不同指标对节段性肺炎支原体肺炎患儿炎症吸收速度的预测价值研究
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摘要
目的评价不同指标对节段性肺炎支原体肺炎(MPP)患儿炎症吸收速度的预测价值。方法选取2013年1月—2014年12月在河北省儿童医院呼吸心内一科住院治疗的节段性MPP患儿156例,根据病程1个月内肺炎是否完全吸收分为部分吸收组(缓慢吸收组,n=116)与完全吸收组(对照组,n=40)。回顾性分析患儿的临床资料,比较两组热程、外周血白细胞计数(WBC)、C反应蛋白(CRP)、ALT、乳酸脱氢酶(LDH)、Ig A、Ig M、IgG及行纤维支气管镜(纤支镜)检查比例和时间,并对有统计学意义的指标进一步绘制受试者工作特征(ROC)曲线,分析其预测价值。结果两组外周血WBC、IgG及行纤支镜检查比例间差异无统计学意义(P>0.05);而缓慢吸收组热程长于对照组,CRP、ALT、LDH、Ig A、Ig M高于对照组,行纤支镜时间晚于对照组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,热程、CRP、ALT、LDH、行纤支镜时间的ROC曲线下面积(AUC)分别为0.666、0.796、0.630、0.707、0.804,对节段性MPP患儿炎症吸收速度的预测有统计学意义(P<0.05);而Ig A、Ig M的AUC分别为0.623、0.569,对节段性MPP患儿炎症吸收速度的预测无统计学意义(P>0.05)。结论热程、CRP、ALT、LDH、行纤支镜时间可预测节段性MPP患儿炎症吸收速度,且CRP、LDH、行纤支镜时间的预测价值优于热程、ALT。
Objective To assess the value of different indexes for predicting the inflammation absorption rate in children with segmental mycoplasma pneumoniae pneumonia( MPP). Methods From January 2013 to December 2014,we enrolled 156 children with segmental MPP who were hospitalized in the First Department of Respiratory and Cardiovascular Medicine of Children's Hospital of Hebei Province. According to pneumonia absorption degree within 1 month,the children were divided into partial absorption group( slow absorption group,n = 116) and complete absorption group( control group,n = 40).A retrospective analysis was made on the clinical data of these children; comparison was made between the two group in duration of fever, WBC of peripheral blood, CRP, ALT, LDH, Ig A, Ig M, IgG and proportion and time of fiber bronchoscope examination; ROC curves of the indexes that showed significant difference between the two groups were made to analyze their predictive value. Results The two groups were not significantly different in WBC of peripheral blood,IgG and proportion of fiber bronchoscope examination( P > 0. 05). Slow absorption group had longer duration of fever,higher CRP,ALT,LDH,Ig A and Ig M,and later start time of fiber bronchoscope examination than control group( P < 0. 05). ROC curves showed that the AUC of duration of fever,CRP,ALT,LDH and time of fiber bronchoscope examination was 0. 666,0. 796,0. 630,0. 707 and 0. 804 respectively,indicating significant predictive value for the inflammation absorption rate in children with segmental MPP( P <0. 05); the AUC of Ig A and Ig M was 0. 623 and 0. 569 respectively,indicating no significant predictive value( P > 0. 05).Conclusion Duration of fever, CRP, ALT, LDH and time of fiber bronchoscope examination can predict inflammation absorption rate in children with segmental MPP, and CRP, LDH and time of fiber bronchoscope examination have better predictive value than duration of fever and ALT.
Objective To assess the value of different indexes for predicting the inflammation absorption rate in children with segmental mycoplasma pneumoniae pneumonia( MPP). Methods From January 2013 to December 2014,we enrolled 156 children with segmental MPP who were hospitalized in the First Department of Respiratory and Cardiovascular Medicine of Children's Hospital of Hebei Province. According to pneumonia absorption degree within 1 month,the children were divided into partial absorption group( slow absorption group,n = 116) and complete absorption group( control group,n = 40).A retrospective analysis was made on the clinical data of these children; comparison was made between the two group in duration of fever, WBC of peripheral blood, CRP, ALT, LDH, Ig A, Ig M, IgG and proportion and time of fiber bronchoscope examination; ROC curves of the indexes that showed significant difference between the two groups were made to analyze their predictive value. Results The two groups were not significantly different in WBC of peripheral blood,IgG and proportion of fiber bronchoscope examination( P > 0. 05). Slow absorption group had longer duration of fever,higher CRP,ALT,LDH,Ig A and Ig M,and later start time of fiber bronchoscope examination than control group( P < 0. 05). ROC curves showed that the AUC of duration of fever,CRP,ALT,LDH and time of fiber bronchoscope examination was 0. 666,0. 796,0. 630,0. 707 and 0. 804 respectively,indicating significant predictive value for the inflammation absorption rate in children with segmental MPP( P <0. 05); the AUC of Ig A and Ig M was 0. 623 and 0. 569 respectively,indicating no significant predictive value( P > 0. 05).Conclusion Duration of fever, CRP, ALT, LDH and time of fiber bronchoscope examination can predict inflammation absorption rate in children with segmental MPP, and CRP, LDH and time of fiber bronchoscope examination have better predictive value than duration of fever and ALT.
引文
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[3]朱影,刘晓琳,叶玉兰.肺炎支原体所致大叶性肺炎46例临床分析[J].中华全科医学,2012,10(4):560-561.
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[6]Ding SG,Wang YT,Wu D,et al.Segmental mycoplasma pneumoniae pneumonia in 69 children[J].Journal of Applied Clinical Pediatrics,2008,23(4):283-284.(in Chinese)丁圣刚,王亚亭,吴德,等.节段性肺炎支原体肺炎69例[J].实用儿科临床杂志,2008,23(4):283-284.
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[9]Li BJ,Liu JG.X-ray manifestation of child mycoplasma pneumoniae pneumonia[J].Journal of China Clinic Medical Imaging,2004,15(3):169-170.(in Chinese)李伯菊,刘建国.小儿肺炎支原体肺炎X线表现[J].中国临床医学影像杂志,2004,15(3):169-170.
[10]徐虹,刘利英,贺海燕.肺炎支原体肺炎患儿临床特征分析[J].实用心脑肺血管病杂志,2014,22(1):75-76.
[11]Vervloet LA,Marguet C,Camargos PA.Infection by mycoplasma pneumoniae and its importance as an etiological agent in childhood community-acquired pneumonias[J].Braz J Infect Dis,2007,11(5):507-514.
[12]Wang YJ,Bai XM,Liu ZJ,et al.The changes and clinic significance of immune function,serum procalcitonin and Creactive protein in children with mycoplasma pneumoniae pneumonia[J].Chinese Pediatric Emergency Medicine,2014,21(8):501-503,507.(in Chinese)王颖洁,白雪梅,刘正娟,等.儿童肺炎支原体肺炎免疫功能、降钙素原及C-反应蛋白变化及意义[J].中国小儿急救医学,2014,21(8):501-503,507.
[13]Han RZ,Hou AC,Lyu F.Changes of serum myocardial zymogram in children with mycoplasma pneumoniae pneumonia and its clinical significance[J].Journal of Applied Clinical Pediatrics,2007,22(16):1225-1226.(in Chinese)韩瑞珠,侯安存,吕芳.肺炎支原体肺炎患儿心肌酶水平变化的意义[J].实用儿科临床杂志,2007,22(16):1225-1226.
[14]Sánchez-Vargas FM,Gómez-Duarte OG.Mycoplasma pneumoniae——an emerging extra pulmonary pathogen[J].Clin Microbiol Infect,2008,14(2):105-117.
[15]Mamessier E,Botturi K,Verloet D,et al.Tregulatory lymphocytes atopy and asthma:a new concept in three dimensions[J].Rev Mal Respir,2005,22(2):305-311.
[16]Tanaka H,Narita M,Teramoto S,et al.Role of interleukin-18and T-helper type 1 cytokines in the development of mycoplasma pneumoniae pneumonia in adults[J].Chest,2002,121(5):1493-1497.
[17]Li CM,Gu L,Yin SJ,et al.Age-specific mycoplasma pneumoniae pneumonia-associated myocardial damage in children[J].J Int Med Res,2013,41(5):1716-1723.
[18]Liu Y,Li M.Research progression of pathogenesis of mycoplasma pneumoniae pneumonia[J].Journal of Clinical Pediatrics,2011,29(2):196-198.(in Chinese)刘洋,李敏.肺炎支原体肺炎发病机制研究进展[J].临床儿科杂志,2011,29(2):196-198.
[19]Suzuyama Y,Iwasaki H,Izumikawa K,et al.Clinical complications of mycoplasma pneumoniae disease——other organs[J].Yale J Biol Med,1983,56(5/6):487-491.
[20]Zhao SQ.Pathogenesis of mycoplasmal pneumoniae pneumonia[J].Pediatric Emergency Medicine,2002,9(3):129-130.(in Chinese)赵淑琴.肺炎支原体肺炎的发病机制[J].小儿急救医学,2002,9(3):129-130.
[21]邓建平,陈云鹏.C反应蛋白、白细胞与中性粒细胞检查在炎症反应中的意义[J].实验与检验医学,2010,28(3):314-326.
[22]Scala R,Naldi M,Maccari U.Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community acquired pneumonia[J].Crit Care,2010,14(2):R80.
[23]An SH,Wang MM,Li JY,et al.Role of flexible bronchoscopy in the diagnosis and treatment of refractory pneumonia in children[J].Chinese Journal of Contemporary Pediatrics,2011,13(7):547-550.(in Chinese)安淑华,王萌萌,李金英,等.纤维支气管镜在小儿难治性肺炎诊断与治疗中的应用[J].中国当代儿科杂志,2011,13(7):547-550.
[24]Liang Y,Liu XC,Jiang QB.Role of flexible bronchoscopy in the treatment of infection-associated atelectasis in children[J].Chinese Journal of Pediatrics,2003,41(9):649-651.(in Chinese)梁昱,刘玺诚,江沁波.纤维支气管镜在儿童感染性肺不张治疗中的作用[J].中华儿科杂志,2003,41(9):649-651.
[2]Touati A,Pereyre S,Bouziri A,et al.Prevalence of mycoplasma pneumoniae-associated respiratory tract infections in hospitalized children:results of a 4-year prospective study in Tunis[J].Diagn Microbiol Infect Dis,2010,68(2):103-109.
[3]朱影,刘晓琳,叶玉兰.肺炎支原体所致大叶性肺炎46例临床分析[J].中华全科医学,2012,10(4):560-561.
[4]Zuo HM,Liu XY,Jiang ZF.Risk factors of developing sequelae after mycoplasma pneumoniae pneumonia in children[J].Journal of Clinical Pediatrics,2008,26(7):566-569.(in Chinese)左慧敏,刘秀云,江载芳.肺炎支原体肺炎患儿发生后遗症的危险因素研究[J].临床儿科杂志,2008,26(7):566-569.
[5]Wang Q,Jiang JF,Zhao DY.Risk factors of extrapulmonary complications after mycoplasma pneumoniae pneumonia[J].Journal of Applied Clinical Pediatrics,2013,28(10):749-751.(in Chinese)王全,蒋健飞,赵德育.肺炎支原体肺炎发生肺外并发症的危险因素[J].中华实用儿科临床杂志,2013,28(10):749-751.
[6]Ding SG,Wang YT,Wu D,et al.Segmental mycoplasma pneumoniae pneumonia in 69 children[J].Journal of Applied Clinical Pediatrics,2008,23(4):283-284.(in Chinese)丁圣刚,王亚亭,吴德,等.节段性肺炎支原体肺炎69例[J].实用儿科临床杂志,2008,23(4):283-284.
[7]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2010:1204-1205.
[8]Chen QF,Yu G,Zhang HL,et al.The features of clinic,radiography and bronchoscope of mycoplasma pneumoniae pneumonia in children[J].Journal of Clinical Pediatrics,2009,27(1):42-45.(in Chinese)陈秋芳,余刚,张海邻,等.小儿支原体肺炎的临床、影像学及内镜特点[J].临床儿科杂志,2009,27(1):42-45.
[9]Li BJ,Liu JG.X-ray manifestation of child mycoplasma pneumoniae pneumonia[J].Journal of China Clinic Medical Imaging,2004,15(3):169-170.(in Chinese)李伯菊,刘建国.小儿肺炎支原体肺炎X线表现[J].中国临床医学影像杂志,2004,15(3):169-170.
[10]徐虹,刘利英,贺海燕.肺炎支原体肺炎患儿临床特征分析[J].实用心脑肺血管病杂志,2014,22(1):75-76.
[11]Vervloet LA,Marguet C,Camargos PA.Infection by mycoplasma pneumoniae and its importance as an etiological agent in childhood community-acquired pneumonias[J].Braz J Infect Dis,2007,11(5):507-514.
[12]Wang YJ,Bai XM,Liu ZJ,et al.The changes and clinic significance of immune function,serum procalcitonin and Creactive protein in children with mycoplasma pneumoniae pneumonia[J].Chinese Pediatric Emergency Medicine,2014,21(8):501-503,507.(in Chinese)王颖洁,白雪梅,刘正娟,等.儿童肺炎支原体肺炎免疫功能、降钙素原及C-反应蛋白变化及意义[J].中国小儿急救医学,2014,21(8):501-503,507.
[13]Han RZ,Hou AC,Lyu F.Changes of serum myocardial zymogram in children with mycoplasma pneumoniae pneumonia and its clinical significance[J].Journal of Applied Clinical Pediatrics,2007,22(16):1225-1226.(in Chinese)韩瑞珠,侯安存,吕芳.肺炎支原体肺炎患儿心肌酶水平变化的意义[J].实用儿科临床杂志,2007,22(16):1225-1226.
[14]Sánchez-Vargas FM,Gómez-Duarte OG.Mycoplasma pneumoniae——an emerging extra pulmonary pathogen[J].Clin Microbiol Infect,2008,14(2):105-117.
[15]Mamessier E,Botturi K,Verloet D,et al.Tregulatory lymphocytes atopy and asthma:a new concept in three dimensions[J].Rev Mal Respir,2005,22(2):305-311.
[16]Tanaka H,Narita M,Teramoto S,et al.Role of interleukin-18and T-helper type 1 cytokines in the development of mycoplasma pneumoniae pneumonia in adults[J].Chest,2002,121(5):1493-1497.
[17]Li CM,Gu L,Yin SJ,et al.Age-specific mycoplasma pneumoniae pneumonia-associated myocardial damage in children[J].J Int Med Res,2013,41(5):1716-1723.
[18]Liu Y,Li M.Research progression of pathogenesis of mycoplasma pneumoniae pneumonia[J].Journal of Clinical Pediatrics,2011,29(2):196-198.(in Chinese)刘洋,李敏.肺炎支原体肺炎发病机制研究进展[J].临床儿科杂志,2011,29(2):196-198.
[19]Suzuyama Y,Iwasaki H,Izumikawa K,et al.Clinical complications of mycoplasma pneumoniae disease——other organs[J].Yale J Biol Med,1983,56(5/6):487-491.
[20]Zhao SQ.Pathogenesis of mycoplasmal pneumoniae pneumonia[J].Pediatric Emergency Medicine,2002,9(3):129-130.(in Chinese)赵淑琴.肺炎支原体肺炎的发病机制[J].小儿急救医学,2002,9(3):129-130.
[21]邓建平,陈云鹏.C反应蛋白、白细胞与中性粒细胞检查在炎症反应中的意义[J].实验与检验医学,2010,28(3):314-326.
[22]Scala R,Naldi M,Maccari U.Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community acquired pneumonia[J].Crit Care,2010,14(2):R80.
[23]An SH,Wang MM,Li JY,et al.Role of flexible bronchoscopy in the diagnosis and treatment of refractory pneumonia in children[J].Chinese Journal of Contemporary Pediatrics,2011,13(7):547-550.(in Chinese)安淑华,王萌萌,李金英,等.纤维支气管镜在小儿难治性肺炎诊断与治疗中的应用[J].中国当代儿科杂志,2011,13(7):547-550.
[24]Liang Y,Liu XC,Jiang QB.Role of flexible bronchoscopy in the treatment of infection-associated atelectasis in children[J].Chinese Journal of Pediatrics,2003,41(9):649-651.(in Chinese)梁昱,刘玺诚,江沁波.纤维支气管镜在儿童感染性肺不张治疗中的作用[J].中华儿科杂志,2003,41(9):649-651.