儿童重症肺炎支原体肺炎合并低氧血症危险因素分析

Risk factors for hypoxemia in children with severe Mycoplasma pneumoniae pneumonia

摘要:

目的 分析儿童重症肺炎支原体肺炎（severe Mycoplasma pneumoniae pneumonia, SMPP）发生低氧血症的危险因素。方法 回顾性收集2023年6—12月由郑州大学第三附属医院收治的SMPP患儿临床资料，将其分为低氧组与非低氧组。采用logistic回归分析评估发生低氧血症的危险因素，并采用受试者操作特征曲线分析不同指标的诊断效能。结果 共纳入113例SMPP患儿，单因素logistic回归分析显示铁蛋白、谷草转氨酶、肌酐、肌酸激酶同工酶、乳酸脱氢酶、α-羟基丁酸脱氢酶、免疫球蛋白G、补体C3、补体C4、年龄、肺外并发症、肺部计算机断层扫描（chest computed tomography, CT）呈细支气管炎型是SMPP患儿发生低氧血症的影响因素（P<0.05）。多因素logistic回归分析显示铁蛋白升高、合并肺外并发症、肺部CT呈细支气管炎型是SMPP患儿发生低氧血症的独立危险因素（P<0.05）。受试者操作特征曲线分析显示三者联合预测低氧血症的灵敏度为71.9%，特异度为95.1%，曲线下面积为0.888（95%CI：0.809~0.968）。结论 当SMPP患儿出现铁蛋白升高，肺部CT为细支气管炎型表现、合并肺外并发症时应高度警惕出现低氧血症可能，应尽早识别并进行有效干预。

Abstract:

Objective To study the risk factors for hypoxemia in children with severe Mycoplasma pneumoniae pneumonia (SMPP).Methods A retrospective collection of clinical data from children diagnosed with SMPP at the Third Affiliated Hospital of Zhengzhou University from June to December 2023 was conducted. The patients were categorized into hypoxemia and non-hypoxemia groups. Logistic regression analysis was used to assess the risk factors for hypoxemia, and receiver operating characteristic (ROC) curve analysis was employed to analyze the diagnostic performance of various indicators.Results A total of 113 children with SMPP were included. Univariate logistic regression analysis showed that ferritin, aspartate aminotransferase, creatinine, creatine kinase isoenzyme, lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase, immunoglobulin G, complement C3, complement C4, age, extrapulmonary complications, and a chest computed tomography (CT) scan showing a bronchiolitis pattern were significant factors for hypoxemia in children with SMPP (P<0.05). Multivariate logistic regression analysis revealed that elevated ferritin levels, presence of extrapulmonary complications, and a bronchiolitis pattern on lung CT were independent risk factors for hypoxemia in these patients (P<0.05). The ROC curve analysis indicated that the combination of these three indicators for predicting hypoxemia had a sensitivity of 71.9%, a specificity of 95.1%, and an area under the curve of 0.888 (95%CI: 0.809-0.968).Conclusions In children with SMPP, when there are elevated ferritin levels, a bronchiolitis pattern on chest CT, and the presence of extrapulmonary complications, there should be a high level of vigilance for the potential development of hypoxemia.