[1]罗永涵,代继宏.儿童支原体肺炎合并肺不张行多次支气管肺泡灌洗术的危险因素分析[J].陆军军医大学学报(原第三军医大学学报),2022,44(18):1856-1861.
　LUO Yonghan,DAI Jihong.Risk factors of multiple bronchoalveolar lavage therapy in children with mycoplasma pneumonia complicated with atelectasis[J].J Amry Med Univ (J Third Mil Med Univ),2022,44(18):1856-1861.
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儿童支原体肺炎合并肺不张行多次支气管肺泡灌洗术的危险因素分析(/HTML )
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陆军军医大学学报（原第三军医大学学报）[ISSN:1000-5404/CN:51-1095/R]

卷:
44卷
期数:
2022年第18期
页码:
1856-1861
栏目:
临床医学
出版日期:
2022-09-30

文章信息/Info

Title:
Risk factors of multiple bronchoalveolar lavage therapy in children with mycoplasma pneumonia complicated with atelectasis
作者:
罗永涵; 代继宏
重庆医科大学附属儿童医院呼吸科，儿童发育疾病研究教育部重点实验室，国家儿童健康与疾病临床医学研究中心，儿童发育重大疾病国家国际科技合作基地，儿科学重庆市重点实验室
Author(s):
LUO Yonghan;  DAI Jihong
Department of Respiratory Diseases, Key Laboratory of Child Development and Disorders Ministry of Education, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, China
 
关键词:
肺炎支原体肺炎; 肺不张; 支气管肺泡灌洗术; 儿童
Keywords:
Mycoplasma pneumoniae pneumonia;  atelectasis;  bronchoalveolar lavage;  children
分类号:
R446.9; R725.631; R725.634
文献标志码:
A
摘要:

目的探究儿童肺炎支原体肺炎（mycoplasma pneumoniae pneumonia，MPP）合并肺不张多次行支气管镜下支气管肺泡灌洗术（bronchoalveolar lavage，BAL）的危险因素。方法采用病例-对照研究设计，分析重庆医科大学附属儿童医院呼吸中心2017年2月至2020年3月期间306例行BAL的MPP合并肺不张患儿的临床资料。根据患儿行BAL次数将患儿分为单次组（n=201）和多次组（≥2次，n=105），对两组间变量进行单因素及多因素分析，探寻MPP合并肺不张患儿多次行BAL的危险因素，用受试者工作特征（receiver operating characteristic，ROC）曲线评估乳酸脱氢酶（lactate dehydrogenase， LDH）及BAL前病程对MPP合并肺不张患儿多次行BAL的预测价值。结果单因素分析提示多次组与单次组在肺外并发症、胸腔积液、左下叶肺不张、支气管开口或管腔狭窄、支气管痰栓形成、全身糖皮质激素使用发生率之间有显著统计学差异（P<0.05）；在血小板计数（platelet count， PLT）、中性粒细胞百分比、C反应蛋白（c-reactive protein， CRP）、降钙素原（procalcitonin，PCT）、 LDH 、BAL前病程、阿奇霉素治疗前病程之间比较差异具有显著统计学意义（P<0.05）。Logistic回归分析提示BAL前病程（P=0.002，OR=1.033，95%CI：1.012~1.055）、LDH（P<0.001，OR=1.004，95%CI：1.002~1.006）、全身糖皮质激素使用（P<0.001，OR=4.663，95%CI： 2.534~8.584）、肺外并发症（P=0.025，OR=2.090，95%CI： 1.097~3.983）是MPP合并肺不张患儿多次行BAL的危险因素。ROC曲线提示LDH的曲线下面积为0.734（95%CI ：0.668~0.800，P<0.01），最佳截断值为374 U/L；BAL前病程的曲线下面积为0.703（95%CI： 0.643~0.763，P<0.01），最佳截断值为13.5 d。结论BAL前病程过长、LDH水平过高、使用全身糖皮质激素以及肺外并发症是MPP合并肺不张患儿多次行BAL的危险因素；在病程<13.5 d进行BAL和积极抗炎治疗有利于提升MPP合并肺不张患儿的临床疗效。

Abstract:

ObjectiveTo explore the risk factors of multiple bronchoalveolar lavages (BAL) in children with Mycoplasma pneumoniae pneumonia (MPP) complicated with atelectasis. MethodsA case-control trail was designed to analyze the clinical data of 306 children with MPP complicated with atelectasis in the Respiratory Center of Children’s Hospital of Chongqing Medical University from February 2017 to March 2020. All cases were divided into single group (n=201) and multiple group (≥ 2 times, n=105) based on the total number of BAL undertaken. Univariate and multivariate analyses were used to analyze the risk factors of multiple BALs. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of clinical course before BAL and lactate dehydrogenase (LDH) for multiple BALs. ResultsUnivariate analysis showed that there were significant differences in the incidence of extrapulmonary complications, pleural effusion, left lower lobe atelectasis, stenosis of the lumen or opening of the bronchus, formation of bronchial mucus plug and use of systemic glucocorticoid between the 2 group (P<0.05). Statistical  differences were in platelet (PLT) count, neutrophil percentage, levels of C-reactive protein (CRP), procalcitonin (PCT) and LDH, and clinical course before azithromycin therapy and clinical course before BAL (P<0.05). Logistic regression analysis showed that clinical course before BAL (P=0.002, OR=1.033, 95%CI: 1.012~1.055),  LDH (P<0.001, OR=1.004, 95%CI: 1.002~1.006),  use of systemic glucocorticoid (P<0.001, OR=4.663, 95%CI: 2.534~8.584) and extrapulmonary complications (P=0.025, OR=2.09, 95%CI: 1.097~3.983） were the risk factors of multiple BALs in children with MPP complicated with atelectasis. The area under ROC curve of LDH was 0.734 (95%CI: 0.668~0.800, P<0.01) and the optimal cutoff value was 374 U/L. The area under ROC curve of clinical course before BAL was 0.703 (95%CI: 0.668~0.800, P<0.01) and the optimal cutoff value was 13.5 d. ConclusionLong clinical course before BAL, high LDH level, use of systemic glucocorticoid and extrapulmonary complications are the risk factors of multiple BALs in children with MPP complicated with atelectasis. BAL before the course is shorter than 13.5 d, and active anti-inflammatory therapy is beneficial to improve the clinical effect of these children.

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更新日期/Last Update: 2022-09-23