[Predictive factors for sequelae of bronchitis obliterans in refractory Mycoplasma pneumoniae pneumonia].

Objective: To investigate the predictive factors for bronchitis obliterans in refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods: A restrospective case summary was conducted 230 patients with RMPP admitted to the Department of No.2 Respiratory Medicine of Beijing Children's Hospital, Capital Medical University from January 2013 to June 2017 were recruited. Clinical data, laboratory results, imaging results and follow-up data were collected. Based on bronchoscopy and imaging findings 1 year after discharge, all patients were divided into two groups: one group had sequelae of bronchitis obliterans (sequelae group) and the other group had not bronchitis obliterans (control group), independent sample t-test and nonparametric test were used to compare the differences in clinical features between the two groups. Receiver operating characteristic (ROC) curve to explore the predictive value of Bronchitis Obliterans in RMPP. Results: Among 230 RMPP children, there were 115 males and 115 females, 95 cases had sequelae group, the age of disease onset was (7.1±2.8) years;135 cases had control group, the age of disease onset was (6.8±2.7) years. The duration of fever, C-reative protein (CRP) and lactate dehydrogenase (LDH) levels, the proportion of ≥2/3 lobe consolidation, pleural effusion and the proportion of airway mucus plug and mucosal necrosis were longer or higher in the sequelae group than those in the control group ((17±9) vs. (12±3) d, (193±59) vs. (98±42) mg/L,730 (660, 814) vs. 486 (452, 522) U/L, 89 cases (93.7%) vs. 73 cases (54.1%), 73 cases (76.8%) vs.59 cases (43.7%), 81 cases (85.3%) vs. 20 cases (14.8%), 67 cases (70.5%) vs. 9 cases (6.7%), t=5.76, 13.35, Z=-6.41, χ2=14.64, 25.04, 22.85, 102.78, all P<0.001). Multivariate Logistic regression analysis showed that the duration of fever ≥10 days (OR=1.200, 95%CI 1.014-1.419), CRP levels increased (OR=1.033, 95%CI 1.022-1.044) and LDH levels increased (OR=1.001, 95%CI 1.000-1.003) were the risk factors for sequelae of bronchitis obliterans in RMPP. ROC curve analysis showed that CRP 137 mg/L had a sensitivity of 82.1% and a specificity of 80.1%; LDH 471 U/L had a sensitivity of 62.7% and a specificity of 60.3% for predicting the development of bronchitis obliterans. Conclusions: The long duration of fever (≥10 d), CRP increase (≥137 mg/L) may be used to predict the occurrence of sequelae of bronchitis obliterans in RMPP. It is helpful for early recognition of risk children.目的： 探讨预测难治性肺炎支原体肺炎（RMPP）可能遗留闭塞性支气管炎的因素。 方法： 回顾性病例总结，收集首都医科大学附属北京儿童医院呼吸二科2013年1月至2017年6月收治RMPP的230例患儿的临床资料、实验室结果、影像学结果及随访资料等，依据支气管镜下表现以及出院1年以上的肺部影像学表现，分为遗留闭塞性支气管炎组（简称闭塞组）和非闭塞性支气管炎组（简称非闭塞组），采用独立样本t检验和非参数检验比较两组患儿临床特征的差异，采用多因素Logistic回归分析闭塞性支气管炎发生的危险因素，采用受试者工作特征（ROC）曲线分析遗留闭塞性支气管炎的预测价值。 结果： 230例RMPP患儿中男115例、女115例，闭塞组95例，就诊年龄（7.1±2.8）岁；非闭塞组135例，就诊年龄（6.8±2.7）岁。闭塞组的发热持续时间、C反应蛋白（CRP）峰值水平、乳酸脱氢酶（LDH）峰值水平、≥2/3肺叶实变、胸腔积液、发生气道黏液栓以及黏膜坏死占比均高于非闭塞组［（17±9）比（12±3）d、（193±59）比（98±42）mg/L、730（660，814）比486（452，522）U/L、89例（93.7%）比73例（54.1%）、73例（76.8%）比59例（43.7%）、81例（85.3%）比20例（14.8%）、67例（70.5%）比9例（6.7%），t=5.76、13.35、Z=-6.41、χ2=14.64、25.04、22.85、102.78，均P<0.001］。多因素Logistic回归分析示发热持续时间≥10 d（OR=1.200，95%CI 1.014~1.419）、CRP升高（OR=1.033，95%CI 1.022~1.044）和LDH升高（OR=1.001，95%CI 1.000~1.003）是RMPP遗留闭塞性支气管炎的独立危险因素。通过ROC曲线分析CRP临界值为137 mg/L，对于预测闭塞性支气管炎的灵敏度为82.1%，特异度为80.1%；LDH临界值为471 U/L，灵敏度为62.7%，特异度为60.3%。 结论： 发热持续时间较长（≥10 d）、CRP升高（≥137 mg/L）是RMPP遗留闭塞性支气管炎的重要预测指标，有助于早期识别。.