摘要
Abstract
Objective To investigate relationship of change in CD4+/CD8+ratio with disease severity and its prediction for plastic bronchitis(PB)in children with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods 237 patients with confirmed Mycoplasma pneumoniae pneumonia(MPP)who admitted to Huamei Campus of Liaocheng Second People's Hospital from January 2020 to December 2023 were selected as study subjects.According to treatment response,the patients were divided into common MPP group(144 cases)and RMPP group(93 cases).The clinical data of the patients were compared between the two groups and influencing factors of RMPP were analyzed.The patients in the RMPP group were further divided into PB subgroup(38 cases)and non-PB subgroup(55 cases)according to whether the patient was complicated with PB.Multivariate Logistic regression was used to analyze influencing factors of occurrence of RMPP.The generalized linear mixed model was used to analyze relationship between CD4+/CD8+ratio and RMPP complicated with PB.The receiver operating characteristic(ROC)curve was used to evaluate predictive value of CD4+/CD8+ratio for RMPP complicated with PB.Results Compared with the common MPP group,the patients in the RMPP group had a longer duration of fever,a larger number of children had persistent high fever for more than 7 days,and they had higher levels of white blood cells(WBC),neutrophil(NEUT),C-reactive protein(CRP),procalcitonin(PCT),lactate dehydrogenase(LDH)and D-dimer,and their serum levels of CD3+,CD4+,CD8+and ratio of CD4+/CD8+were lower,the differences were statistically significant between the two groups(t/χ2=1.999-22.720,all P<0.05).Multivariate Logistic regression analysis showed that fever duration and WBC level were risk factors for RMPP,and CD4+/CD8+ratio was a protective factor for RMPP(OR=1.962,2.258 and 0.015 respectively,all P<0.05).Subgroup analysis showed that the correlation between CD4+/CD8+and RMPP complicated with PB was stable:the smaller the CD4+/CD8+ratio,the greater the risk of RMPP complicated with PB.The ROC curve analysis showed that the area under the curve(AUC)of the CD4+/CD8+ratio for predicting RMPP complicated with PB was 0.831(95%CI:0.741-0.917),with a sensitivity of 85.25%and a specificity of 86.32%.Conclusion The ratio of CD4+/CD8+is correlated with severity of MPP and is a protective factor for occurrence of RMPP and the smaller the ratio of CD4+/CD8+,the greater the risk of RMPP complicated with PB.关键词
儿童/肺炎支原体肺炎/难治性/CD4+/CD8+比值/塑型性支气管炎/疾病严重程度Key words
children/Mycoplasma pneumoniae pneumonia/refractory/CD4+/CD8+ratio/plastic bronchitis/severity of disease分类
医药卫生
