河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (8): 914-919,938.doi: 10.3969/j.issn.1007-3205.2021.08.011

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RMPP患儿血常规、免疫球蛋白、D-D表达及预测塑型性支气管炎发生风险的效能研究

  

  1. 1.徐州医科大学宿迁临床学院儿科教研室，江苏 宿迁 223800；2.徐州医科大学附属医院儿科，江苏 徐州 221000
  • 出版日期:2021-08-25 发布日期:2021-08-27
  • 作者简介:李欢欢（1983-），女，江苏徐州人，徐州医科大学宿迁临床学院主治医师，医学学士，从事儿科疾病诊治研究。
  • 基金资助:
    江苏省妇幼健康科研项目（F201643）

Blood routine, immunoglobulin, D-D expression and their efficiency of predicting the risk of plastic bronchitis in children with RMPP

  1. 1.Pediatrics Teaching and Research Section, Suqian Clinical College of Xuzhou Medical University， Jiangsu 
    Province, Suqian 223800， China； 2.Department of Pediatrics, the Affiliated Hospital of 
    Xuzhou Medical University， Jiangsu Province, Xuzhou 221000， China
  • Online:2021-08-25 Published:2021-08-27

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摘要： 目的  探讨难治性肺炎支原体肺炎（refractory mycoplasma pneumoniae pneumonia，RMPP）患儿血常规、免疫球蛋白、D-二聚体（D-Dimer，D-D）表达及预测塑型性支气管炎发生风险的效能。
方法  选取RMPP患儿（RMPP组）125例，肺炎支原体肺炎（mycoplasma pneumoniae pneumonia，MPP）患儿（MPP组）125例。比较2组血常规［白细胞计数（white blood cell count，WBC）、中性粒细胞百分比（percentage of neutrophils，N%）、淋巴细胞百分比（percentage of lymphocytes，L%）、血小板（platelet，PLT）、乳酸脱氢酶（lactate dehydro-genase，LDH）、C反应蛋白（C-reactive protein，CRP)、红细胞分布宽度（red blood cell distribution width，RDW）、前清蛋白（pre-albumin，PAB）］、血清免疫球蛋白［免疫球蛋白（immunoglobulin，Ig）A、IgM、IgE、IgG］、D-D水平。比较RMPP组是否发生塑型性支气管炎患儿血常规、免疫球蛋白、D-D水平。探究发生塑型性支气管炎的影响因素、各指标与塑型性支气管炎严重程度［第三代小儿死亡危险评分（pediatric risk of mortalityⅢ，PRISMⅢ）］的相关性及预测塑型性支气管炎的效能。
结果  RMPP组WBC、N%、LDH、CRP、IgM、IgE、D-D水平高于MPP组，L%、PLT、PAB水平低于MPP组（P＜0.05）。RMPP组中塑型性支气管炎患儿N%、LDH、CRP、IgM、IgE、D-D水平高于无塑型性支气管炎患儿，L%、PLT、PAB低于无塑型性支气管炎患儿（P＜0.05）。多因素Logistic回归分析，结果显示，N%、CRP、IgM、IgE、D-D升高是发生塑型性支气管炎的危险因素（P＜0.05）。Pearson分析显示，发生塑型性支气管炎患儿N%、CRP、IgM、IgE、D-D与PRISMⅢ评分呈正相关（P＜0.05）。绘制N%、CRP、IgM、IgE、D-D预测塑型性支气管炎的ROC曲线，显示各指标联合预测的AUC最高为0.896，大于各指标单独预测的AUC，最佳敏感度为84.21%、特异度为85.85%；N%+CRP预测Ⅰ型塑型性支气管炎的AUC为0.867，大于各指标单独预测的AUC，最佳敏感度为70.00%、特异度为88.89%。
结论  血常规、免疫球蛋白、D-D在PMPP患儿中的表达明显异常，三者联合检测在预测塑型性支气管炎发生风险方面具有良好作用。


关键词: 肺炎, 支原体, 免疫球蛋白类, D-二聚体 

Abstract: Objective  To explore blood routine, immunoglobulin, D-Dimer(DD) expression and their efficiency in predicting the risk of plastic bronchitis in children with refractory mycoplasma pneumoniae pneumonia(RMPP). 
Methods  A total of 125 children with RMPP(RMPP group) and 125 children with Mycoplasma pneumoniae pneumonia(MPP) (MPP group) in our hospital were selected. The blood routine ［white blood cell count(WBC), percentage of neutrophils(N%), percentage of lymphocytes(L%), platelet(PLT), lactate dehydro-genase(LDH), C-reactive protein(CRP), red blood cell distribution width(RDW), pre-albumin(PAB)］,serum immunoglobulin ［immunoglobulin(Ig) A, IgM, IgE, IgG］ and D-D level of children with or without plastic bronchitis were compared between the two groups and in RMPP group. The influencing factors of plastic bronchitis, the correlation between various indicators and the severity of plastic bronchitis ［pediatric risk of mortality Ⅲ(PRISM Ⅲ)］, and the efficiency of predicting plastic bronchitis were explored. 
Results  WBC, N%, LDH, CRP, IgM, IgE, and D-D in RMPP group were higher than those in MPP group, while L%, PLT, and PAB were lower than those in MPP group(P＜0.05). In the RMPP group, N%, LDH, CRP, IgM, IgE, and DD in children with plastic bronchitis were higher than those in children without plastic bronchitis, while L%, PLT, and PAB were lower than those in children without plastic bronchitis(P＜0.05). Multivariate Logistic regression analysis showed that an increase in IgM, IgE, N%, CRP, and D-D was a risk factor for plastic bronchitis(P＜0.05). Pearson analysis revealed that there was a positive correlation between N%, CRP, IgM, IgE, D-D and PRISMⅢ scorein children with plastic bronchitis(P＜0.05). The receiver operating characteristic(ROC)curve of N%, CRP, IgM, IgE, D-D to predict plastic bronchitis was drawn, and the area under the ROC curve(AUC) of IgM, IgE, N%, CRP, and D-D combined to predict plastic bronchitis was 0.896, which was greater than the AUC predicted by each index alone, with the best sensitivity of 84.21% and specificity of 85.85%. The AUC predicted by N%+CRP for type I plastic bronchitis was 0.867, which was greater than the AUC predicted by each index alone. The optimal sensitivity was 70.00% and the specificity was 88.89%. 
Conclusion  The expression of blood routine, immunoglobulin, and D-D in children with PMPP is obviously abnormal, and the combined detection of the three has a good effect in predicting the risk of plastic bronchitis. 


Key words: pneumonia, mycoplasma, immunoglobulins, D-dimer

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