摘要
目的 探讨影响支气管肺泡灌洗术(BAL)治疗重症肺炎支原体肺炎(MPP)患儿疗效的因素.方法 回顾性分析2022年4月～2023年10月在扬州大学附属医院儿科住院治疗的151例行BAL治疗的重症MPP患儿的临床资料,根据疗效不同分为疗效明显组(n=109)和疗效欠佳组(n=42).对两组变量分别进行单因素及多因素Logistic回归分析,探讨可能影响BAL治疗重症MPP患儿疗效的因素.结果 单因素分析结果显示,两组在热程、肺外并发症、血中性粒细胞百分比、血乳酸脱氢酶(LDH)、血D-二聚体、胸腔积液、累及多个肺叶(≥2)、肺不张、支气管镜下支气管开口或管腔狭窄、BAL前病程、使用全身糖皮质激素方面比较,差异有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,使用全身糖皮质激素、血LDH过高、肺不张、BAL前病程过长是BAL治疗重症MPP患儿疗效欠佳的独立危险因素(P＜0.05).使用全身糖皮质激素、肺不张、血LDH和BAL前病程单独预测及四者联合预测BAL治疗重症MPP患儿疗效欠佳的AUC分别为0.615(95%CI:0.520～0.709,P=0.029)、0.657(95%CI:0.551～0.762,P=0.003)、0.838(95%CI:0.772～0.910,P＜0.001)、0.741(95%CI:0.664～0.826,P＜0.001)和0.919(95%CI:0.876～0.961,P＜0.001),联合预测的效能高于血LDH、BAL前病程、使用全身糖皮质激素、肺不张单独预测.结论 BAL前病程过长、血LDH过高、肺不张、使用全身糖皮质激素是BAL治疗重症MPP患儿效果欠佳的独立危险因素.
Abstract
Objective To investigate the influencing factors of the efficacy of bronchoalveolar lavage(BAL)in the treatment of children with severe Mycoplasma pneumoniae pneumonia(MPP).Methods The clinical data of 151 children with severe MPP who underwent BAL treatment in the pediatric ward of the Affiliated Hospital of Yangzhou University from April 2022 to October 2023 were retrospectively analyzed and divided into obvious curative effect group(n=109)and poor curative effect group(n=42),according to the different curative effects.Univariate and multivariate Logistic regression analysis were performed on the variables between the two groups to explore the factors that may affect the efficacy of BAL in the treatment of severe MPP children.Results The results of univariate analysis showed that there were statistically significant differences(P<0.05)between the two groups in terms of fever duration,extrapulmonary complications,percentage of blood neutrophils,blood lactate dehydrogenase(LDH),blood D-dimer,pleural effusion,involvement of multiple lobes(≥2),atelectasis,bronchoscopic bronchial opening or lumen stenosis,course of disease before BAL,and use of systemic glucocorticoids.Multivariate Logistic regression analysis showed that the use of systemic glucocorticoids,high blood LDH,atelectasis,and prolonged pre-BAL course of disease were independent risk factors for poor efficacy of BAL in children with severe MPP(P<0.05).The AUCs of systemic glucocorticoids,atelectasis,blood LDH,and pre-BAL course of disease alone and in combination for predicting poor efficacy of BAL in children with severe MPP were 0.615(95%CI:0.520-0.709,P=0.029),0.657(95%CI:0.551-0.762,P=0.003),0.838(95%CI:0.772-0.910,P<0.001),0.741(95%CI:0.664-0.826,P<0.001)and 0.919(95%CI:0.876-0.961,P<0.001),respectively.The efficacy of combined prediction was higher than that of blood LDH,pre-BAL course of disease,systemic glucocorticoid,and atelectasis alone.Conclusion Prolonged pre-BAL course of disease,high blood LDH,atelectasis,and use of systemic glucocorticoids are independent risk factors for poor efficacy of BAL in children with severe MPP.
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