儿童大叶性肺炎的临床特征及进展为重症大叶性肺炎的危险因素

Clinical features of lobar pneumonia in children and risk factors for progressing to severe lobar pneumonia

摘要

目的 分析儿童大叶性肺炎的临床特征及实验室指标,探究早期识别重症大叶性肺炎的危险因素。方法 收集2023年5月至2025年6月在西安交通大学第一附属医院儿科住院治疗的449例大叶性肺炎患儿的临床资料,根据纳排标准共纳入337例进行研究,依据《儿童社区获得性肺炎诊疗规范(2019版)》对病情的严重程度进行评估,分为轻症和重症大叶性肺炎两组,研究两组人口学特征、影像学实变部位、病原学以及实验室指标,对有统计学差异的实验室指标采用受试者工作特征(ROC)曲线下面积(AUC)判断其在诊断重症大叶性肺炎中的临床价值。结果 本研究中58.8%的大叶性肺炎患儿发病年龄为学龄期,65.6%的患儿为肺炎支原体感染;在胸部影像学上,55.5%的大叶性肺炎实变部位为右肺,且两组间肺部影像学实变部位存在统计学差异(χ²=6.877,P＜0.05);在实验室指标中,重症大叶性肺炎组患儿的中性粒细胞计数(NEU)、C-反应蛋白(CRP)、白介素-6(IL-6)、降钙素原(PCT)、D-二聚体(D-D)、纤维蛋白原(FIB)、乳酸脱氢酶(LDH)均高于轻症大叶性肺炎组,且两组间存在统计学差异(Z 介于-5.934到-2.088之间,P＜0.05);对有统计学差异的实验室指标进行诊断价值分析,其 AUC 均大于0.5,说明上述实验室指标升高有可能是评估轻症大叶性肺炎进展为重症大叶性肺炎的危险因素。结论 儿童大叶性肺炎的好发年龄为学龄期儿童,且肺炎支原体为主要的病原体;在胸部影像学上,大叶性肺炎的实变部位主要累及右肺;实验室指标 NEU、CRP、IL-6、PCT、D-D、FIB、LDH 有可能作为早期识别重症大叶性肺炎的指标。

Abstract

Objective To systematically analyze clinical features and laboratory indexes of children with lobar pneumonia,and to further provide diagnostic clues for severe cases. Methods Clinical data of 449 children diagnosed as lobar pneumonia in Department of Pediatrics,The First Affiliated Hospital of Xi'an Jiaotong University from May 2023 to June 2025 were collected and 337 children were included in study according to inclusion and exclusion criteria.Severity of the disease was evaluated according to Guideline for Diagnosis and Treatment of Community-Acquired Pneumonia in Children (2019 Version),and the children were divided into two groups:mild lobar pneumonia group and severe lobar pneumonia group.Demographic characteristics,distribution of pulmonary consolidation sites on chest imaging film,etiology and laboratory indexes were analyzed and compared between the two groups.Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to determine clinical diagnostic values of those laboratory indexes with statistical differences for severe lobar pneumonia. Results In this study,58.8% of lobar pneumonia cases occurred in school-age children,and 65.6% of children were infected with Mycoplasma pneumoniae.On chest imaging film,consolidation site of 55.5% of the lobar pneumonia cases was located in the right lung,and there was a statistical difference between the two groups (χ²=6.877,P＜0.05).In laboratory indexes,neutrophil count (NEU),levels of C-reactive protein (CRP),procalcitonin (PCT),interleukin-6 (IL-6),D-dimer (D-D),fibrinogen (FIB) and lactate dehydrogenase (LDH) of the children with severe lobar pneumonia were higher than those of the children with mild lobar pneumonia,there were statistical significance between the two groups (Z=-5.934--2.088,all P＜0.05).Analysis of diagnostic values of these laboratory indexes with statistical differences showed that their AUCs were all＞0.5,indicating that these increased laboratory indexes were risk factors for mild lobar pneumonia progressing to severe lobar pneumonia. Conclusion Susceptible age of lobar pneumonia is school-age of children,and Mycoplasma pneumoniae is the main pathogen.And consolidation site on chest imaging film in lobar pneumonia is mostly in the right lung.Such laboratory indexes as NEU,CRP,PCT,IL-6,D-D,FIB and LDH could be regarded as markers for early identification of severe lobar pneumonia.

关键词

儿童 / 大叶性肺炎 / 实验室指标 / 临床特征

Key words

children / lobar pneumonia / laboratory index / clinical feature

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基金资助

国家自然科学基金(82211530115)

陕西省重点研发项目(2020SF001)