161例肺炎支原体肺炎临床特征

Clinical characteristics of Mycoplasma pneumoniae pneumonia in 161 patients

  • 摘要:
    目的 探讨新型冠状病毒流行后肺炎支原体性肺炎(MPP)的临床特点, 为早期临床诊治提供帮助。
    方法 回顾性分析2023年7至2024年8月就诊于解放军总医院第一医学中心发热门诊的MPP患者的临床资料, 对不同年龄段和合并其他病原体情况患者的实验室检测结果进行统计学分析。
    结果 本研究共纳入MPP患者161例, 其中男性78例(48.45%), 女性83例(51.55%), 平均年龄(32.98±14.35)岁, 20~40岁患者70例, 占比高达43.48%。依据痰液病原学结果分为单纯MPP组92例(57.14%), MPP+混合组69例(42.86%), 其中包括MPP+细菌组42例(60.87%), MPP+真菌组10例(14.49%), MPP+病毒组17例(24.64%);各组间年龄比较有统计学差异(P<0.05);各组性别、白细胞计数和单核细胞百分比比较无统计学差异, 淋巴细胞百分比在单纯MPP组最高, C-反应蛋白(CRP)和白细胞介素(IL-6)水平在MPP+细菌组最高, 比较差异均有统计学意义(P<0.05)。将所有患者年龄按≤20岁、>20~40岁、>40岁分为3组, 不同年龄组白细胞计数、淋巴细胞百分比、单核细胞百分比和IL-6水平比较无统计学差异, 而>20~40岁年龄组CRP水平最高(P=0.025)。随机森林模型分析显示在MPP患者临床特征中, CRP权重最高(22.65%), 对模型构建起着关键作用。其他因素所占比重依次为年龄(17.02%)、淋巴细胞百分比(15.34%)、白细胞计数(14.86%)、单核细胞百分比(14.39%)、IL-6(13.61%)和性别(2.13%)。
    结论 新型冠状病毒暴发流行后, MPP仍多见于<40岁患者, 近半数合并其他病原体感染, 而CRP更有助于对MPP感染早期进行临床诊治。

     

    Abstract:
    OBJECTIVE To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) after COVID-19 epidemic so as to offer help for early clinical diagnosis and treatment.
    METHODS The clinical data that were collected from the MPP patients who were treated in the fever clinic of the First Medical Center of Chinese PLA General Hospital from Jul. 2023 to Aug. 2024 were retrospectively analyzed. The results of laboratory tests for the different age groups of patients complicated with other pathogens were statistically analyzed.
    RESULTS Of totally 161 MPP patients who were enrolled in the study, 78 (48.85%) were male, and 83 (51.55%) were female; the average age was (32.98±14.35) years old, and the patients aged between 20 and 40 years old accounted for 43.48% (70 cases). The enrolled patients were divided into the simple MPP group with 92 (57.14%) cases and the MPP+ mixed group with 69 (42.86%) cases according to the result of etiological test of sputum; the patients of MPP+ mixed group were divided into the MPP + bacteria group with 42(60.87%) cases, the MPP+fungi group with 10(14.49%) cases, and the MPP+ viruses group with 17(24.64%)cases. There was significant difference in the age among the groups(P<0.05); there were no significant differences in the sex, white blood cell counts and percentage of mononuclear cells among the groups, the percentage of lymphocytes was highest in the simple MPP group, the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) were highest in the MPP + bacteria group, and there were significant differences (P<0.05). All of the patients were divided into three groups: the ≤20-year-old group the >20-40-year old group and the >40-year-old group. There were no significant differences in the white blood cell counts, percentage of lymphocytes, percentage of mononuclear cells and IL-6 level among the three groups, and the CRP level was highest in the >20-40-year old group(P=0.025). Random forest model analysis showed that the weight of CRP was highest (22.65%) among the clinical characteristics of the MPP patients, which played a key role in construction of model. As for other factors, the weight of age was 17.02%, the percentage of lymphocytes 15.34%, the white blood cells counts 14.86%, the percentage of mononuclear cells 14.39%, the IL-6 13.61%, the gender 2.13%.
    CONCLUSION MPP maintains common among the patients aged less than 40 years old after the COVID-19 epidemic, nearly half of the patients are complicated with the infections of other pathogens, and CRP is more helpful for the clinical diagnosis and treatment of the MPP in early stage.

     

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