CAJ | 학술논문

目的：分析普通肺炎支原体肺炎（ MPP）进展为难治性MPP的相关因素，为早期识别难治性MPP提供参考。方法采集2012年9月至2013年8月复旦大学附属儿科医院住院的MPP且排除了其他常见病毒和细菌感染的病例，分为难治性MPP组和普通MPP组。复习文献收集与难治性MPP相关的指标，采集入院次日相关实验室检查指标、入院3 d内采集胸部X线和CT资料；以单因素和多因素分析进展为难治性MPP的相关因素。结果653例MPP患儿进入分析，占同期收治肺炎患儿的51.9%（653/1257例）。难治性MPP组300例，男171例；普通MPP组353例，男221例。①单因素分析显示，难治性MPP组年龄显著高于普通MPP组，（66.8±37.5）vs（51.4±34.4）月龄，>3岁的比例也显著高于普通MPP组（234/300 vs 224/353，P<0.01）。难治性MPP组发热时间和住院天数均显著高于普通MPP组（P均<0.01）；CK、LDH、HBDH、ALT、AST、CRP、PCT和IL-6水平难治性MPP组均显著高于普通MPP组；难治性MPP组肺渗出面积评分显著高于普通MPP组，（1.95±1.12）vs（1.55±0.97），P<0.01。②选择单因素分析后有统计学意义的临床、实验室和影像学指标行逐步Logistic回归分析，发热天数（OR=1.954，95%CI：1.403~2.722）、血清LDH水平（OR=1.009，95%CI：1.001~1.018）和肺渗出面积评分（OR=2.422，95%CI：1.111~5.279）是难治性MPP的独立相关因素。结论肺炎支原体已成为社区获得性肺炎住院患儿的主要病原体，难治性MPP病例常发生于3岁以上儿童。疾病早期存在持续高热、肺部渗出面积大、血清LDH水平增高是进展为难治性MPP的独立相关因素。
목적：분석보통폐염지원체폐염（ MPP）진전위난치성MPP적상관인소，위조기식별난치성MPP제공삼고。방법채집2012년9월지2013년8월복단대학부속인과의원주원적MPP차배제료기타상견병독화세균감염적병례，분위난치성MPP조화보통MPP조。복습문헌수집여난치성MPP상관적지표，채집입원차일상관실험실검사지표、입원3 d내채집흉부X선화CT자료；이단인소화다인소분석진전위난치성MPP적상관인소。결과653례MPP환인진입분석，점동기수치폐염환인적51.9%（653/1257례）。난치성MPP조300례，남171례；보통MPP조353례，남221례。①단인소분석현시，난치성MPP조년령현저고우보통MPP조，（66.8±37.5）vs（51.4±34.4）월령，>3세적비례야현저고우보통MPP조（234/300 vs 224/353，P<0.01）。난치성MPP조발열시간화주원천수균현저고우보통MPP조（P균<0.01）；CK、LDH、HBDH、ALT、AST、CRP、PCT화IL-6수평난치성MPP조균현저고우보통MPP조；난치성MPP조폐삼출면적평분현저고우보통MPP조，（1.95±1.12）vs（1.55±0.97），P<0.01。②선택단인소분석후유통계학의의적림상、실험실화영상학지표행축보Logistic회귀분석，발열천수（OR=1.954，95%CI：1.403~2.722）、혈청LDH수평（OR=1.009，95%CI：1.001~1.018）화폐삼출면적평분（OR=2.422，95%CI：1.111~5.279）시난치성MPP적독립상관인소。결론폐염지원체이성위사구획득성폐염주원환인적주요병원체，난치성MPP병례상발생우3세이상인동。질병조기존재지속고열、폐부삼출면적대、혈청LDH수평증고시진전위난치성MPP적독립상관인소。
Objective To analyze the associated factors of refractory Mycoplasma pneumoniae ( Mp ) pneumonia. Methods The cases of Mono-Mp pneumonia admitted in Children's Hospital of Fudan University from September 2012 to August 2013 were collected,and divided into two groups,refractory Mp pneumonia( RMPP ) and usual Mp pneumonia( UMPP ) . Laboratory outcomes collected by literature review were performed on the next day of admission. Chest X-ray and/or CT data were also collected in the first 3 days after admission. The laboratory outcomes and chest images were analyzed for the associated factors of refractory Mp pneumonia by univariate and multivariate logistic regression analysis. Results 653 cases of Mono-Mp pneumonia were collected,covered 51. 7%(653/1257)of the total number of pneumonia. There were 300 cases in refractory pneumonia group,171 boys and 129 girls. And there were 353 cases in normal pneumonia group,221 boys and 132 girls. ①Univariate analysis showed the age in RMPP group was significantly higher than that of UMPP group,(66. 8 ± 37. 5)vs(51. 4 ± 34. 4) months,P<0. 01;the proportion of cases over 3 years old in RMPP group was also significantly higher than that in UMPP group (234/300 vs 224/353,P<0. 01);the hospitalized days and febrile days in RMPP group were significantly higher than those in UMPP group(P<0. 01,respectively);laboratory outcomes in RMPP group,CK,LDH,HBDH,ALT,AST,CRP,PCT,IL-6, were significantly higher than those in UMPP group( P <0. 01,respectively);infiltration area of chest images in RMPP was significantly greater than that in UMPP,(1. 95 ± 1. 12)vs(1. 55 ± 0. 97),P <0. 01. ② Those significant outcomes in univariate analysis were chosen to perform stepwise logistic regression,and the analysis showed that febrile days( OR=1. 954, 95%CI:1. 403_2. 722),serum LDH level(OR=1. 009,95%CI:1. 001_1. 018),and infiltration area of chest images(OR=2. 422,95%CI:1. 111_5. 279)were the independent associated factors of RMPP. Conclusion Mp became a major pathogen of hospitalized children with CAP. Severe cases often occurred in children over 3 years old. The persistent fever,the large area of infiltration in chest images,high level of serum LDH in the early stage suggested that it may progress into severe pneumonia.