摘要
背景 近年来,儿童肺炎支原体肺炎的发病率持续上升,重症肺炎支原体肺炎的发病人数也相应升高,引起了临床医师的广泛关注.了解与重症肺炎支原体肺炎相关的危险因素,以判断患儿病情的严重程度、预防重症发生和减少后遗症,一直是研究的热点.虽然已经有许多关于重症肺炎支原体肺炎危险因素的研究,但这些研究在时间和地理区域上存在差异,因此需要进行系统综述及分析以对其进行全面了解.目的 系统评价重症肺炎支原体肺炎的危险因素.方法 计算机检索中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普网(VIP)、中国生物医学文献数据库(CBM)、独秀学术搜索数据库(Duxiu)、中华医学期刊全文数据库(Yiigle)、Cochrane Library、PubMed、Embase、Web of Science、Science Direct和BioMed Central,检索涉及儿童重症肺炎支原体肺炎危险因素的相关研究,检索时限均从建库至 2023 年 8 月.由 2 位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 14.0 和RevMan 5.4 软件进行Meta分析.结果 共纳入 22 个研究,均为回顾性病例对照研究,包括 4531 例患儿.Meta分析结果显示,C反应蛋白(CRP)(OR=1.92,95%CI=1.72～2.15,P<0.00001)、红细胞沉降率(ESR)(OR=2.61,95%CI=2.12～3.22,P<0.00001)、降钙素原(PCT)(OR=2.60,95%CI=1.43～4.75,P=0.002)、D-二聚体(OR=4.36,95%CI=2.93～6.50,P<0.00001)、白细胞计数(WBC)(OR=1.98,95%CI=1.66～2.36,P<0.00001)、肺下叶病变(OR=5.70,95%CI=3.48～9.35,P<0.00001)、肺大片状病变(OR=6.37,95%CI=4.09～9.92,P<0.00001)、高肺炎支原体抗体滴度(OR=2.83,95%CI=1.78～4.49,P<0.0001)、乳酸脱氢酶(LDH)(OR=1.03,95%CI=1.00～1.05,P=0.05)、发热时间(OR=8.33,95%CI=3.38～20.56,P<0.00001)是儿童重症肺炎支原体肺炎的影响因素.结论 炎性标志物(CRP、ESR、PCT、LDH、WBC)的升高、出现影像学特征性改变(大片状实变、下叶病变)、高肺炎支原体抗体滴度、D-二聚体升高以及发热时间延长可能为儿童重症肺炎支原体肺炎的危险因素.未来需要更高质量的研究来进一步探讨其他临床、影像学和实验室结果与儿童重症肺炎支原体肺炎之间的关系,并基于发现的危险因素建立预后模型.
Abstract
Background In recent years,the incidence of Mycoplasma pneumoniae pneumonia in children has continued to rise,with a corresponding increase in the number of severe Mycoplasma pneumoniae pneumonia,attracting widespread attention from clinical physicians.Understanding the risk factors associated with severe Mycoplasma pneumoniae pneumonia with the aim to determine the severity of the condition in affected children,prevent the occurrence of severe cases,and reduce sequelae has been a focal point in research.Although numerous studies have been conducted on the risk factors of severe Mycoplasma pneumoniae pneumonia,variations in time and geographical regions of the studies necessitate a systematic review and analysis for a comprehensive understanding.Objective To systematically review the risk factors for severe Mycoplasma pneumoniae pneumonia.Methods CNKI,Wanfang Data,VIP,CBM,Duxiu,Yiigle,Cochrane Library,PubMed,Embase,Web of Science,Science Direct,and BioMed Central were searched for studies related to risk factors of severe Mycoplasma pneumoniae pneumonia in children from inception to August 2023.Two investigators independently screened literature,extracted data,and assessed the bias risk of included studies.Meta-analysis was performed using Stata 14.0 and RevMan 5.4 software.Results A total of 22 retrospective case-control studies involving 4531 childre were included.Meta-analysis showed that C-reactive protein(CRP)(OR=1.92,95％CI=1.72-2.15,P<0.00001),erythrocyte sedimentation rate(ESR)(OR=2.61,95％CI=2.12-3.22),P<0.00001),procalcitonin(PCT)(OR=2.60,95％CI =1.43-4.75,P=0.002),D-dimer(OR=4.36,95％CI=2.93-6.50,P<0.00001),white blood cell count(WBC)(OR=1.98,95％CI=1.66-2.36,P<0.00001),lower lobe lesions(OR=5.70,95％CI=3.48-9.35,P<0.00001),large patchy lesions(OR=6.37,95％CI=4.09-9.92,P<0.00001),high Mycoplasma pneumoniae antibody titers(OR=2.83,95％CI=1.78-4.49,P<0.0001),lactate dehydrogenase(LDH)(OR=1.03,95％CI=1.00-1.05,P=0.05),and duration of fever(OR=8.33,95％CI=3.38-20.56,P<0.00001)were positively correlated with severe Mycoplasma pneumoniae pneumonia in children.Conclusion Elevated inflammatory markers(CRP,ESR,PCT,LDH,WBC),the presence of characteristic imaging changes(large patchy consolidation,lower lobe lesions),high Mycoplasma pneumoniae antibody titer,elevated D-dimer,and prolonged fever duration may be risk factors for severe Mycoplasma pneumoniae pneumonia in children.Future high-quality studies are needed to further explore the relationship of other clinical,radiographic,and laboratory findings with severe Mycoplasma pneumoniae pneumonia in children,and develop prognostic models based on identified risk factors.
维普
万方数据