背景:由肺炎支原体引起的大叶肺炎是一种相对难以治疗的儿童肺炎。治疗后射线照相分辨率的时间是可变的,长的恢复时间会导致一些负面影响,它引起了我们的注意。因此,探索与射线照相分辨率延迟相关的因素将有助于在早期阶段识别这些儿童并为早期干预做好准备.
方法:收集阜阳人民医院儿科收治的339例肺炎支原体引起的大叶性肺炎患儿资料,中国从2021年1月到2022年6月。放电后,患儿在门诊和微信平台上定期随访>8周。根据肺部影像学(胸部X线摄影或胸部CT平片)在8周内是否恢复正常,将患儿分为延迟恢复组(DRG)69例和正常恢复组(NRG)270例。儿童的一般信息,实验室检查结果,支气管镜检查结果,并对影像学表现进行回顾性分析.进行单因素分析以确定由肺炎支原体引起的大叶性肺炎的影像学延迟消退的危险因素。对差异有统计学意义的因素进行多因素logistic回归分析。然后进行接收器工作特性(ROC)分析以计算延迟射线照相分辨率的早期预测指标的截止值。
结果:单因素分析表明,以下方面在DRG中明显大于NRG:总发热持续时间,住院时间,C反应蛋白(CRP)水平,乳酸脱氢酶(LDH)水平,D-二聚体水平,涉及两个或多个肺叶的肺部病变,大量的胸腔积液,介入支气管镜检查的时间,和粘液栓的形成。多因素logistic回归分析显示,住院时间,CRP水平,LDH水平,涉及两个或多个肺叶的肺部病变,大量胸腔积液是肺炎支原体致大叶性肺炎X线表现延迟的独立危险因素。受试者工作特征曲线上的临界值为住院时间≥10.5天,CRP水平≥25.92mg/L,LDH水平≥378U/L
结论:如果由肺炎支原体引起的大叶性肺炎患者的住院时间≥10.5天,CRP水平≥25.92mg/L,LDH等级≥378U/L,射线照相分辨率的时间极有可能超过8周。儿科医生必须对这些因素保持高度警惕,尽早控制感染,加强气道管理,并密切随访,避免肺炎支原体肺炎的并发症和后遗症。
BACKGROUND: Lobar pneumonia caused by Mycoplasma pneumoniae is a relatively difficult-to-treat pneumonia in children. The time of radiographic resolution after treatment is variable, a long recovery time can result in several negative effects, and it has attracted our attention. Therefore, exploring factors associated with delayed radiographic resolution will help to identify these children at an early stage and prepare for early intervention.
METHODS: The data of 339 children with lobar pneumonia caused by Mycoplasma pneumoniae were collected from the Department of Pediatrics of Fu Yang People\'s Hospital, China from January 2021 to June 2022. After discharge, the children were regularly followed up in the outpatient department and on the WeChat platform for > 8 weeks. According to whether pulmonary imaging (chest radiography or plain chest computed tomography) returned to normal within 8 weeks, the children were divided into the delayed recovery group (DRG) (n = 69) and the normal recovery group (NRG) (n = 270). The children\'s general information, laboratory examination findings, bronchoscopy results, and imaging findings were retrospectively analyzed. Single-factor analysis was performed to identify the risk factors for delayed radiographic resolution of lobar pneumonia caused by Mycoplasma pneumoniae, and the factors with statistically significant differences underwent multiple-factor logistic regression analysis. Receiver operating characteristic (ROC) analysis was then performed to calculate the cutoff value of early predictive indicators of delayed radiographic resolution.
RESULTS: Single-factor analysis showed that the following were significantly greater in the DRG than NRG: total fever duration, the hospitalization time, C-reactive protein (CRP) level, lactate dehydrogenase (LDH) level, D-dimer level, pulmonary lesions involving two or more lobes, a large amount of pleural effusion, the time to interventional bronchoscopy, and mucus plugs formation. Multivariate logistic regression analysis showed that the hospitalization time, CRP level, LDH level, pulmonary lesions involving two or more lobes, and a large amount of pleural effusion were independent risk factors for delayed radiographic resolution of lobar pneumonia caused by Mycoplasma pneumoniae. The cutoff values on the receiver operating characteristic curve were a hospitalization time of ≥ 10.5 days, CRP level of ≥ 25.92 mg/L, and LDH level of ≥ 378 U/L.
CONCLUSIONS: If patients with lobar pneumonia caused by Mycoplasma pneumoniae have a hospitalization time of ≥ 10.5 days, CRP level of ≥ 25.92 mg/L, and LDH level ≥ 378 U/L, the time of radiographic resolution is highly likely to exceed 8 weeks. Pediatricians must maintain a high level of vigilance for these factors, control the infection as early as possible, strengthen airway management, and follow up closely to avoid complications and sequelae of Mycoplasma pneumoniae pneumonia.