0~14岁儿童肺炎支原体肺炎合并胸腔积液的临床特点及危险因素分析

Clinical Characteristics and Risk Factors Analysis of Mycoplasma Pneumoniae Pneumonia Complicated with Pleural Effusion in Children Aged 0~14 Years Old

摘要: 目的：研究0~14岁儿童肺炎支原体肺炎(MMP)合并胸腔积液(PE)的临床特点及危险因素，为临床诊治提供参考依据。方法：回顾性分析回顾性分析2021年6月至2024年6月我院儿科住院的社区获得性肺炎患儿的临床资料，共收取772例肺炎患儿，其中MMP患儿695例、MPP合并PE患儿77例，收集患儿的各项资料，包括临床特征及实验室检查资料，分析临床特点及危险因素。结果：1) 秋冬季是MMP合并PE的好发季节，MMP合并PE患儿年龄、热峰均高于MPP患儿，且热程，阿奇霉素治疗时间明显延长(P < 0.05)。2) 与MPP组相比，MMP合并PE组的中性粒细胞百分比(NE%)、C-反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)水平均升高，白细胞(WBC)、淋巴细胞百分比(LYM%)水平均降低，差异有统计学意义(P < 0.05)。3) Logistic回归分析显示阿奇霉素治疗时间、血清CRP、LDH水平是MMP合并PE的独立危险因素(P < 0.05)，通过ROC曲线分析确定血清CRP、LDH预测发生MMP合并PE的危险值依次为19.9 mg/L、334.5 U/L。4) 疫情后MMP合并PE患儿明显多于疫情前患病人数，疫情后MMP合并PE患儿的热程少于疫情前患儿，实验室检查方面，与疫情前相比，疫情后MMP合并PE患儿的PCT水平降低(P < 0.05)。结论：秋冬季是MMP合并PE的好发季节，MPP合并PE患儿年龄更大，热峰更高，热程及阿奇霉素治疗时间长，另阿奇霉素治疗时间与血清CRP、LDH水平均为MMP合并PE患儿的高危因素，对于血清CRP高于19.9 mg/L和(或) LDH高于334.5 U/L的MMP患儿应充分重视并积极治疗。

Abstract: Objective: To investigate the clinical characteristics and risk factors of Mycoplasma pneumoniae pneumonia (MMP) complicated with pleural effusion (PE) in children aged 0~14 years, and provide reference for clinical diagnosis and treatment. Method: A retrospective analysis was conducted on the clinical data of community-acquired pneumonia patients admitted to our pediatric department from June 2021 to June 2024. A total of 772 pneumonia patients were collected, including 695 children with MMP and 77 children with MPP and PE. Various data, including clinical characteristics and laboratory examination data, were collected to analyze the clinical features and risk factors of the patients. Result: 1) Autumn and winter are the most common seasons for MMP combined with PE. Children with MMP combined with PE have higher age and fever peak than those with MPP, and the fever course and azithromycin treatment time are significantly prolonged (P < 0.05). 2) Compared with the MPP group, the MMP combined with PE group showed an increase in neutrophil percentage (NE%), C-reactive protein (CRP), procalcitonin (PCT), and lactate dehydrogenase (LDH) levels, while white blood cell (WBC) and lymphocyte percentage (LYM%) levels decreased, with statistical significance (P < 0.05). 3) Logistic regression analysis showed that treatment time with azithromycin, serum CRP, and LDH levels were independent risk factors for MMP combined with PE (P < 0.05). ROC curve analysis determined that serum CRP and LDH predicted the risk values for MMP combined with PE to be 19.9 mg/L and 334.5 U/L, respectively. 4) After the epidemic, the number of children with MMP combined with PE was significantly higher than before the epidemic. The fever level of children with MMP combined with PE after the epidemic was lower than before the epidemic. In terms of laboratory tests, compared with before the epidemic, the PCT level of children with MMP combined with PE after the epidemic decreased (P < 0.05). Conclusion: Autumn and winter are the peak seasons for MMP combined with PE. Children with MPP combined with PE are older, have higher fever peaks, longer fever duration and azithromycin treatment time. In addition, azithromycin treatment time and serum CRP and LDH levels are high-risk factors for MMP combined with PE. For MMP children with serum CRP higher than 19.9 mg/L and/or LDH higher than 334.5 U/L, full attention and active treatment should be given.