重症肺炎支原体肺炎患儿CRP、LDH等实验室指标的预警价值及支气管镜下特点

张立霞; 朱峰; 李传景; 刘祥蕾; 阚月月; 郭庆立

doi:10.16766/j.cnki.issn.1674-4152.003575

重症肺炎支原体肺炎患儿CRP、LDH等实验室指标的预警价值及支气管镜下特点

doi: 10.16766/j.cnki.issn.1674-4152.003575

安徽医科大学附属宿州医院儿童呼吸科，安徽宿州 234000

基金项目:

安徽省临床医学研究转化专项项目 202304295107020119

宿州市卫生健康科研项目 SZWJ2022a037

详细信息

通讯作者:
张立霞，E-mail：zlxszslyy@163.com

中图分类号: R375.2 R446
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出版历程
- 收稿日期: 2024-01-12
- 网络出版日期: 2024-09-05

Early warning value and bronchoscopic characteristics of experimental indicators such as CRP and LDH in severe Mycoplasma pneumoniae

Children's Respiratory Department of Suzhou Hospital Affiliated to Anhui Medical University, Suzhou, Anhui 234000, China

摘要

摘要: 目的探讨重症肺炎支原体肺炎(SMPP)患儿实验室指标的预警价值及支气管镜下临床特点，为早期诊断SMPP提供参考。方法收集2023年1—12月在安徽医科大学附属宿州医院住院的80例肺炎支原体肺炎患儿的临床资料，按照病情轻重分为重症组和普通组，每组各40例患儿。比较2组一般情况、实验室指标、支气管镜下特点的差异，并行统计分析。结果 2组中性粒细胞比例、降钙素原(PCT)差异无统计学意义(P＞0.05)，而重症组白细胞(WBC)、C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、D-二聚体(D-D)均高于普通组(P＜0.05)。多因素logistic回归分析显示，WBC、CRP、LDH、D-D为SMPP的独立影响因素(P＜0.05)。ROC曲线分析显示，CRP、LDH、D-D对SMPP的诊断有较高的预测价值(P＜0.05)，最佳阈值分别为19.42 mg/L、361.00 IU/L、1.075 mg/L。重症组行支气管镜比例、镜下黏液栓痰及灌洗液中性粒细胞比例均高于普通组(P < 0.05)。结论 CRP、LDH、D-D为SMPP的独立影响因素，当CRP＞19.42 mg/L、LDH＞361.00 IU/L、D-D＞1.075 mg/L时有助于早期识别SMPP。SMPP镜下发生黏液栓比例高，需积极行支气管镜治疗，同时灌洗液外观较浑浊、中性粒细胞比例高，可进一步评估病情。
- 重症肺炎支原体肺炎 /
- 实验指标 /
- 预警价值 /
- 支气管镜
Abstract: Objective To explore the early warning value of experimental indicators for severe Mycoplasma pneumoniae pneumonia (SMPP) and the clinical characteristics under bronchoscopy, and provide reference for early diagnosis of SMPP. Methods The case data of children with Mycoplasma pneumoniae pneumonia (MPP) admitted to Suzhou Hospital Affiliated to Anhui Medical University from January to December 2023 was collected. According to the severity of the condition, they were divided into a severe group and a common group, with 40 cases randomly selected from each group. The differences in general conditions, experimental indicators, and bronchoscopy characteristics between the two groups were compared for statistical analysis. Results There was no statistically significant difference in the proportion of neutrophils and procalcitonin (PCT) between the two groups (P>0.05), while the severe group had higher levels of white blood cells (WBC), C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-dimer (D-D) than the normal group (P < 0.05). Multivariate logistic regression analysis showed that WBC, CRP, LDH, and D-D were independent risk factors for SMPP (P < 0.05). ROC curve analysis showed that CRP, LDH, and D-D have high predictive value for the diagnosis of SMPP (P < 0.05), with the optimal thresholds of 19.42 mg/L, 361.00 IU/L, and 1.075 mg/L, respectively. The proportion of bronchoscopy, mucus emboli under bronchoscopy, and neutrophil count in lavage fluid in the severe group were higher than those in the normal group (P < 0.05). Conclusion CRP, LDH, and D-D are independent risk factors for SMPP. When CRP>19.42 mg/L, LDH>361.00 IU/L, and D-D>1.075 mg/L, it is helpful for early identification of SMPP. The proportion of mucus embolism under SMPP endoscopy is high, and active bronchoscopy treatment is needed. At the same time, the appearance of the lavage fluid is cloudy and the proportion of neutrophils is high, which can further evaluate the condition.
- Severe Mycoplasma pneumoniae pneumonia /
- Experimental indicators /
- Early warning value /
- Bronchoscopy

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图 1 SMPP各独立危险因素的受试者工作特征曲线分析

Figure 1. Receiver operating characteristic curve analysis of independent risk factors for SMPP

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图 2 2组支气管镜下痰液堵塞表现

注：A为普通组黏液痰；B为普通组淡黄色脓痰；C为重症组条形黏液栓；D为重症组塑形黏液栓。

Figure 2. Bronchoscopic findings of sputum obstruction in two groups

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图 3 2组灌洗液外观特点

注：A示普通组灌洗液稍浑浊；B示重症组灌洗液浑浊。

Figure 3. Appearance characteristics of lavage fluid in two groups

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表 1 2组肺炎支原体肺炎患儿实验室指标比较[M(P₂₅, P₇₅)]

Table 1. Comparison of laboratory indicators between two groups of children with Mycoplasma pneumoniae pneumonia[M(P₂₅, P₇₅)]

组别	例数	WBC(×10⁹/L)	中性粒细胞比例(%)	CRP(mg/L)	PCT(ng/mL)	LDH(IU/L)	D-D(mg/L)
重症组	40	9.17(6.84, 11.37)	63.50(59.13, 73.60)	21.32(10.55, 29.33)	0.130(0.083, 0.178)	346.00(321.00, 407.25)	1.145(0.940, 1.720)
普通组	40	7.02(5.52, 9.60)	63.60(55.63, 68.85)	8.45(4.60, 13.60)	0.095(0.050, 0.150)	278.00(258.00, 295.75)	0.695(0.430, 0.820)
Z值		-2.579	-1.511	-4.335	-1.735	-6.140	-5.914
P值		0.010	0.131	<0.001	0.083	<0.001	<0.001

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表 2 重症支原体肺炎影响因素的多因素logistic回归分析

Table 2. Multivariate logistic regression analysis of laboratory indicators for severe Mycoplasma pneumoniae pneumonia

变量	B	SE	Waldχ²	P值	OR值	95% CI
WBC(×10⁹/L)	0.232	0.089	6.727	0.009	1.261	1.058~1.502
CRP(mg/L)	0.067	0.023	8.536	0.003	1.069	1.022~1.118
PCT(ng/mL)	1.621	1.542	1.105	0.293	5.057	0.246~103.823
LDH(IU/L)	0.045	0.010	18.619	<0.001	1.046	1.025~1.068
D-D(mg/L)	2.299	1.004	5.244	0.022	9.960	1.393~71.226

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表 3 各指标对SMPP的预测价值分析

Table 3. Analysis of predictive value of each indicator for SMPP

变量	最佳阈值	AUC	95% CI	SE	P值	灵敏度	特异度	约登指数
WBC(×10⁹/L)	7.61	0.639	0.428~0.849	0.107	0.192	0.742	0.600	0.342
CRP(mg/L)	19.42	0.734	0.542~0.926	0.098	0.028	0.710	0.800	0.510
LDH(IU/L)	361.00	0.884	0.781~0.986	0.052	<0.001	0.839	0.900	0.739
D-D(mg/L)	1.075	0.829	0.673~0.985	0.080	0.002	0.904	0.700	0.603
三项指标联合		0.948	0.885~1.000	0.033	<0.001	0.935	0.900	0.835

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表 4 2组行支气管镜治疗肺炎支原体肺炎患儿支气管镜下痰液堵塞情况及灌洗液特点

Table 4. Sputum obstruction and characteristics of lavage fluid in children with Mycoplasma pneumoniae pneumonia treated by bronchoscopy in two groups

组别	例数	气管内非黏液栓痰[例(%)]	气管内黏液栓痰[例(%)]	灌洗液中性粒细胞比例(%)
重症组	32	7(21.87)	17(53.12)	61.68±13.54
普通组	15	8(53.33)	3(20.00)	40.50±17.93
统计量			3.969^b
P值		0.027^a	<0.001
注：^a为采用Fisher精确检验，^b为t值。

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