不同实验室指标对肺炎支原体肺炎诊断价值的探讨

Exploration of the Diagnostic Value of Different Laboratory Indicators for Mycoplasma pneumoniae Pneumonia

摘要: 目的：探讨血凝指标、乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、降钙素原(PCT)及血浆白蛋白在重症支原体肺炎患儿中的价值。方法：收集2022年6月~2024年6月于青岛大学附属威海市立第二医院儿科住院治疗的支原体肺炎(MPP)患儿115例，进行回顾性分析。按病情严重程度分为重症组(SMPP组) 45例、非重症组(NSMPP组) 70例。比较两组患儿实验室指标包括血凝指标、LDH、CRP、PCT及血浆白蛋白的变化及与临床的相关性。结果：1) SMPP患儿的D-二聚体(D-D)水平明显高于NSMPP患儿，凝血酶原时间(PT)延长，凝血酶时间(TT)缩短，差异具有统计学意义(P均 < 0.05)，FIB水平无统计学差异(P > 0.05)。2) SMPP患儿LDH、CRP、PCT明显高于NSMPP患儿，白蛋白水平则低于NSMPP (P均 < 0.05)。3) 在SMPP患儿中，存在CRP及PCT增高的患儿对治疗的反应较正常患儿稍差，应用糖皮质激素时间较长，且肺部影像学大片状影比例增高，出现胸腔积液、脓气胸、肺不张、肺气肿等肺部并发症的比例亦增高。当出现LDH + D-D或D-D + FIB增高时，伴或不伴有TT缩短(短于NSMPP$\overline{x}$ )时，患儿发生塑形性支气管炎概率增加。结论：NSMPP与SMPP患儿相比，CRP、PCT、LDH、血浆白蛋白及血凝指标，对临床鉴别有提示作用。

Abstract: Objective: To explore the value of blood coagulation indicators, lactate dehydrogenase (LDH), C-reactive protein (CRP), procalcitonin (PCT), and plasma albumin in children with severe mycoplasma pneumonia. Method: A retrospective analysis was conducted on 115 children with Mycoplasma pneumoniae pneumonia (MPP) who were hospitalized in the pediatric department of Weihai Municipal Second Hospital affiliated with Qingdao University from June 2022 to June 2024. According to the severity of the condition, there were 45 cases in the severe group (SMPP group) and 70 cases in the non severe group (NSMPP group). Compare the changes in laboratory indicators, including coagulation index, LDH, CRP, PCT, and plasma albumin, between two groups of pediatric patients and their correlation with clinical outcomes. Result: 1) The levels of D-dimer (D-D) in SMPP patients were significantly higher than those in NSMPP patients, with prolonged prothrombin time (PT) and shortened thrombin time (TT), and the differences were statistically significant (P < 0.05 for both). There was no statistically significant difference in FIB levels (P > 0.05). 2) The levels of LDH, CRP, and PCT in SMPP patients were significantly higher than those in NSMPP patients, while the levels of albumin were lower than those in NSMPP patients (all P < 0.05). 3) In children with SMPP, those with elevated levels of CRP and PCT have slightly poorer response to treatment compared to normal children, longer use of glucocorticoids, and an increased proportion of large patchy shadows in lung imaging. The incidence of pulmonary complications such as pleural effusion, pneumothorax, atelectasis, and emphysema also increases. When there is an increase in LDH + D-D or D-D + FIB, with or without TT shortening (shorter than NSMPP$\overline{x}$ ), the probability of children developing plastic bronchitis increases. Conclusion: Compared with SMPP patients, CRP, PCT, LDH, Plasma albumin and coagulation indicators have a suggestive effect on clinical differentiation.