摘要
目的 探究C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、红细胞沉降率(ESR)与肺炎支原体肺炎(MPP)恢复期患儿发生气道高反应性(AHR)的关系分析.方法 回顾性选择2019年8月至2022年8月于西部战区总医院住院的MPP恢复期患儿102例,根据患儿是否发生AHR,分为AHR 组(n=48)及非AHR组(n=54).比较两组的CRP、LDH、ESR水平、肺功能指标[用力肺活量(FVC)、第1 s用力呼气容积(FEV1)、峰值呼气流速(PEF)与最大呼气中段流速(MEF25-75)]、气道反应性指标[基础呼吸传导率(Grs cont)、基础呼吸阻力(Rrs cont)、传导率下降斜率(SGrs)、特异性气道传导下降第35百分位(PD35)、最小诱发累积剂量(Dmin)],分析CRP、LDH、ESR水平与气道反应性指标的相关性,并采用受试者工作特征(ROC)曲线评估CRP、LDH、ESR对MPP恢复期患儿发生AHR的预测价值.结果 AHR组的 CRP、LDH、ESR 水平分别为(47.34±7.65)mg/L、(315.26±68.32)U/L、(45.71±6.25)mm/h,均高于非 AHR 组[(26.21±6.28)mg/L、(284.53±61.09)U/L、(31.46±5.13)mm/h],差异均有统计学意义(P＜0.05).AHR 组的FVC、FEV1、PEF、MEF25-75 水平分别为(83.01±10.43)％、(74.35±9.27)％、(70.29±7.63)％、(75.54±9.25)％,均低于非 AHR 组[(87.82±12.06)％、(83.49±12.38)％、(78.11±9.54)％、(80.02±10.37)％],差异均有统计学意义(P＜0.05).AHR 组的 Grs cont、SGrs、PD35、Dmin 水平分别为(0.13±0.03)L/(s·cmH2O)、(0.03±0.01)L/(s· cmH2O·min)、1.59±0.42、1.24±0.33,均低于非 AHR 组[(0.17±0.05)L/(s·cmH2O)、(0.05±0.02)L/(s· cmH2O·min)、4.06±1.15、3.97±0.82],Rrs cont 水平为(8.75±1.63)cmH2O/(L·s),高于非 AHR组[(8.12±1.31)cmH2O/(L·s)],差异均有统计学意义(P＜0.05).CRP、LDH、ESR与患儿的Grs cont、SGrs、PD35、Dmin水平均呈负相关(P＜0.05),CRP、LDH、ESR与患儿Rrs cont水平均呈正相关(P＜0.05).ROC曲线分析结果显示,3项指标联合预测MPP儿童恢复期发生AHR的曲线下面积为0.878,均高于单一的CRP、LDH、ESR的0.804、0.674、0.760.结论 CRP、LDH、ESR可作为MPP恢复期患儿发生AHR的重要标志物,可为临床评估患儿病情及用药提供参考.
Abstract
Objective To explore the relationship between C-reactive protein(CRP),lactate dehydrogenase(LDH),erythrocyte sedi-mentation rate(ESR)and airway hyperresponsiventss(AHR)in children with mycoplasma pneumoniae pneumonia(MPP)during convalescence.Methods A total of 102 children with MPP during convalescence who were admitted to Western War Zone General Hospital were enrolled between August 2019 and August 2022.According to presence or absence of AHR,they were divided into AHR group(n=48)and non-AHR group(n=54).The levels of CRP,LDH and ESR,pulmonary function indexes[forced vital capacity(FVC),forced expiratory volume in the first sec-ond(FEV1),peak expiratory flow(PEF)and MEF25-75]and airway reactivity indexes[basic respiratory conductivity(Grs cont),basic respir-atory resistance(Rrs cont),slope of conductivity decline(SGrs),35th percentile specific airway conduction decline(PD35),minimum induced cumulative dose(Dmin)]in the two groups were compared.The correlation between CRP,LDH,ESR levels and airway reactivity indexes was analyzed,and the predictive value of CRP,LDH and ESR for AHR was evaluated by receiver operating characteristic(ROC)curve.Results The levels of CRP,LDH and ESR in AHR group were(47.34±7.65)mg/L,(315.26±68.32)U/L,and(45.71±6.25)mm/h,respectively,which were higher than those in the non-AHR group[(26.21±6.28)mg/L,(284.53±61.09)U/L,and(31.46±5.13)mm/h],the differences were statistically significant(P＜0.05).The levels of FVC,FEV1,PEF and MEF25-75 in AHR group were(83.01±10.43)％,(74.35±9.27)％,(70.29±7.63)％,(75.54±9.25)％,which were lower than those in non-AHR group[(87.82±12.06)％,(83.49 ±12.38)％,(78.11±9.54)％,(80.02±10.37)％],the differences were statistically significant(P＜0.05).The levels of Grs cont,SGrs,PD35 and Dmin in AHR group were(0.13±0.03)L/(s·cmH2O),(0.03±0.01)L/(s·cmH2O·min),1.59±0.42,1.24± 0.33,which were lower than those in non-AHR group[(0.17±0.05)L/(s·cmH2O),(0.05±0.02)L/(s·cmH2O·min),4.06± 1.15,3.97±0.82],while Rrs cont was(8.75±1.63)cmH2 O/(L·s),which was higher than that in non-AHR group[(8.12±1.31)cmH2O/(L·s)],the differences were statistically significant(P＜0.05).The levels of CRP,LDH and ESR were negatively correlated with Grs cont,SGrs,PD35 and Dmin(P＜0.05),while positively correlated with Rrs cont(P＜0.05).ROC curves analysis showed that AUC of CRP combined with LDH and ESR for predicting AHR was 0.878,greater than that of single index(0.804,0.674,0.760).Conclusion CRP,LDH and ESR can be applied as important markers to predict AHR in children with MPP during convalescence,which can provide reference for clinical conditions and medication in MPP children.
维普
万方数据