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

罗永涵; 代继宏

doi:10.16016/j.2097-0927.202111142

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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

临床医学 | 更新时间：2026-01-09

- 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
- Risk factors of multiple bronchoalveolar lavage therapy in children with mycoplasma pneumonia complicated with atelectasis
- 陆军军医大学学报 2022年44卷第18期页码：1856-1861
- 作者机构：
  
  400014 重庆，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
- 作者简介：
  
  [ 代继宏，E-mail: danieljh@163.com DAI Jihong, E-mail: danieljh@163.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202111142
  中图分类号： R446.9;R725.631;R725.634
- 收稿：2021-11-19，
  
  修回：2022-01-30，
  
  纸质出版：2022-09-30
- 稿件说明：
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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, 2022,44(18):1856-1861.

Yonghan LUO, Jihong DAI. Risk factors of multiple bronchoalveolar lavage therapy in children with mycoplasma pneumonia complicated with atelectasis[J]. Journal of Army Medical University, 2022, 44(18): 1856-1861.
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, 2022,44(18):1856-1861. DOI： 10.16016/j.2097-0927.202111142.

Yonghan LUO, Jihong DAI. Risk factors of multiple bronchoalveolar lavage therapy in children with mycoplasma pneumonia complicated with atelectasis[J]. Journal of Army Medical University, 2022, 44(18): 1856-1861. DOI： 10.16016/j.2097-0927.202111142.

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(

=201)和多次组(≥2次，

=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(

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(

0.05)。Logistic回归分析提示BAL前病程(

=0.002，

=1.033，95%

: 1.012~1.055)、LDH(

0.001，

=1.004，95%

: 1.002~1.006)、全身糖皮质激素使用(

0.001，

=4.663，95%

: 2.534~8.584)、肺外并发症(

=0.025，

=2.090，95%

: 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%

: 0.668~0.800，

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%

: 0.643~0.763，

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

Objective

To explore the risk factors of multiple bronchoalveolar lavages (BAL) in children with

Mycoplasma pneumoniae

pneumonia (MPP) complicated with atelectasis.

Methods

A case-control trail wa

s 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 (

=201) and multiple group (≥ 2 times

=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.

Results

Univariate 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 (

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 (

0.05). Logistic regression analysis showed that clinical course before BAL (

=0.002

=1.033

95%

: 1.012~1.055)

LDH (

0.001

=1.004

95%

: 1.002~1.006)

use of systemic glucocorticoid (

0.001

=4.663

95%

: 2.534~8.584) and extrapulmonary complications (

=0.025

=2.09

95%

: 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%

: 0.668~0.800

0.01) and the optimal cutoff value was 374 U/L. The area under ROC curve of cl

inical course before BAL was 0.703 (95%

: 0.668~0.800

0.01) and the optimal cutoff value was 13.5 d.

Conclusion

Long 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.

关键词

Keywords

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