儿童大环内酯类耐药肺炎支原体肺炎发生塑型性支气管炎的临床特征及危险因素分析

doi:10.12372/jcp.2026.25e1017

摘要/Abstract

摘要：

目的探讨儿童大环内酯类耐药肺炎支原体肺炎(MRMPP)发生塑型性支气管炎(PB)的临床特征及危险因素。方法回顾性分析2023年10月至2024年1月于医院呼吸科住院的156例MRMPP患儿的临床资料，根据电子支气管镜检查结果分为PB组（44例）和非PB组（112例）。比较两组临床特征及实验室指标，对单因素分析有统计学意义的连续变量进行ROC曲线分析，确定最佳截断值并转化为定性变量，进一步行多因素二元logistic回归分析筛选独立危险因素。结果单因素分析显示，PB组在胸腔积液、重症肺炎、氧疗支持、住院时长、年龄、发热时长、C-反应蛋白、降钙素原、D-二聚体、乳酸脱氢酶及肺泡灌洗液肺炎支原体DNA水平方面均高于非PB组（均P<0.05）。ROC曲线分析得出D-二聚体、乳酸脱氢酶和肺泡灌洗液肺炎支原体DNA的截断值分别为1.655 mg/L、364.5 IU/mL和428 500 copies/mL。多因素logistic回归分析显示，D-二聚体>1.655 mg/L（OR=14.002，95%CI：4.063~48.251）、乳酸脱氢酶>364.5 U/L（OR=6.865，95%CI：2.251~20.933）和肺泡灌洗液肺炎支原体DNA>428 500 copies/mL（OR=12.306，95%CI：3.586~42.236）是MRMPP发生PB的独立危险因素（均P<0.001）。结论 D-二聚体、乳酸脱氢酶和肺泡灌洗液肺炎支原体DNA水平升高是儿童MRMPP发生PB的独立危险因素，临床中监测这些指标有助于早期识别PB风险。

关键词: 肺炎支原体肺炎, 大环内酯类耐药, 塑型性支气管炎, 儿童

Abstract:

Objective To investigate the clinical characteristics and risk factors for plastic bronchitis (PB) in children with macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP). Methods A retrospective analysis was conducted on 156 children hospitalized with MRMPP in the Department of Respiratory between October 2023 and January 2024. Based on electronic bronchoscopy findings, patients were divided into a PB group (n=44) and a non-PB group (n=112). Clinical characteristics and laboratory indicators were compared between the two groups. Continuous variables showing statistical significance in univariate analysis were analyzed using receiver operating characteristic (ROC) curves to determine optimal cut-off values, which were then used to convert these variables into categorical variables. Independent risk factors were identified via multivariate binary logistic regression analysis. Results Univariate analysis revealed that the PB group had significantly higher incidences of pleural effusion, severe pneumonia, oxygen therapy support, as well as significantly longer hospitalization duration, older age, longer fever duration, and higher levels of C-reactive protein, procalcitonin, D-dimer, lactate dehydrogenase (LDH), and M. pneumoniae DNA in bronchoalveolar lavage fluid (BALF) compared to the non-PB group (all P<0.05). ROC curve analysis determined the optimal cut-off values for D-dimer, LDH, and BALF M. pneumoniae DNA to be 1.655 mg/L, 364.5 IU/mL, and 428500 copies/mL, respectively. Multivariate logistic regression analysis identified D-dimer>1.655 mg/L (OR=14.002, 95% CI: 4.063-48.251), LDH>364.5 IU/mL (OR=6.865, 95% CI: 2.251-20.933), and BALF M. pneumoniae DNA>428500 copies/mL (OR=12.306, 95% CI: 3.586-42.236) as independent risk factors for PB in MRMPP (all P<0.001). Conclusion Elevated levels of D-dimer, LDH, and M. pneumoniae DNA in BALF are independent risk factors for PB in children with MRMPP. Monitoring these indicators is crucial for the early identification of children at risk of developing PB.

Key words: Mycoplasma pneumoniae pneumonia, macrolide-resistant, plastic bronchitis, child

中图分类号:

牛艳华, 董晓艳. 儿童大环内酯类耐药肺炎支原体肺炎发生塑型性支气管炎的临床特征及危险因素分析[J]. 临床儿科杂志, 2026, 44(2): 111-117.

NIU Yanhua, DONG Xiaoyan. Clinical characteristics and risk factors for plastic bronchitis in children with macrolide-resistant Mycoplasma pneumoniae pneumonia[J]. Journal of Clinical Pediatrics, 2026, 44(2): 111-117.

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变量	非PB组（n=112例）	PB组（n=44例）	χ²值	P
性别（男）	54(48.21）	20(45.45）	0.10	0.756
胸腔积液	38(33.93)	28(63.64)	11.42	<0.001
重症肺炎	89(79.46)	41(93.18)	4.28	0.039
氧疗支持	4(3.57)	8(18.18)	9.50	0.002
使用呼吸机	0(0.00）	2(4.55）	-	0.078^1）
肺不张	8(7.14)	6(13.64)	1.63	0.202

变量	非PB组（n=112例）	PB组（n=44例）	统计量	P
住院时长[M(P₂₅~P₇₅)]/d	6.00(6.00~7.00)	8.00(6.00~9.00)	Z=3.81	<0.001
年龄（$\bar{x}±s$±s）/月	89.10±31.10	100.43±28.81	t=2.16	0.038
入院时发热时长（$\bar{x}±s$）/d	5.86±2.09	7.09±2.13	t=3.22	0.002
总发热时长（$\bar{x}±s$）/d	6.40±2.15	8.39±2.28	t=4.96	<0.001
白细胞计数[M(P₂₅~P₇₅)]×10⁹·L^-1	7.53(5.71~10.13)	7.03(5.85~9.60)	Z=0.13	0.900
血小板计数[M(P₂₅~P₇₅)]×10⁹·L^-1	287.00(242.50~387.25)	297.00(236.00~351.00)	Z=0.07	0.943
C-反应蛋白[M(P₂₅~P₇₅)]/mg·L^-1	9.00(5.00~17.75)	13.50(5.25~30.25)	Z=2.24	0.025
PCT[M(P₂₅~P₇₅)]/ng·mL^-1	0.04(0.02~0.07)	0.06(0.03~0.09)	Z=2.29	0.022
D-二聚体[M(P₂₅~P₇₅)]/mg·L^-1	0.53(0.36~0.77)	1.93(0.71~3.06)	Z=5.78	<0.001
LDH[M(P₂₅~P₇₅)]/U·L^-1	345.00(295.75~423.50)	477.50(378.00~665.00)	Z=4.83	<0.001
IgE[M(P₂₅~P₇₅)]/IU·mL^-1	145.00（66.10~410.00）	286.00(39.70~670.25)	Z=0.47	0.635
BALF MP-DNA[M(P₂₅~P₇₅)]/copies· mL^-1	415 000(71 600~3 630 000)	3 705 000(811 500~8 850 000)	Z=3.24	0.001

检验变量	截断值	敏感度	特异性	AUC	P	95% CI
住院时长/d	7.5	0.545	0.764	0.688	<0.001	0.595~0.781
年龄/月	87.5	0.750	0.473	0.604	0.045	0.507~0.700
入院时发热时长/d	6.5	0.591	0.636	0.651	0.004	0.559~0.743
总发热时长/d	6.5	0.864	0.518	0.725	<0.001	0.641~0.809
CRP/mg·L^-1	18.5	0.409	0.791	0.614	0.027	0.515~0.714
PCT/ng·mL^-1	0.055	0.545	0.673	0.623	0.018	0.527~0.718
D-二聚体/mg·L^-1	1.655	0.591	0.927	0.796	<0.001	0.710~0.883
LDH/U·L^-1	364.5	0.864	0.600	0.750	<0.001	0.661~0.838
BALF MP-DNA/copies· mL^-1	428 500	0.841	0.500	0.665	0.001	0.571~0.759

影响因素	偏回归系数	标准误	χ²值	OR(95% CI)	P
D-二聚体>1.655 mg·L^-1	2.639	0.631	17.480	14.002(4.063~48.251)	<0.001
LDH>364.5 U·L^-1	1.926	0.569	11.469	6.865(2.251~20.933)	<0.001
BALF MP-DNA>428 500 copies·mL^-1	2.510	0.629	15.917	12.306(3.586~42.236)	<0.001
常量	-4.592	0.750	37.527	-	<0.001