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

Abstract

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

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.

Figures/Tables 6

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References 24

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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	－

Risk factors analysis of severe refractory Mycoplasma pneumoniae pneumonia complicated with bronchitis obliterans in children

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