乌鲁木齐市单中心小儿难治性肺炎的危险因素分析

发布时间：2018-09-10 16:52

【摘要】：目的:探寻小儿难治性肺炎的相关危险因素并对其进行分析,为及早识别和治疗小儿难治性肺炎提供有力依据,改善难治性肺炎的预后。方法:采用临床流行病学方法选取2011年12月-2016年12月期间在新疆医科大学第一附属医院确诊并住院的肺炎患儿中的219例符合难治性肺炎诊断的患儿为病例组,同时随机选取同期住院的400例普通肺炎患儿作为对照组,对其临床资料进行回顾性分析。首先对可能导致难治性肺炎发生的高危因素进行单因素分析,其次对有显著意义的单因素进行多因素Logistic回归分析。观察项目包括8项临床和17项检验指标及影像学诊断资料。结果:年龄、贫血,佝偻病、营养不良、先天性心脏病、先天性气道发育异常、多重耐药菌感染、特应性体质、影像学特点(肺下叶和或大片状阴影)、合并有胸腔积液和(或)肺不张、WBC、N%(均为外周血)、(血清)LDH、CRP、ESR、PCT、IL-6、ESR、25羟维生素D、IgG、IgM、IgA、CD3阳性率、CD4阳性率、CD8阳性率、血清补体C3、C4,与患儿是否为难治性肺炎的发生密切相关(P0.05),多因素非条件的Logistic回归结果:是否合并先天性心脏病(OR=3.908)、是否合并先天性气道发育异常(OR=3.718)、渗出影面积(OR=11.422)、LDH(OR=3.288)、合并有胸腔积液(OR=11.66)或肺不张(OR=6.57)、是否为营养不良(OR=3.036)、年龄(OR=1.764)、CRP(OR=6.228)、ESR(OR=1.263)是难治性肺炎的独立危险因素,P0.05,差异有统计学意义。结论:单因素分析结果表明:本次研究中除肺炎支原体感染外所有指标均为小儿难治性肺炎的危险因素。其中,年龄、先天性心脏病、先天性气道发育异常、营养不良、合并并发症、CRP、ESR等为独立危险因素(P0.05),从而有助于对小儿难治性肺炎的早期诊断,早期治疗,减缓并发症的发生并改善预后。
[Abstract]:Objective: to explore the risk factors and analyze the risk factors of refractory pneumonia in children, so as to provide evidence for early identification and treatment of refractory pneumonia in children and improve the prognosis of refractory pneumonia. Methods: from December 2011 to December 2016, 219 children with pneumonia diagnosed and hospitalized in the first affiliated Hospital of Xinjiang Medical University were selected as the case group by clinical epidemiology. At the same time, 400 children with common pneumonia were randomly selected as control group and their clinical data were analyzed retrospectively. First, univariate analysis of the high risk factors that may lead to refractory pneumonia, and then multivariate Logistic regression analysis of the significant single factor. The observation items included 8 clinical items, 17 test indexes and imaging diagnostic data. Results: age, anemia, rickets, malnutrition, congenital heart disease, congenital airway dysplasia, multidrug resistant bacteria infection, atopic constitution, Imaging features (lower lobes of lung and or large shadow), with pleural effusion and / or atelectasis (all peripheral blood), (serum), the positive rate of LDH,CRP,ESR,PCT,IL-6,ESR,25 hydroxyvitamin D titer IgMMA-IgA- CD3 positive rate and CD4 positive rate and CD8 positive rate, and the positive rate of CD _ 4 and CD _ 8 in the patients with pulmonary effusion and / or atelectasis. Serum complement C _ 3 C _ 4 was closely related to the occurrence of refractory pneumonia in children (P0.05). The results of multivariate Logistic regression were as follows: congenital heart disease (OR=3.908), congenital airway dysplasia (OR=3.718), effusion area (OR=11.422) and OR=3.288. Pleural effusion (OR=11.66) or atelectasis (OR=6.57), dystrophy (OR=3.036), and age (OR=1.764) OR=6.228 (OR=1.263) were independent risk factors for refractory pneumonia (P 0.05). Conclusion: univariate analysis showed that all the indexes except mycoplasma pneumoniae infection were risk factors of refractory pneumonia in children. Among them, age, congenital heart disease, congenital airway dysplasia, malnutrition, complicated complications and CRP ESR were independent risk factors (P0.05), which contributed to the early diagnosis and early treatment of refractory pneumonia in children. To slow down the occurrence of complications and improve the prognosis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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