多项实验室指标综合评价在儿童重症肺炎 并发塑形性支气管炎中的临床意义

Clinical Significance of Comprehensive Evaluation of Multiple Laboratory Indicators in Children with Severe Pneumonia Complicated by Plastic Bronchitis

摘要: 目的：探讨住院儿童重症肺炎并发塑形性支气管炎的危险因素，为临床早期识别提供依据。方法：收集2022年6月~2024年12月于青岛大学附属威海市立第二医院儿科住院治疗的重症肺炎患儿76例，其中并发塑形性支气管炎(PB)患儿25例进行回顾性分析。比较PB与非塑形性支气管炎(NPB)两组患儿临床资料及危险因素。结果：1) 两组患儿临床资料的比较：PB住院时间明显长于NPB组(P = 0.005)，年龄、性别无显著性差异。2) 两组患儿实验室指标比较：PB患儿的、降钙素原(PCT)、乳酸脱氢酶(LDH)明显高于NPB患儿，而白蛋白则低于NPB患儿。差异均具有统计学意义(P < 0.05)。PB患儿的凝血酶原时间(PT)及D-二聚体(D-D)水平高于NPB患儿，差异均具有统计学意义(P < 0.05)，白细胞及血小板计数两组无统计学差异。3) 两组患儿影像学比较：PB组大叶性肺炎发生率明显高于NPB组(P = 0.018)。4) 两组患儿肺泡灌洗液病原学比较：在PB组100%患儿发生肺炎支原体感染，合并细菌感染发生率(60%)明显高于合并病毒及单纯支原体感染。结论：1) 重症肺炎合并PB患儿存在着多项实验室指标异常，除了重视PCT、LDH及D-D外，需重视血清白蛋白水平。2) 警惕肺部影像学显示大叶性肺炎及肺泡灌洗液中合并细菌感染和耐药支原体肺炎感染患儿发生塑形性支气管炎可能。3) 需要多项实验室指标的综合评价早期识别儿童重症肺炎并发塑形性支气管炎。

Abstract: Objective: To explore the risk factors of severe pneumonia complicated with plastic bronchitis in hospitalized children, and to provide evidence for early identification. Methods: A retrospective analysis was conducted on 76 children with severe pneumonia hospitalized in the Department of Pediatrics of Weihai Second Hospital of Qingdao University from June 2022 to December 2024, including 25 children with plastic bronchitis (PB). The clinical data risk factors of the two groups of children with PB and non-plastic bronchitis (NPB) were compared. Results: 1) Comparison of clinical data of the groups of children: The hospitalization time of the PB group was significantly longer than that of the NPB group (P = 0.005), and these was no significant difference in age and gender. 2) Comparison of laboratory indicators of the two groups of children: PCT, LDH, and albumin were significantly higher in the PB patients than in the NPB patients, while albumin was lower in the PB patients than in the NPB patients. The differences were statistically significant (P < 0.05). Prothrombin time (PT) and D-dimer (D-D) levels were higher in PB patients than in NPB patients, and the differences were significant (P < 0.05), while there was no statistically significant difference in the white blood cell and platelet count between the two groups. 3) Comparison of findings of the two groups of children: The incidence of lobar pneumonia in the PB group was significantly higher than that in the NPB group (P = 0.018). 4) Comparison of pathological findings in bronchoalveolar lavage fluid of the two groups of children: In the PB group, 100% children had Mycoplasma pneumoniae infection, and the incidence of bacterial infection (60%) was significantly higher than that of viral and pure Mycoplasma infection. Conclusion: 1) Children with severe pneumonia complicated with PB had abnormal multiple laboratory indicators. In addition to paying attention to PCT, LDH and D-D, it is necessary to pay attention to the level of serum albumin. 2) Be alert to the possibility of children with plastic bronchitis when the pulmonary imaging shows lobar pneum and when there is a combination of bacterial infection and macrolide-resistant Mycoplasma pneumoniae infection in bronchoalveolar lavage fluid. 3) Laboratory indicators are needed for comprehensive evaluation to early identify children with severe pneumonia complicated with plastic bronchitis.