中国实验诊断学

目的 探讨血清相关炎症标志物和肺功能指标在儿童肺炎支原体肺炎(MPP)中的改变及其对病情严重程度的预测价值。方法 选取2023年1月1日至2023年12月31日因MP感染确诊为MPP患儿174例为研究对象进行回顾性分析。根据病情的严重程度分为，轻症MPP组(n=85例),重症MPP组(n=89例)。比较两组患儿实验室指标、肺功能和影像学相关指标间的差异，采用多因素Logistic回归分析重症MPP患儿的危险因素，采用受试者工作特征曲线(ROC)分析各指标对重症MPP的早期预测价值。结果 两组患儿在热程、发热程度、肺部体征、阿奇霉素使用时间、影像学特征、病变范围、住院时间的差异有统计学意义(P<0.05)。两组患儿入院时重症MPP组血清炎症指标WBC、NEUT、ESR、LDH、CRP和D-dimer均高于轻症MPP组(P<0.05);重症MPP组CD4⁺/CD8⁺低于轻症MPP组(P<0.05)。重症MPP组患儿肺功能相关指标均低于轻症MPP组，差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示，高水平的ESR(P=0.013,OR=1.293,95%CI=1.057～1.582)、CRP(P=0.014,OR=1.173,95%CI=1.033～1.326)、LDH(P=0.046,OR=1.237,95%CI=1.140～1.689)、D-dimer(P=0.038,OR=1.569,95%CI=1.346～2.387)和低水平的FEV₁/FVC%(P=0.044,OR=0.704,95%CI=0.501～0.990)是重症MPP的独立危险因素。各指标联合检测对预测重症MPP的AUC显著高于单一检测指标(Z=1.267、2.102、1.380、1.831、2.026,P<0.05)。结论 血清相关炎症指标ESR、CRP、LDH、D-dimer升高，FEV₁/FVC%降低是重症MPP的独立危险因素，联合检测对MPP病情严重程度具有较高的预测价值。

Objective To investigate the changes in serum inflammatory markers and pulmonary function indicators in children with Mycoplasma pneumoniae pneumonia(MPP) and assessed their predictive value for disease severity.Methods 174 children diagnosed with MPP due to MP infection from January 1,2023 to December 31,2023 were selected as the study objects for retrospective analysis.According to the severity of the disease, they were divided into mild MPP group(n=85 cases) and severe MPP group(n=89 cases).The differences of laboratory indicators, lung function and imaging related indicators were compared between the two groups.The risk factors of children with severe MPP were analyzed by multivariate Logistic regression, and the early predictive value of each indicator for severe MPP was analyzed by receiver operating characteristic curve(ROC).Results There were significant differences in heat course, fever degree, pulmonary signs, azithromycin use time, imaging features, lesion scope and hospital stay between the two groups(P<0.05).The serum inflammatory indexes WBC,NEUT,ESR,LDH,CRP and D-dimer in severe MPP group were higher than those in mild MPP group at admission(P<0.05).CD4⁺/CD8⁺ in severe MPP group was lower than that in mild MPP group(P<0.05).The relevant indexes of lung function in the severe MPP group were lower than those in the mild MPP group, and the difference was significant(P<0.05).Multivariate Logistic regression analysis showed that high levels of ESR(P=0.013,OR=1.293,95%CI=1.057～1.582)、CRP(P=0.014,OR=1.173,95%CI=1.033～1.326)、LDH(P=0.046,OR=1.237,95%CI=1.140～1.689)、D-dimer(P=0.038,OR=1.569,95%CI=1.346～2.387) and low level of FEV₁/FVC%(P=0.044,OR=0.704,95%CI=0.501～0.990) was an independent risk factor for severe MPP.The AUC for predicting severe MPP was significantly higher with combined detection than with single detection(Z=1.267,2.102,1.380,1.831,2.026,P<0.05).Conclusion Serum related inflammatory indicators ESR,CRP,LDH,D-dimer increased, FEV₁/FVC% decreased, which is an independent risk factor for severe MPP,and the combined detection has high predictive value.