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| 儿童难治性肺炎支原体肺炎的早期预警指标 |
| Early warning indicators for refractory Mycoplasma pneumoniae pneumonia in children |
| 投稿时间：2023-07-04 修订日期：2023-09-14 |
| DOI： |
| 中文关键词: 难治性支原体肺炎；肺炎支原体；D-二聚体；早期诊断 |
| 英文关键词: Refractory Mycoplasam pneumoniae pneumonia;Mycoplasma pneumoniae;D-dimer;Early diagnosis |
| 基金项目: |
| 作者 | 单位 | 邮编 | | 刘冬霞* | 济宁市第一人民医院 | 272011 |
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| 中文摘要: |
| 目的 研究儿童难治性肺炎支原体肺炎的早期预警指标。方法 回顾分析2021年6月至2022年7月在济宁市第一人民儿科呼吸病区确诊治疗的220例肺炎支原体肺炎的患儿病历资料，根据其临床表现、实验室检查、临床疗效，将其分为普通支原体肺炎组(Mycoplasam pneumoniae pneumonia,MPP组，120例）和难治性肺炎支原体肺炎组（refractory Mycoplasam pneumoniae pneumonia,RMPP组，100例），比较2组患儿的一般临床资料、实验室检查结果，将差异有统计学意义的指标进行Logistic（LR）逐步回归分析，得出难治性肺炎支原体肺炎的独立预测指标，然后通过受试者工作特征曲线（ROC）分析找到各预测指标诊断价值最大的临界（cut off）值。结果 2组患儿的WBC计数、中性粒细胞百分比（NEUT%）的比较，差异均无统计学意义（Z =-1.492、-0.508，均P >0.05），RMPP组患儿的血小板计数（PLT）、C-反应蛋白、乳酸脱氢酶（LDH）、血浆D-二聚体的水平均高于MPP组，而血T淋巴细胞CD4+/CD8+比值明显低于MPP组，其差异均有统计学意义（Z =-5.112、-6.415、-9.632、-7.467、-10.106、-9.686，均为P <0.05），将其纳入Logistic逐步回归分析，结果显示C-反应蛋白(B值=0.046、S.E=0.0232、OR =1.047、P =0.048）、D-二聚体（B值=0.001、S.E=0.0005、OR=1.001、P =0.04）、CD4+/CD8+比值（B值=-1.975、S.E=0.9606、OR =0.139、P =0.04）是儿童难治性肺炎支原体肺炎的独立预测指标，CRP、血浆D-二聚体、CRP+D-二聚体、CD4+/CD8+比值ROC曲线下的面积分别为0.8764、0.9049、0.9013、0.8721，故CRP、CD4+/CD8+诊断正确性中等，血浆D-二聚体、D-二聚体+CRP联合诊断的正确性较高。结论 C-反应蛋白≥52.5mg/L、D-二聚体≥2750ng/ml、T淋巴细胞CD4+/CD8+比值≤1.375是儿童难治性支原体肺炎的早期独立预警指标，其中D-二聚体诊断价值最大。 |
| 英文摘要: |
| Objective To study the early warning indicators for refractory Mycoplasma pneumoniae pneumonia in children.Methods Retrospective analysis of the clinical datas of 220 children with Mycoplasma pneumoniae pneumonia diagnosed and treated in the First People's Pediatric Respiratory Ward of Jining City from June 2021 to July 2022,According to the clinical manifestations, laboratory tests, and clinical efficacy, the patients was divided into the ordinary mycoplasma pneumonia group (MPP group, 120 cases) and the refractory mycoplasma pneumonia group (RMPP group, 100 cases).After comparing the general clinical data and laboratory tests of two groups of children,logistic (LR) stepwise regression analysis was carried out on the statistically significant indicators to obtain independent predictive indicators for refractory Mycoplasma pneumoniae pneumonia,and then,the critical (cut off) value with the maximum diagnostic value for each predictive indicator is found,through the analysis of the receiver operating characteristic curve (ROC), The children in the RMPP group were divided into two groups according to the cut off value of independent predictors. Resuts There was no significant differences in WBC count and neutrophil percentage (NEUT%) between the two group children(all P>0.05),The RMPP group had higher levels of platelet count (PLT), C-reactive protein, lactate dehydrogenase (LDH), and plasma D-dimer than the MPP group, while the CD4+/CD8+ratio of blood T lymphocytes was significantly lower than the MPP group, and the differences were statistically significant（Z=-5.112、-6.415、-9.632、-7.467、-10.106、-9.686，all P<0.05).Bringing them into logistic stepwise regression analysis, the results showed that C-reactive protein (B-value=0.046,S.E=0.0232,OR=1.047,P=0.048),D-dimer(B=0.001, S.E=0.0005,OR=1.001,P=0.04), and CD4+/CD8+ ratio (B=-1.975, S.E=0.9606、OR=0.139, P=0.04) were independent predictors of refractory Mycoplasma pneumoniae pneumonia in children,The areas under the ROC curves of CRP, plasma D-dimer, CRP+D-dimer,and CD4+/CD8+ratio are 0.8764, 0.9049, 0.9013, and 0.8721, respectively. Therefore, the diagnostic accuracy of CRP and CD4+/CD8+is moderate, and the diagnostic accuracy of the plasma D-dimer and D-dimer+CRP is relatively high.ConclusionsC-reactive protein≥52.5mg/L, D-dimer≥2750ng/ml, and T lymphocyte CD4+/CD8+ ratio ≤1.375 are early independent warning indicators for refractory mycoplasma pneumonia in children, among which D-dimer has the greatest diagnostic value. |
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