目的 研究儿童坏死性肺炎的早期预测指标。方法 回顾性分析43例儿童坏死性肺炎与83例大叶性肺炎的临床资料,对比两组患儿的性别、年龄、发热天数、实验室检查结果及支气管镜表现,将两组间差异有统计学意义的指标纳入多因素logistic回归分析,以了解坏死性肺炎的早期预测指标。结果 坏死性肺炎组女性患儿所占比例高于大叶性肺炎组(P<0.05)。坏死性肺炎组发热天数、外周血白细胞计数(WBC)、中性粒细胞百分比(NE%)、超敏C-反应蛋白(hs-CRP)、血清白蛋白(ALB)、血清乳酸脱氢酶(LDH)水平高于大叶性肺炎组(P<0.05)。坏死性肺炎组支气管镜下见大量痰栓堵塞需要活检钳才能清除的患儿比例及肺泡灌洗液呈浑浊的米汤样的患儿比例均高于大叶性肺炎组(P<0.05)。多因素logistic回归分析显示,女性、支气管镜下出现痰栓堵塞需要活检钳才能清除及发热天数、WBC、hs-CRP、LDH是坏死性肺炎的独立预测指标,后4项ROC曲线临界值分别为18.5d、15.1×109/L、121.5mg/L、353.5U/L。结论 WBC升高(≥15.1×109/L)、hs-CRP升高(≥121.5mg/L)、血清LDH升高(≥353.5U/L)、支气管镜下出现痰栓堵塞需要活检钳才能清除以及肺泡灌洗液呈浑浊的米汤样,可作为儿童坏死性肺炎的早期预测指标。

Objective To investigate the early predictors of necrotizing pneumonia in children. Methods The clinical data of 43 children with necrotizing pneumonia and 83 children with lobar pneumonia were retrospectively analyzed. Sex, age, the number of days with fever, laboratory examination results, and bronchoscopic findings were compared between the two groups. The multiple logistic regression analysis was used to identify the early predictors of necrotizing pneumonia. Results The necrotizing pneumonia group had a higher percentage of girls than the lobar pneumonia group (P<0.05). Compared with the lobar pneumonia group, the necrotizing pneumonia group had a larger number of days with fever, a higher peripheral blood white blood cell count (WBC), a higher percentage of neutrophils (NE%), and higher serum levels of high-sensitivity C-reactive protein (hs-CRP), albumin (Alb), and lactate dehydrogenase (LDH) (P<0.05). The necrotizing pneumonia group also had higher percentages of children with a large amount of sputum bolt under a bronchoscope which needed to be removed with biopsy forceps and children with ricewater-like bronchoalveolar lavage fluid (P<0.05). The multiple logistic regression analysis showed that being a female, the presence of sputum bolt under a bronchoscope which needed to be removed with biopsy forceps, the number of days with fever, WBC, hs-CRP, and LDH were independent predictors of necrotizing pneumonia. The receiver operating characteristic curve analysis showed that the cut-off values of the latter 4 predictors were 18.5 d, 15.1×109/L, 121.5 mg/L, and 353.5 U/L, respectively. Conclusions Increased WBC (≥15.1×109/L), increased hs-CRP (≥121.5 mg/L), increased serum LDH (≥353.5 U/L), and the presence of sputum bolt under a bronchoscope which needs to be removed with biopsy forceps and rice-water-like bronchoalveolar lavage fluid may be the early predictors of necrotizing pneumonia in children.