMPP）患儿临床特点及危险因素。方法回顾性分析2023年3月至9月在儿呼吸内科住院治疗的大环内酯类耐药肺炎支原体肺炎（MPP）患儿的临床资料，根据病情严重程度分为耐药重症组和耐药非重症组，比较两组间临床特征，分析影响SMPP发生的危险因素。结果纳入224例大环内酯类耐药MPP患儿，耐药重症组132例，男65例、女67例，中位年龄7.0（5.0~9.0）岁；耐药非重症组92例，男46例、女46例，中位年龄7.0（5.0~9.0）岁。二分类多因素logistic回归分析结果发现，发热时间延长，D-二聚体水平升高及肺实变是预测大环内酯类耐药SMPP发生的独立危险因素（P<0.05），而乳酸脱氢酶、IgE水平升高，可能与耐药SMPP发生相关（P<0.05）。ROC曲线分析显示，发热时间、乳酸脱氢酶、D-二聚体对于预测大环内酯类耐药SMPP的发生均有中等诊断价值（AUC>0.8，P<0.05）。所有耐药MPP患儿经治疗后痊愈出院。耐药重症组住院天数为7.0（6.0~9.0）天，显著长于耐药非重症组[6.0（5.0~7.0）天]；耐药重症组住院费用12 283（10 836~15 012）元，明显高于耐药非重症组[9 769（8 756~11 642）元]，差异均有统计学意义（P<0.01）。结论大环内酯类耐药SMPP发热时间及住院天数长，炎症指标明显升高，肺部影像学改变重，给患儿家庭带来的经济负担更沉重。

关键词: 肺炎支原体, 耐药, 重症肺炎, 危险因素, 儿童

Abstract:

Objective To explore the clinical features and risk factors of macrolide-resistant severe Mycoplasma pneumoniae pneumonia (SMPP) in children. Methods The clinical data of children with macrolide-resistant Mycoplasma pneumoniae pneumonia (MPP) who were hospitalized in the Department of Pediatric Respiratory Medicine from March to September 2023 were retrospectively analyzed. According to the severity of the disease, the patients were divided into macrolide-resistant severe group and macrolide-resistant non-severe group. The clinical characteristics of the two groups were compared, and the risk factors affecting SMPP were analyzed. Results A total of 224 children with macrolide resistant MPP were included, including 132 in the severe group (65 boys and 67 girls), with a median age of 7.0 (5.0-9.0) years. There were 92 patients in the macrolide-resistant non-severe group, 46 boys and 46 girls, with a median age of 7.0 (5.0-9.0) years. The results of binary logistic regression analysis showed that prolonged fever time, increased D-dimer level and lung consolidation were independent risk factors for predicting the occurrence of macrolide-resistant SMPP (P<0.05), while higher lactate dehydrogenase and IgE levels may be correlated with the occurrence of macrolide-resistant SMPP (P<0.05). ROC curve analysis showed that the duration of fever, lactate dehydrogenase and D-dimer had moderate diagnostic value in predicting the occurrence of macrolide-resistant SMPP (AUC>0.8, P<0.05). All patients with macrolide-resistant Mycoplasma pneumoniae pneumonia were cured and discharged after treatment. The length of hospital stay in the macrolide-resistant severe group was 7.0 (6.0-9.0) days, significantly longer than that in macrolide-resistant non-severe group [6.0 (5.0-7.0) days] (P<0.01). The hospitalization cost in the macrolide-resistant severe group was 12283 (10836-15012) yuan, which was significantly higher than that in the macrolide-resistant non-severe group [9769 (8756-11642) yuan], and the differences were statistically significant (P<0.01). Conclusions Children with macrolide-resistant SMPP experienced more prolonged fevers and hospital stays, markedly elevated inflammatory markers, and severe alterations in lung imaging, all of which raised the financial strain on their families.

Key words: Mycoplasma pneumoniae, macrolide-resistant, severe pneumonia, risk factor, child

陈梦雪, 李京阳, 杨芬, 田野, 李菁, 丁国栋. 儿童大环内酯类耐药重症肺炎支原体肺炎的临床特征及危险因素分析[J]. 临床儿科杂志, 2024, 42(3): 187-192.

CHEN Mengxue, LI Jingyang, YANG Fen, TIAN Ye, LI Jing, DING Guodong. Clinical features and risk factors of macrolide-resistant severe Mycoplasma pneumoniae pneumonia in children[J]. Journal of Clinical Pediatrics, 2024, 42(3): 187-192.

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项目	耐药重症组(n=132)	耐药非重症组(n=92)	统计量	P
年龄[M(P₂₅~P₇₅)]/岁	7.0(5.0~9.0)	7.0(5.0~9.0)	Z=0.04	0.971
男性[n(%)]	65(49.2)	46(50.0)	χ²=0.01	0.911
发热时间[M(P₂₅~P₇₅)]/d	8.0(7.0~9.0)	5.0(4.0~6.0)	Z=9.45	<0.001
白细胞计数[M(P₂₅~P₇₅)]×10⁹·L^-1	7.5(5.9~9.0)	6.6(5.3~8.1)	Z=1.78	0.076
血小板计数[M(P₂₅~P₇₅)]×10⁹·L^-1	319.5(252.8~382.5)	309.5(255.3~397.5)	Z=0.37	0.710
C-反应蛋白[M(P₂₅~P₇₅)]/mg·L^-1	14.0(6.3~27.0)	5.0(3.0~13.0)	Z=4.94	<0.001
降钙素原[M(P₂₅~P₇₅)]/ng·mL^-1	0.2(0.1~0.4)	0.1(0.1~0.3)	Z=3.59	<0.001
乳酸脱氢酶[M(P₂₅~P₇₅)]/U·L^-1	352.0(325.0~402.0)	285.5(259.8~317.0)	Z=8.94	<0.001
铁蛋白[M(P₂₅~P₇₅)]/μg·L^-1	120.0(89.0~164.8)	92.4(59.6~123.5)	Z=4.10	<0.001
红细胞沉降率[M(P₂₅~P₇₅)]/mm·h^-1	31.0(23.3~42.8)	24.0(17.0~33.0)	Z=3.23	0.001
肌钙蛋白Ⅰ[M(P₂₅~P₇₅)]/ng·mL^-1	0.002(0.002~0.003)	0.002(0.002~0.002)	Z=2.09	0.036
丙氨酸氨基转移酶[M(P₂₅~P₇₅)]/U·L^-1	16.0(13.0~23.0)	14.5(12.0~19.8)	Z=2.15	0.032
D-二聚体[M(P₂₅~P₇₅)]/mg·L^-1	0.8(0.6~1.1)	0.5(0.4~0.6)	Z=7.77	<0.001
IgE[M(P₂₅~P₇₅)]/IU·mL^-1	168.0(53.3~410.0)	80.4(31.2~229.0)	Z=2.85	0.004

项目	耐药重症组(n=132)	耐药非重症组(n=92)	统计量	P
胸腔积液	15(11.4)	0(0)	-	0.001¹⁾
肺实变	92(69.7)	41(44.6)	χ²=14.20	<0.001
病变范围			χ²=22.88	<0.001
斑片状或云絮状影	33(25.0)	52(56.5)
大片状阴影	99(75.0)	40(43.5)

变量	偏回归系数	标准误	χ²值	P	OR(95%CI)
IgE	0.00	0.00	7.47	0.006	1.00(1.00~1.01)
乳酸脱氢酶	0.03	0.01	14.82	<0.001	1.03(1.02~1.05)
发热时间	1.11	0.25	19.71	<0.001	3.04(1.86~4.97)
肺实变	1.60	0.65	6.07	0.014	4.97(1.39~17.79)
D-二聚体	4.37	1.34	10.57	0.001	79.15(5.68~1 103.49)
常量	-21.28	3.69	33.31	<0.001	-

变量	最佳阈值	AUC(95%CI)	P	灵敏度/%	特异度/%	约登指数
IgE/IU·mL^-1	128.0	0.60(0.52~0.68)	0.021	55.9	63.3	0.19
D-二聚体/mg·L^-1	0.6	0.81(0.74~0.87)	<0.001	73.9	78.5	0.52
乳酸脱氢酶/U·L^-1	324.5	0.85(0.80~0.91)	<0.001	74.8	86.1	0.61
发热时间/d	6.5	0.88(0.83~0.93)	<0.001	81.1	81.0	0.62