肺炎支原体肺炎患儿心肌损害的影响因素分析

目的探讨肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)患儿心肌损害的影响因素,为临床早期诊治提供参考。方法选取2017年1月-2018年12月于湖北省武汉儿童医院心内科住院的MPP患儿258例,进行回顾性研究,根据是否发生心肌损害分为心肌损害组(n=54)和非心肌损害组(n=204),比较两组一般临床资料及实验室指标的差异,并采用多因素Logistic回归分析筛选MPP患儿心肌损害的影响因素。结果心肌损害组高热、发热持续时间>7 d、大环内酯类抗菌药物使用起始时间>7 d、合并其他肺外并发症比例及肺炎支原体(Mycoplasma pneumoniae,MP)抗体滴度>1∶80、N-末端脑钠肽前体N-terminal-proBNP,NT-proBNP)、C-反应蛋白(C-reactive protein,CRP)、缺血修饰白蛋白(Ischemic modified albumin,IMA)、红细胞分布宽度(red blood cell distribution width,RDW)水平均高于非心肌损害组(P<0.05)。多因素Logistic回归分析结果显示,发热程度、发热持续时间、大环内酯类抗菌药物使用起始时间、CRP、IMA、RDW是MPP患儿并发心肌损害的危险因素(P<0.05)。结论MPP患儿治疗期间应行心脏标志物检查及心电图检查,结合这些因素有助于早期发现心肌损害并及时干预。

Analysis of influencing factors in myocardial damage in children with Mycoplasma pneumoniae pneumonia

OBJECTIVE To explore the influencing factors in myocardial damage in children patients with Mycoplasma pneumoniae pneumonia(MPP),and to provide reference for clinical early diagnosis and treatment.METHODS A total of 258 children patients with MPP hospitalized in department of cardiology of Wuhan Children’s Hospital from January 2017 to December 2018 were recruited for the retrospective study.According to whether myocardial damage occurred,the patients were divided into the myocardial damage group(n=54)and the non-myocardial damage group(n=204).The general clinical data and laboratory parameters were compared between the two groups,and multivariate Logistic regression analysis was used to screen the influencing factors in myocardial damage in children patients with MPP.RESULTS The proportions of high fever,fever duration>7 d,starting time of application of macrolide antibiotics>7 d,other extrapulmonary complications and M.pneumoniae(MP)antibody titer>1:80 and levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),C-reactive protein(CRP),ischemia modified album(IMA)and red blood cell distribution width(RDW)in the myocardial damage group were significantly higher than that in the non-myocardial damage group(P<0.05).Multivariate Logistic regression analysis showed that the related factors which might induce myocardial damage in children patients with MPP were fever degree,fever duration,starting time of application of macrolide antibiotics,CRP,IMA and RDW(P<0.05).CONCLUSION Patients with MPP should undergo cardiac markers and electrocardiogram examinations during the treatment.Combination of these indexes may help early detection of myocardial damage and prompt intervention.