摘要
目的探讨儿童肺炎支原体肺炎(MPP)发生肝损害的危险因素。方法回顾性分析2018年1月—2021年1月天津中医药大学第一附属医院收治的265例MPP患儿的临床资料和实验室指标,根据其有无合并肝损害分为单纯MPP组及MPP合并肝损害组。比较两组间相关指标的差异,并对患儿发生肝损害的相关因素进行Logistic回归分析。结果265例MPP患儿中有26例发生肝损害(发生率9.8%),单因素分析表明,两组在热峰(>39.0℃)、热程(≥7 d)、住院时间(≥10 d)、大环内酯类抗生素应用(≥7 d)、胸腔积液、肺实变、肺不张、累计肺叶≥2、心肌损害、D-二聚体值(>200μg/L)、外周血白细胞计数>10×10^(9)/L、C-反应蛋白>10 mg/L、乳酸脱氢酶>120 U/L及激素使用方面比较,差异均有统计学意义(均P<0.05);多因素Logistic回归分析结果显示,热峰(>39.0℃)、热程(≥7 d)、住院病程(≥10 d)、大环内酯类应用(≥7 d)、累计肺叶≥2、胸腔积液、肺实变、肺不张、心肌损害、白细胞计数>10×10^(9)/L、C-反应蛋白>10 mg/L、乳酸脱氢酶>120 U/L及D-二聚体值>200μg/L均为导致儿童MPP发生肝损害的独立危险因素(OR>1,P<0.05),糖皮质激素应用则为保护性因素。结论较高的热峰、较长的热程、较重的肺内影像学改变及过强免疫炎症反应和高凝状态等是MPP发生肝损害的高危因素,而糖皮质激素应用则为保护性因素,临床应当权衡利弊,及时干预,从而降低并发症的发生,改善患儿预后。
Objective To explore the risk factors of liver damage in children with Mycoplasma pneumoniae pneumonia(MPP).Methods The clinical data and laboratory indicators of 265 children with MPP admitted to our hospital from January 2018 to January 2021 were retrospectively analyzed.According to the presence or absence of liver damage,they were divided into simple MPP group and MPP combined liver damage group.The difference in related indicators between the two groups,and the logistic regression analysis of the factors related to liver damage in children.Results 26 of the 265 children with MPP had liver damage(incidence rate 9.8%).Univariate analysis showed that the two groups were in heat peak(>39.0℃),heat history(≥7 d),hospitalization time(≥10 d),Application of macrolide antibiotics(≥7 d),pleural effusion,pulmonary consolidation,atelectasis,cumulative lobes≥2,myocardial damage,D-dimer value(>200μg/L),peripheral blood white blood cell count>10×10^(9)/L,C-reactive protein>10 mg/L,lactate dehydrogenase>120 U/L,and hormone use were statistically different(P<0.05);the results of multivariate logistic regression analysis showed that the heat peak(>39.0℃),heat course(≥7 d),hospitalization course(≥10 d),application of macrolides(≥7 d),cumulative lobes≥2,pleural effusion,lung consolidation,atelectasis,myocardial damage,white blood cells Count>10×10^(9)/L,C-reactive protein>10mg/L,lactate dehydrogenase>120 U/L and D-dimer value>200μg/L are independent risks of liver damage in children with MPP Factors(OR>1,P<0.05),glucocorticoid application is a protective factor.Conclusion Higher heat peak,longer heat duration,heavier lung imaging changes,excessive immune inflammatory response and hypercoagulable state are high risk factors for liver damage in MPP,while glucocorticoid application is protective Factors,clinicians should weigh the pros and cons and intervene in time to reduce the incidence of complications and improve the prognosis of children.
作者
黄争光
李新民
孙丹
韩耀巍
HUANG Zheng-Guang;LI Xin-Min;SUN Dan(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China)
出处
《中国妇幼保健》
CAS
2022年第3期431-435,共5页
Maternal and Child Health Care of China
基金
国家自然科学基金面上项目(82074491)
天津中医药大学第一附属医院“拓新工程”基金科研课题(院201704)。
关键词
肺炎支原体肺炎
儿童
肝损害
危险因素
Mycoplasma pneumoniae pneumonia
Children
Liver damage
Risk factors
