儿童重症难治性肺炎支原体肺炎并发闭塞性支气管炎危险因素分析

doi:10.12372/jcp.2025.24e0129

摘要/Abstract

摘要：

目的探讨儿童重症难治性肺炎支原体肺炎（SRMPP）并发闭塞性支气管炎的独立危险因素。方法回顾性分析2021年10月至2023年10月儿科住院的SRMPP患儿的临床资料，根据是否并发闭塞性支气管炎分为闭塞组和非闭塞组，比较两组间临床特征差异，采用多因素logistic回归分析SRMPP并发闭塞性支气管炎的独立危险因素，采用受试者工作特征（ROC）曲线分析各因素对于SRMPP并发闭塞性支气管炎的预测价值。结果纳入SRMPP 110例，男60例、女50例，中位年龄6.0（4.0~8.0）岁，40例并发闭塞性支气管炎。多因素logistic回归分析显示，D-二聚体水平升高和塑形黏液栓是SRMPP并发闭塞性支气管炎的独立危险因素（P<0.05），而高水平的前白蛋白是其独立保护因素（P<0.05）。ROC曲线分析发现D-二聚体升高、前白蛋白水平降低、塑形性黏液栓预测SRMPP并发闭塞性支气管炎的ROC曲线下面积（AUC）分别为0.69、0.74和0.70。结论对于血清前白蛋白水平≤13.2 mg/dL、血浆D-二聚体水平≥1.85 mg/L、塑形性黏液栓形成的SRMPP患儿，需警惕闭塞性支气管炎的发生。

关键词: 重症难治性肺炎支原体肺炎, 闭塞性支气管炎, 儿童

Abstract:

Objective To explore the independent risk factors of severe refractory Mycoplasma pneumoniae pneumonia (SRMPP) complicated with bronchitis obliterans in children. Methods The clinical data of children with SRMPP admitted to the Department of Pediatrics from October 2021 to October 2023 were retrospectively analyzed. All patients were divided into two groups: one group had the sequelae of bronchitis obliterans (occluded group) and the other group had not bronchitis obliterans (non-occluded group), and the differences in clinical characteristics between the two groups were compared. Multivariate logistic regression was used to analyze the independent risk factors of SRMPP complicated with bronchiolitis obliterans, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of each factor for SRMPP complicated with bronchiolitis obliterans. Results A total of 110 SRMPP children (60 boys and 50 girls) with a median age of 6.0 (4.0-8.0) years were included, 40 of whom were complicated with obliterated bronchitis. Multivariate logistic regression analysis showed that increased D-dimer level and plastic mucus plugs were independent risk factors for SRMPP complicated with bronchiolitis obliterans (P<0.05), while high levels of prealbumin were independent protective factor (P<0.05). ROC curve analysis showed that the areas under the ROC curve (AUC) of D-dimer increase, prealbumin decrease and plastic mucus plugs in predicting SRMPP complicated with bronchitis obliterans were 0.69, 0.74 and 0.70, respectively. Conclusions For SRMPP children with serum prealbumin level≤13.2 mg/dL,plasma D-dimer level≥1.85 mg/L, and plastic mucus plug formation, it is necessary to be alert to the occurrence of bronchitis obliterans.

Key words: severe refractory Mycoplasma pneumoniae pneumonia, bronchitis obliteran, child

刘冬霞, 金蓉, 林荣军. 儿童重症难治性肺炎支原体肺炎并发闭塞性支气管炎危险因素分析[J]. 临床儿科杂志, 2025, 43(1): 29-34.

LIU Dongxia, JIN Rong, LIN Rongjun. Risk factors analysis of severe refractory Mycoplasma pneumoniae pneumonia complicated with bronchitis obliterans in children[J]. Journal of Clinical Pediatrics, 2025, 43(1): 29-34.

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项目	闭塞组(n=40)	非闭塞组(n=70)	统计量	P
男性[n(%)]	22(55.0)	40(57.1)	χ²=0.05	0.827
年龄分布[n(%)]
<5岁	7(17.5)	26(37.1)	χ²=4.68	0.031
≥5岁	33(82.5)	44(62.9)
年龄[M(P₂₅~P₇₅)]/岁	6.5(5.0~8.0)	5.5(4.0~7.0)	Z=1.82	0.069
BMI($\bar{x} \pm s$)/kg·m^-2	15.5±1.4	15.4±1.0	t=0.81	0.419
过敏史[n(%)]	12(30.0)	9(12.9)	χ²=4.84	0.028
哮喘	7(17.5)	2(2.9)	χ²=5.45	0.020
过敏性鼻炎	3(7.5)	2(2.9)	χ²=0.42	0.516
特应性皮炎	1(2.5)	2(2.9)	χ²=0.00	1.000
食物过敏	1(2.5)	3(2.9)	χ²=0.00	1.000
热程[M(P₂₅~P₇₅)]/d	9.0(8.0~10.8)	9.0(8.0~10.0)	Z=0.10	0.924
热峰[M(P₂₅~P₇₅)]/℃	39.5(39.0~40.0)	39.5(39.0~40.0)	Z=1.41	0.159
气促[n(%)]	10(25.0)	16(22.9)	χ²=0.07	0.799
SpO₂<93%[n(%)]	13(32.5)	10(14.3)	χ²=5.11	0.024
呼吸音减低[n(%)]	26(65.0)	37(52.9)	χ²=1.53	0.216
气管镜检查[n(%)]
黏膜糜烂、坏死	28(70.0)	20(28.6)	χ²=17.76	<0.001
塑形性黏液栓	29(72.5)	17(24.3)	χ²=24.32	<0.001

项目	闭塞组(n=40)	非闭塞组(n=70)	统计量	P
WBC($\bar{x} \pm s$)/×10⁹·L^-1	8.2±2.4	7.5±2.0	t=1.61	0.110
NEUT($\bar{x} \pm s$)/%	68.9±8.1	67.3±7.4	t=1.02	0.312
PLT($\bar{x} \pm s$)/×10⁹·L^-1	263.5±30.0	252.2±33.3	t=1.76	0.081
PCT[M(P₂₅~P₇₅)]/ng·mL^-1	0.2(0.1~0.3)	0.2(0.1~0.3)	Z=0.64	0.519
CRP($\bar{x} \pm s$)/mg·L^-1	88.5±17.6	76.0±17.4	t=3.59	0.001
LDH($\bar{x} \pm s$)/U·L^-1	254.1±66.9	248.3±67.8	t=0.44	0.664
D-二聚体[M(P₂₅~P₇₅)]/mg·L^-1	2.4(1.7~3.2)	1.7(1.1~2.2)	Z=3.23	<0.001
IL-10($\bar{x} \pm s$)/ng·L^-1	5.6±1.3	4.8±1.4	t=2.99	0.003
ALB($\bar{x} \pm s$)/g·L^-1	42.7±4.6	42.7±4.5	t=0.04	0.965
前白蛋白[M(P₂₅~P₇₅)]/mg·dL^-1	10.3(6.7~13.5)	14.2(10.1~19.1)	Z=4.15	<0.001
ALT($\bar{x} \pm s$)/U·L^-1	10.9±2.9	10.3±2.2	t=1.33	0.185
CK-MB[M(P₂₅~P₇₅)]/ng·mL^-1	3.7(1.9~4.9)	3.7(1.9~4.9)	Z=0.07	0.948

项目	偏回归系数	标准误	χ²值	P	OR(95%CI)
前白蛋白	－0.20	0.06	12.06	0.001	0.82(0.73~0.92)
D-二聚体	0.81	0.30	7.28	0.007	2.25(1.25~4.05)
塑形性黏液栓	1.77	0.51	11.94	0.001	5.87(2.15~16.03)
常量	－0.40	0.97	0.17	0.679	－

项目	截断值	灵敏度/%	特异度/%	AUC	P	约登指数
前白蛋白	13.20 mg·dL^-1	61.43	75.00	0.74	<0.001	0.36
D-二聚体	1.85 mg·L^-1	61.43	67.50	0.69	0.001	0.29
塑形性黏液栓	－	80.00	60.00	0.70	<0.001	－