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
Clinical features and risk factors of macrolide-resistant severe Mycoplasma pneumoniae pneumonia in children
Received date: 2024-01-11
Online published: 2024-03-06
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。
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 . DOI: 10.12372/jcp.2024.24e0026
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
[1] | Liu TY, Lee WJ, Tsai CM, et al. Serum lactate dehydrogenase isoenzymes 4 plus 5 is a better biomarker than total lactate dehydrogenase for refractory Mycoplasma pneumoniae pneumonia in children[J]. Pediatr Neonatol, 2018, 59(5): 501-506. |
[2] | Gao LW, Yin J, Hu YH, et al. The epidemiology of paediatric Mycoplasma pneumoniae pneumonia in North China: 2006 to 2016[J]. Epidemiol Infect, 2019, 147: e192. |
[3] | 闫超, 孙红妹, 赵汉青, 等. 北京地区10年间住院患儿肺炎支原体感染流行特征分析[J]. 中华实用儿科临床杂志, 2019, 34(16): 1211-1214. |
[4] | Yan C, Xue G, Zhao H, et al. Molecular and clinical characteristics of severe Mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2019, 54(7): 1012-1021. |
[5] | 陈佳怡, 尚云晓. 耐大环内酯类药物的儿童肺炎支原体肺炎的研究进展[J]. 国际儿科学杂志, 2020, 47(5): 335-339. |
[6] | 王亨, 刘金荣, 赵顺英. 儿童重症肺炎支原体肺炎的诊治进展[J]. 中华实用儿科临床杂志, 2023, 38(11) : 842-845. |
[7] | Zhou Y, Shan Y, Cui Y, et al. Characteristics and outcome of severe Mycoplasma pneumoniae pneumonia admitted to PICU in Shanghai: a retrospective cohort study[J]. Crit Care Explor, 2021, 3(3): e0366. |
[8] | 胡亚美, 江载芳. 诸福棠实用儿科学[M]. 第8版. 北京: 人民卫生出版社, 2015: 1280-1282. |
[9] | 中华人民共和国国家卫生健康委员会. 儿童肺炎支原体肺炎诊疗指南(2023年版)[J]. 中国合理用药探索, 2023, 20(3): 16-24. |
[10] | 中华人民共和国国家健康委员会, 国家中医药局. 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志, 2019, 12(1): 6-13. |
[11] | Kim K, Jung S, Kim M, et al. Global trends in the proportion of macrolide-resistant Mycoplasma pneumoniae infections: a systematic review and meta-analysis[J]. JAMA Netw Open, 2022, 5(7): e2220949. |
[12] | Chen YC, Hsu WY, Chang TH. Macrolide-resistant Mycoplasma pneumoniae infections in pediatric community-acquired pneumonia[J]. Emerg Infect Dis, 2020, 26(7): 1382-1391. |
[13] | Yan C, Xue G, Zhao H, et al. Molecular and clinical characteristics of severe Mycoplasma pneumoniae pneumonia in children[J]. Pediatric Pulmonology, 2019, 54(7): 1012-1021. |
[14] | Lee KL, Lee CM, Yang TL, et al. Severe Mycoplasma pneumoniae pneumonia requiring intensive care in children, 2010-2019 [J]. J Formos Med Assoc, 2021, 120(1 Pt 1):281-291. |
[15] | 刘莉萍, 杨泽玉, 王玉, 等. 儿童重症肺炎支原体肺炎的临床特征及相关危险因素分析[J]. 中国小儿急救医学, 2023, 30(6): 451-456. |
[16] | Poddighe D, Comi EV, Brambilla I, et al. Increased total serum immunoglobulin E in children developing Mycoplasma pneumoniae-related extra-pulmonary diseases[J]. Iran J Allergy Asthma Immunol, 2018, 17(5): 490-496. |
[17] | Zhu Y, Luo Y, Li L, et al. Immune response plays a role in Mycoplasma pneumoniae pneumonia[J]. Front Immunol, 2023, 14: 1189647. |
[18] | 国家卫生计生委合理用药专家委员会儿童用药专业组. 中国儿童肺炎支原体感染实验室诊断规范和临床实践专家共识(2019年)[J]. 中华儿科杂志, 2020, 58(5): 366-373. |
[19] | Zheng Y, Hua L, Zhao Q, et al. The level of D-Dimer is positively correlated with the severity of Mycoplasma pneumoniae pneumonia in children[J]. Front Cell Infect Microbiol, 2021, 11: 687391. |
[20] | Qiu J, Ge J, Cao L. D-dimer: the risk factor of children's severe Mycoplasma pneumoniae pneumonia[J]. Front Pediatr, 2022, 10: 828437. |
[21] | 张敏. 儿童重症肺炎支原体肺炎的临床特点及影像学表现分析[J]. 中国CT和MRI杂志, 2020, 18(2): 37-40. |
[22] | Cho YJ, Han MS, Kim WS, et al. Correlation between chest radiographic findings and clinical features in hospitalized children with Mycoplasma pneumoniae pneumonia[J]. PLoS One, 2019, 14(8): e0219463. |
[23] | Guo H, He Z, Li M, et al. Imbalance of peripheral blood Th17 and Treg responses in children with refractory Mycoplasma pneumoniae pneumonia[J]. Infect Chemother, 2016, 22(3): 162-166. |
[24] | 刘峰. 肺炎支原体肺炎与预后相关的临床指标[J]. 临床儿科杂志, 2022, 40(4): 247-251. |
[25] | 赵顺英, 陈志敏, 刘瀚旻, 等. 国家卫生健康委员会《儿童肺炎支原体肺炎诊治指南(2023 年版)》重点解读[J]. 临床儿科杂志, 2023, 41(3): 224-228. |
[26] | Zhou LL, Li Y, Xu ZF, et al. Increased total serum immunoglobulin E is likely to cause complications of Mycoplasma pneumoniae pneumonia in children[J]. Front Cell Infect Microbiol, 2021, 11: 783635. |
/
〈 |
|
〉 |