儿童肺炎支原体肺炎肺外损害的危险因素分析

目的研究儿童肺炎支原体肺炎（mycoplasma pneumoniae pneumonia，MPP）发生肺外损害的相关危险因素，以助指导临床上准确诊治疾病，减少肺外损害的发生。方法以319例MPP患儿作为临床资料进行回顾性分析，将其中合并肺外损害的152例作为研究组，无肺外损害的167例作为对照组，对两组患儿的年龄、性别、体重、发热峰值、热程、喘息、白细胞计数、中性粒细胞计数、血沉（ESR）、C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素（IL）-6、IL-8、IL-10、肿瘤坏死因子-α（TNF-α）、体液免疫（IgA、IgG、IgM）、细胞免疫（CD4/CD8比值）、胸腔积液、肺部病变程度等因素进行单因素分析，差异有统计学意义的因素进行多因素logistic回归分析。结果（1）319例MPP患儿中发生肺外器官损害的有152例，占47.6％。发生肺外损害患儿中，主要受累系统是消化系统（56.6％）、血液系统（17.1％）及心血管系统（14.5％）。部分（6.6%）患儿2个及2个以上系统受累。（2）单因素分析：研究组患儿热程≥10 d、有胸腔积液、肺部实变影比例高于对照组（P＜0.05）；研究组血沉、CRP、PCT、IL-6、IL-8、IL-10、TNF-α高于对照组，CD4/CD8比值低于对照组（P＜0.05）。而两组患儿在年龄、性别、体重、发热峰值、喘息、白细胞计数、中性粒细胞计数、体液免疫（IgA、IgG、IgM）上的差异无统计学意义（P＞0.05）。（3）多因素logistic回归结果分析：血沉、CRP、PCT、IL-6、IL-8、IL-10、TNF-α的升高、CD4/CD8比值的降低、热程≥10 d、肺实变影是MPP发生肺外损害的危险因素。结论（1）儿童MPP引起肺外损害较为常见，表现形式多样，可累及消化、心血管、血液、神经、泌尿、皮肤肌肉关节等系统，在临床中可表现为单一系统累及，也可表现为2个及2个以上系统累及。（2）血沉、CRP、PCT、IL-6、IL-8、IL-10、TNF-α的升高、CD4/CD8比值的降低、热程≥10 d、肺实变影是MPP发生肺外损害的危险因素，临床上应予以重视，达到早期发现、干预及治疗。

Risk factors for extrapulmonary damage in pediatric patients with mycoplasma pneumoniae pneumonia

ObjectiveTo study the risk factors responsible for extrapulmonary damage in pediatric patients with mycoplasma pneumoniae pneumonia (MPP), in order to make a diagnosis and give a treatment accurately, finally to reduce extrapulmonary damage of MPP. Methods The case control study was conducted in 319 children of MPP during 2015 April to 2017 July of our hospital. We regarded 152 cases with extrapulmonary damage as a study group and 167 cases without extrapulmonary damage as a control group. We analyzed and made a comparison between the two groups in age, sex, body weight, fever, wheezing, white blood cell count, neutrophil count, blood sedimentation, C reaction protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), humoral immunity (IgA, IgG, IgM), cell immunity (CD4, CD8), effusion, lung patchy shadow and etc. ResultsThe extrapulmonary damage occurred in 152 cases (47.6%). The digestive system (56.6%), blood system (17.1%) and cardiovascular system (14.5%) were mainly damaged. Some children had bi-organ affection or multi-organ affection (10.7%). The results of t-test and Chi-square test showed that fever over 10 days, effusion and lung patchy shadow of study group were significantly higher than control group (P<0.05); ESR, CRP, PCT, IL-6, IL-8, IL-10, and TNF-α of study group was significantly higher than control group (P<0.05). CD4/CD8 lymphocyte subset of study group was significantly lower than control group (P<0.05). The differences between age，sex，body weight，fever, wheezing，white blood cell count，neutrophil count，humoral immunity (IgA, IgG, IgM) of two groups had no statistically significances. Logistic regression analysis showed that fever over 10 days, lung patchy shadow, high ESR, CRP, PCT, IL-6, IL-8, IL-10, TNF-α and low CD4/CD8 lymphocyte subset were the risk factors of MPP extrapulmonary damage. ConclusionMPP extrapulmonary damage in pediatric patients is commonp; the digestive, cardiovascular, nervous, blood, urinary, skin muscle joint systems can be involved. It can be presented as a single system involved and also as two or more than two systems involved. MPP extrapulmonary damage is easy to misdiagnosis because there are no typical clinical symptoms, when the children have long duration fever, lung patchy shadow, high ESR, CRP, PCT, IL-6, IL-8, IL-10, TNF-α and low CD4/CD8, clinical doctors should pay attention to it.