摘要
目的分析儿童细菌性肺炎与肺炎支原体肺炎合并中至大量胸腔积液的临床特征及预测指标。方法回顾性收集2015年6月~2020年6月在苏州大学附属儿童医院住院的55例肺炎合并中至大量胸腔积液患儿临床资料,根据病原菌分为细菌组和肺炎支原体组,分析比较两组患儿的临床特征、实验室检查结果、治疗及转归等情况。结果55例肺炎合并中至大量胸腔积液患儿,其中细菌组23例,肺炎支原体组32例。与肺炎支原体组比较,细菌组患儿年龄小,住院时间长,更易出现呼吸急促症状,需要吸氧和胸腔闭式引流的例数明显增多,而肺内形成痰栓的例数明显减少。实验室检查发现,与肺炎支原体组比较,细菌组外周血白细胞计数、外周血中性粒细胞计数、C反应蛋白、降钙素原、纤维蛋白原、胸腔积液白细胞计数、胸腔积液中性粒细胞百分比、胸腔积液乳酸脱氢酶明显升高;而CD3^(+)淋巴细胞百分比、CD3^(+)CD8^(+)淋巴细胞百分比、胸腔积液葡萄糖较肺炎支原体组降低,差异均有统计学意义(均P<0.05)。胸腔积液白细胞计数、胸腔积液乳酸脱氢酶、胸腔积液葡萄糖、C反应蛋白4个因素可作为细菌或肺炎支原体感染引起肺炎旁中大量胸腔积液的有价值预测指标,临界值分别为10070.0×10^(6)/L、4542.2U/L、3.42mmol/L及63.9mg/L。结论肺炎合并中至大量胸腔积液患儿病情重,早期行胸腔穿刺抽液检查,有助于细菌或肺炎支原体感染的鉴别诊断。当肺炎合并中至大量胸腔积液患儿胸腔积液白细胞计数≥10070.0×10^(6)/L,胸腔积液乳酸脱氢酶≥4542.2U/L,胸腔积液葡萄糖≤3.42mmol/L,C反应蛋白≥63.9mg/L时,考虑可能是肺炎合并中至大量胸腔积液患儿作为区别细菌或肺炎支原体感染的指标。
Objective To analyze the clinical characteristics and predictive indicators between bacterial pneumonia and Mycoplasma pneumoniae(MP)pneumonia in children with the moderate and massive pleural effusion.Methods A retrospective observational study of 55 pneumonia with the moderate and massive pleural effusion cases who were hospitalized in Children′s Hospital of Soochow University from June 2015 to June 2020 was conducted.According to the pathogen,patients were divided into two groups,bacterial group and MP group,and the clinical manifestations,laboratory data,hospital course and prognosis between two groups were analyzed.Results Of the totally of 55 pneumonia with the moderate and massive pleural effusion patients,23 were in the bacteria group,32 were in the MP group.Compared with the MP group,the patients in the bacterial group were younger,longer hospital stay,more likely to develop tachypnea,more needed to oxygen therapy and undergo chest drainage,while the number of patients form sputum bolt in lung was higher in MP group than that in bacteria group.The values of peripheral white blood cell,peripheral neutrophils,C reactive protein(CRP),procalcitonin(PCT),fibrinogen,pleural fluid white blood cell,the percentage of neutrophils in pleural effusion,pleural fluid lactic dehydrogenase in bacteria group were significantly higher than those in MP group,while the values of CD3^(+)lymphocyte percentage,CD3^(+)CD8^(+)lymphocyte percentage,pleural fluid glucose were lower in bacteria group than those in MP group,and the differences were statistically significant(all P<0.05).The ROC curves analysis showed that the cut-off values of the 4 predictors including pleural fluid white blood cell,pleural fluid lactic dehydrogenase,pleural fluid glucose and CRP were 10070.0×10^(6)/L,4542.2U/L,3.42mmol/L and 63.9mg/L,respectively.Conclusion Pneumonia with the moderate and massive pleural effusion in patients is severe.Early examination of thoracocentesis is helpful for the differential diagnosis of bacterial or MP infection.When
作者
王坤
孔小行
成芳芳
田健美
周卫芳
WANG Kun;KONG Xiaoxing;CHENG Fangfang(Children′s Hospital of Soo-chow University,Jiangsu 215000,China)
出处
《医学研究杂志》
2022年第2期114-119,共6页
Journal of Medical Research
基金
江苏省苏州市科技发展计划项目(SZS2020310)。
关键词
细菌
肺炎支原体
胸腔积液
肺炎
Bacteria
Mycoplasma pneumoniae
Pleural effusion
Pneumonia
