通讯作者: 吴美慧, 1245668031@qq.com

DOI：10.12201/bmr.202507.00035

Analysis of risk factors of bronchopneumonia and lobar pneumonia caused by mycoplasma pneumoniae

• 摘要：目的 比较儿童肺炎支原体(MP)所致支气管肺炎和大叶性肺炎患儿的实验室指标,探讨患儿大叶性肺炎的危险因素。方法 收集并分析2023年7月-10月山东省威海市妇幼保健院收治的424例诊断为MP感染所致的肺炎患儿的相关资料,根据胸片将其分为为支气管肺炎组(178例)和大叶性肺炎组(246例),比较两组的年龄、住院天数、实验室指标、临床特点的差异,进行统计学分析。结果 大叶性肺炎的患儿年龄、住院天数明显高于支气管肺炎患儿(P<0.05)；大叶性肺炎的患儿乳酸脱氢酶(lactate dehydrogenase,LDH)、腺苷脱氨酶(Adenosine deaminase,ADA)、C-反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、D-二聚体明显高于支气管肺炎患儿(P<0.05)；大叶性肺炎患儿发生混合感染、胸腔积液、合并其他脏器损害、感染耐药型MP、行支气管镜检查的比例高于支气管肺炎患儿(P<0.05)。年长儿童(OR=1.285,95%CI:1.165-1.418)、LDH(OR=1.008,95%CI:1.004-1.012)、ADA(OR=1.113,95%CI:1.057-1.173)、CRP(OR=1.023,95%CI:1.002-1.045)、ESR(OR=1.031,95%CI:1.009-1.054)、D-二聚体(OR=4.500,95%CI:2.163-9.360)增高是患儿感染MP后发生大叶性肺炎的危险因素。LDH、ADA、CRP、ESR、D-二聚体均对患儿发生大叶性肺炎有一定的预测价值, 其曲线下面积分别为0.612(95%CI:0.558-0.666,P<0.0001)、0.704(95%CI:0.654-0.753,P<0.0001)、0.659(95%CI:0.606-0.712,P<0.0001)0.645(95%CI:0.592-0.697,P<0.0001)、0.679(95%CI:0.626-0.732,P<0.0001)。当LDH、ADA、CRP、ESR、D-二聚体联合预测时,其曲线下面积0.793(95%CI:0.750-.837,P<0.0001)。结论 MP所致的支气管肺炎和大叶性肺炎在实验室多种指标中都存在明显差异,导致患儿预后不同,多指标综合分析有利于临床对两种肺炎的鉴别诊断,警惕肺炎支原体大叶性肺炎的发生。

  关键词： 肺炎支原体；支气管肺炎；大叶性肺炎；危险因素; ; ; 

   

  Abstract: Objective To compare the laboratory indicators of bronchopneumonia caused by mycoplasma pneumoniae (MP) and lobar pneumonia in children, and to explore the risk factors of lobar pneumonia in children. Methods The data of 424 children diagnosed with pneumonia caused by MP infection in Weihai Maternal and Child Health Hospital of Shandong Province from July to October 2023 were collected and analyzed. They were divided into bronchopneumonia group (178 cases) and lobular pneumonia group (246 cases) according to chest radiographs. The differences in age, laboratory indicators and length of stay between the two groups were compared for statistical analysis. Results The age and hospitalization days of lobar pneumonia were significantly higher than those of bronchopneumonia (P<0.05). Lactate dehydrogenase (LDH), C-reactive protein (CRP), Adenosine deaminase (ADA), erythrocyte sedimentation rate (ESR) and D-dimer in children with lobar pneumonia were significantly higher than those in children with bronchopneumonia (P<0.05). The proportion of children with lobar pneumonia with mixed infection, pleural effusion, other organ damage, drug-resistant MP and bronchoscopy was higher than that of children with bronchopneumonia (P<0.05).Older children (OR=1.285, 95%CI: 1.165-1.418), LDH (OR=1.008, 95%CI: 1.004-1.012), ADA (OR=1.113, 95%CI: 1.057-1.173), CRP (OR=1.023, 95%CI: 1.002-1.045), ESR (OR=1.031, 95%CI: 1.009-1.054) and D-dimer (OR=4.500, 95%CI: 2.163-9.360) were risk factors for lobular pneumonia in children infected with MP. LDH, ADA, CRP, ESR, D-dimer all have certain predictive value for lobar pneumonia in children, and the area under the curve is respectively 0.612(95%CI:0.558-0.666,P<0.0001), 0.704(95%CI:0.654-0.753,P<0.0001), 0.659(95%CI:0.606-0.712,P<0.0001), 0.645(95%CI:0.592-0.697,P<0.0001), 0.679(95%CI:0.626-0.732,P<0.0001). When LDH, ADA, CRP, ESR and D-dimer were predicted together, the area under the curve was 0.793(95%CI:0.750-.837,P<0.0001). Conclusion There are obvious differences between bronchopneumonia caused by MP and lobar pneumonia in various laboratory indicators, leading to different prognosis of children. Comprehensive analysis of multiple indicators is conducive to the clinical differential diagnosis of the two types of pneumonia, and to guard against the occurrence of mycoplasma pneumoniae lobar pneumonia.

  Key words: Mycoplasma; pneumoniae, Bronchopneumonia, Lobar; pneumonia, Risk; factor

  提交时间：2025-07-11

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• 序号	提交日期	编号	操作
  1	2025-06-15	bmr.202507.00035V1	下载

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