儿童难治性肺炎支原体肺炎早期识别指标的研究

目的 探讨儿童难治性肺炎支原体肺炎（refractory mycoplasma pneumoniae pneumonia, RMPP）早期有效的识别指标。方法 选取2021年6月至2023年6月湖州市第一人民医院住院并确诊为RMPP的患儿30例，设为观察组；选取同期普通型肺炎支原体肺炎（general mycoplasma pneumoniae pneumonia, GMPP）患儿40例，设为对照组。所有患儿入院后均进行血干扰素（interferon-γ，IFN）-γ、D-二聚体、乳酸脱氢酶（lactate dehydrogenase，LDH）、C反应蛋白（C-reactive protein，CRP）检测，并进行咽试子肺炎支原体核酸及耐药位点检测。比较两组患儿血IFN-γ、D-二聚体、LDH、CRP在肺炎支原体肺炎病程早期的表达情况。并绘制受试者操作特征（receiver operating characteristic，ROC）曲线，分析各指标对RMPP的预测作用。分析大环内酯类耐药与RMPP的相关性。结果 观察组IFN-γ、D-二聚体、CRP表达水平显著高于对照组，差异有统计学意义（P<0.05），观察组LDH表达水平与对照组比较，差异无统计学意义（P>0.05）；ROC曲线下面积（area under the curve，AUC）比较，IFN-γ的AUC最大，为0.908（95%CI：0.840~0.976，P<0.001）；CRP为0.760（95%CI：0.637~0.883，P<0.001）；D-二聚体为0.698（95%CI：0.573~0.822，P=0.005）；LDH为0.575（95%CI：0.434~0.715，P=0.288），说明IFN-γ对RMPP的诊断作用明显优于其他变量。RMPP病例中大环内酯类耐药比例明显高于GMPP组。结论 IFN-γ、CRP、D-二聚体、大环内酯类耐药因素在对RMPP的早期预测中具有一定效能，其中IFN-γ>24pg/ml时对RMPP预测效果最佳，结合耐药情况可作为预测RMPP的良好指标。

Study on early identification indicators of refractory Mycoplasma pneumoniae pneumonia in children

Objective To explore the effective early identification indicators of refractory mycoplasma pneumoniae pneumonia (RMPP) in children. Methods Thirty children admitted to Department of Pediatrics the First People’s Hospital of Huzhou and diagnosed with RMPP from June 2021 to June 2023 were selected as the study group. Forty children with mycoplasma pneumoniae pneumonia (GMPP) were selected as the control group. Blood interferon (IFN)-γ, D-dimer, lactate dehydrogenase (LDH) and C-reactive protein (CRP) were detected in all children after admission. Pharynx samples were collected for detection of Mycoplasma pneumoniae nucleic acid and drug resistance sites. The expression of IFN-γ, D-dimer, LDH and CRP in the early stage of mycoplasma pneumoniae pneumonia was compared between the two groups. Receiver operating characteristic (ROC) curve was drawn to analyze the predictive effect of each index on RMPP. To analyze the correlation between macrolide resistance and RMPP. Results The expression levels of IFN-γ, D-dimer and CRP in the study group were significantly higher than those in the control group. The difference between the two groups was statistically significant (P<0.05). There was no significant difference in LDH expression between the study group and the control group (P>0.05). By comparing the area under the ROC curve (AUC). IFN-γ had the highest AUC of 0.908 (95%CI: 0.840-0.976, P<0.001). CRP was 0.760 (95%CI: 0.637-0.883, P<0.001). D-dimer was 0.698(95%CI: 0.573-0.822, P=0.005). LDH was 0.575(95%CI: 0.434-0.715, P=0.288). These results indicate that IFN-γ has better diagnostic effect on RMPP than other variables. The proportion of macrolide resistance in RMPP patients was significantly higher than that in GMPP group. Conclusion IFN-γ, CRP, D-dimer, macrolide resistance factors have certain efficacy in the early prediction of RMPP. RMPP had the best prediction effect when IFN-γ> 24pg/ml. Combined with drug resistance factors can be used as a good indicator to predict RMPP.