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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (4): 280-284.

• 论著 • 上一篇    下一篇

重症肺炎支原体肺炎患儿临床特征与儿童危重病例评分的相关性分析

王程毅1,王世彪1,刘光华1,宋朝敏2,陈钦1   

  1. 福建省妇幼保健院,福建医科大学教学医院 1 儿科，2 新生儿科 福州，350001
  • 收稿日期:2016-05-26 修回日期:2016-08-29 出版日期:2016-08-25 发布日期:2016-08-25
  • 通讯作者: 刘光华

Analysis of correlations between clinical characteristics and pediatric critical illness score in children with severe Mycoplasma pneumoniae pneumonia

WANG Cheng-yi1， WANG Shi-biao1， LIU Guang-hua1， SONG Chao-min2,  CHEN Qin1   

  1. 1 Department of Pediatrics, 2 Department of Neonatology, Fujian Province Maternity and Children Health Hospital, Fujian Medical University Teaching Hospital, Fuzhou 350001, China
  • Received:2016-05-26 Revised:2016-08-29 Online:2016-08-25 Published:2016-08-25
  • Contact: LIU Guang-hua

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摘要：

目的 探讨重症肺炎支原体肺炎(MPP)患儿临床特征与儿童危重病例评分（PICS）的相关性。方法 纳入2014年1月至2015年12月福建省妇幼保健院PICU住院的重症MPP患儿，根据PICS分为极危重组（<70分）、危重组(~80分)和非危重组（>80分），从病史中截取年龄、性别、发热时间，入院48 h内实验室检查指标，ECG和胸部X线和CT描述。对上述指标行3组间的单因素分析，对有统计学意义的指标进一步行多因素Logistic回归分析，分析其临床特征与PICS的相关性。结果 114例重症MPP患儿进入本文分析,男61例,女53例。合并心血管系统损害29例，消化系统损害23例，神经系统损害18例，血液系统损害27例。非危重组77例，危重组30例,极危重组7例，3组年龄、性别构成差异无统计学意义。3组异常ECG比例、合并2个及以上系统损害比例、合并2种及以上病原感染、病程>12 d比例、前白蛋白、D-二聚体水平差异均有统计学意义。多因素分析显示，合并2种及以上病原感染比例（OR=7.147,95%CI: 1.435~35.59）、D-二聚体水平（OR=1.507,95%CI：1.054~2.156）与PICS呈正相关，前白蛋白水平与PICS呈负相关（OR=0.914,95%CI:0.845~0.990）。结论 儿童重症MPP合并2种及以上病原感染、D-二聚体、前白蛋白水平和PICS相关。

Abstract:

Objective To investigate the relationship between clinical characteristics and pediatric critical illness score in children with severe Mycoplasma pneumoniae pneumonia (MPP).Methods Retrospective analysis was utilized for the clinical data (age, sex, duration of fever, laboratory examination, outcome of ECG，chest X-ray and CT within 48 h after admission) of the children who were hospitalized at PICU of Fujian Maternity and Children Health Hospital due to severe MPP from January 2014 to December 2015. According to the pediatric critical illness score (PCIS) criteria, patients were divided into extremely critical group (PCIS<70), critical group (80>PCIS>70) and non-critical group (PCIS>80). The clinical characteristics were screened by univariate analysis, and then statistically significant clinical markers were analyzed by multivariate logistic regression analysis. These comparison and analysis were conducted with regard to the relationship between their clinical characteristics and PCIS.Results A total of 114 children hospitalized with severe MPP were enrolled, including 61 males and 53 females. Cardiovascular system damage was found in 29 cases, 23 cases were with digestive system damage, 18 cases with nervous system damage, 27 cases with hematological system damage. They were divided into 3 groups in accordance with PCIS: 77 were in non-critical group, 30 were in critical group, 7 were in extremely critical group. Among three groups, there were no significantly differences in age and sex. There were statistical significances in the proportions of abnormal electrocardiographic pattern, extrapulmonary complications of 2 or more organ damages, co-infection of 2 or more noxaes and course of disease more than 12 days. Prealbumin level decreased and D-Dimer level increased among three groups, both with statistical significance. Multivariate logistic regression analysis showed there was positive correlation between the proportions of co-infection of 2 or more noxaes (OR=7.147,95%CI: 1.435 to 35.59), D-Dimer level (OR=1.507,95%CI：1.054 to 2.156) and PCIS, there was negative correlation between prealbumin level (OR=0.914,95%CI:0.845 to 0.990) and PCIS in children.Conclusion Co-infection of 2 or more noxaes, D-Dimer, prealbumin may be related to the severity of severe MPP.