摘要
【目的】探究肺炎支原体肺炎(MPP)患儿混合感染中医证型及危险因素相关性。【方法】选择深圳市中医院儿科收治的MPP住院患儿106例,根据中医辨证标准进行辨证分型;收集患儿的各项临床资料,包括性别、年龄、入院前病程、住院时间、总病程、发热天数、C反应蛋白(CRP)、血常规、有无喘息、肺外并发症等资料,应用SPSS 21.0软件进行数据统计,分析各项检查指标、中医证型与MPP患儿混合感染的相关性。【结果】(1)中医证型方面,106例MPP患儿中,以痰热蕴肺证最多见,其次为风寒袭肺证、痰湿闭肺证。不同证型患儿的性别、年龄比较,差异无统计学意义(P>0.05);其中,以肺气亏虚证、肺阴亏虚证患儿的发热时间最长,痰湿闭肺证患儿的发热时间最短,以肺气亏虚证、肺阴亏虚证患儿的总住院天数最多、病程最长,差异均有统计学意义(P<0.01);CRP在风热闭肺证、风寒袭肺证中明显升高,差异有统计学意义(P<0.01);而不同中医证型患儿的血沉(ESR)水平比较,差异无统计学意义(P>0.05)。(2)感染情况方面,非感染者28例,占26.42%;感染者78例,占73.58%。单一感染23例(21.70%),混合细菌感染20例(18.87%),混合病毒感染18例(16.98%),混合病毒细菌感染17例(16.04%)。(3)不同证型的各种感染情况比较,差异均有统计学意义(P<0.01)。单一感染中,风寒袭肺证占比最高,其次是痰热蕴肺证、风热闭肺证;混合病毒感染和混合细菌感染中,风寒袭肺证与痰热蕴肺证占比最高;混合病毒细菌感染中,肺气亏虚证占比最高,其次为肺阴亏虚证。(4)不同类型感染患儿发热>10 d及肺外并发症比较,差异均有统计学意义(P<0.05或P<0.01);不同类型感染患儿喘息比较,差异无统计学意义(P>0.05);不同类型感染患儿的白细胞计数(WBC)、中性粒细胞(NEU)水平比较,差异均有统计学意义(P<0.01)。(5)多因素Logistic回归分析结果显示,肺外并发症、痰热蕴肺证的发生是混合病毒感染的独立危险因素(P<0.05或P<0.01);发热>10 d、WBC、风寒袭肺证的发生是混合细菌感染的独立危险因素(P<0.05或P<0.01);肺气亏虚证的发生是混合病毒细菌感染的独立危险因素(P<0.01)。【结论】该研究纳入的MPP患儿中混合感染检出率高,混合感染中以病毒感染为主;针对各类型感染的MPP患儿需首先进行中医辨证,重视混合病毒与细菌感染的相关检查,以避免多种混合感染的发生;发热时间长、WBC升高的患儿尤其须注意细菌感染的可能。
Objective To investigate the correlation between traditional Chinese medicine(TCM)syndrome types and risk factors of mixed infection in children with mycoplasma pneumoniae pneumonia(MPP).Methods A total of 106 hospitalized children with MPP admitted to the Pediatrics Department of Shenzhen Traditional Chinese Medicine Hospital were collected.The MPP children were classified into various syndrome types according to TCM syndrome differentiation criteria,and then their clinical data of gender,age,course of disease before admission,hospital stay,total duration of illness,days of fever,C-reactive protein(CRP),blood routine test results,presence of wheezing,and extrapulmonary complications,were collected.SPSS 21.0 software was used for data statistics,and the correlation of the examination indexes and TCM syndrome types with the mixed infections in MPP children was analyzed.Results(1)Of the 106 MPP children,the syndrome of phlegm-heat accumulated in the lung accounted for the most,followed by wind-cold attacking the lung syndrome and phlegmdamp obstructing the lung syndrome.No statistically significant difference was shown in the gender and age of children with different TCM syndromes(P>0.05).The MPP children with lung-qi deficiency syndrome and lungyin deficiency syndrome had the longest fever time,duration of illness and hospital stay,the children with phlegmdamp obstructing the lung syndrome had the shortest fever time,and the difference was statistically significant(P<0.01).CRP level was significantly increased in the children with wind-heat obstructing the lung syndrome and wind-cold attacking the lung syndrome,and the difference was statistically significant(P<0.01).No statistically significant difference was shown in the erythrocyte sedimentation rate(ESR)of children with different TCM syndromes(P>0.05).(2)As for the infection,28 cases(26.42%)had no infection and 78 cases(73.58%)were infected.There were 23 cases of single infection(21.70%),20 cases of mixed bacterial infection(18.87%),18 cases of mixed viral infection(16.98%),and 17 cases of mixed viral and bacterial infection(16.04%).(3)Statistically significant differences were shown in various infection situations among the MPP children with different syndrome types(P<0.01).In the children with single infection,wind-cold attacking the lung syndrome accounted for the highest proportion,followed by phlegm-heat accumulating in the lung syndrome and wind-heat obstructing the lung syndrome.In the children with mixed viral infections and mixed bacterial infections,windcold attacking the lung syndrome and phlegm-heat accumulating in the lung syndrome accounted for the highest proportion.In the children with mixed viral and bacterial infections,lung qi deficiency syndrome accounted for the highest proportion,followed by lung yin deficiency syndrome.(4)Statistically significant difference was shown in the incidence of extrapulmonary complications among the MPP children with various types of infections and suffering fever more than 10 days(P<0.05 or P<0.01).No statistically significant difference was shown in the presence of wheezing among the MPP children with various types of infections(P>0.05).The difference of white blood cell(WBC)and neutrophils(NEU)levels in MPP children with various types of infections was statistically significant(P<0.01).(5)The results of multivariate logistic regression analysis showed that the occurrence of extrapulmonary complications and presence of phlegm-heat accumulating in the lung syndrome were the independent risk factors for mixed viral infection(P<0.05 or P<0.01),fever time more than 10 days,WBC count,and wind-cold attacking the lung syndrome were the independent risk factors for mixed bacterial infection(P<0.05 or P<0.01),and the presence of lung qi deficiency syndrome was an independent risk factor for mixed viral and bacterial infection(P<0.01).Conclusion In this study,the detection rate of mixed infections in MPP children is high,and viral infections account for the most.For the treatment of MPP children with various types of infections,TCM syndrome differentiation should be conducted first,and the examination of mixed viral and bacterial infections should also be done to avoid the occurrence of multiple mixed infections.For the children with continuous fever and elevated WBC count,more attention should be especially paid to the possibility of occurrence of bacterial infections.
作者
刘齐
蔡庆智
喻闽凤
马永易
纪建建
LIU Qi;CAI Qing-Zhi;YU Min-Feng;MA Yong-Yi;JI Jian-Jian(The Fourth Clinical Medical School of Guangzhou University of Chinese Medicine,Shenzhen 518033 Guangdong,China;Liuzhou Traditional Chinese Medicine Hospital of Guangxi University of Chinese Medicine,Liuzhou 545001 Guangxi,China;Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033 Guangdong,China;Jiangsu Provincial Hospital of Traditional Chinese Medicine,Nanjing 210004 Jiangsu,China)
出处
《广州中医药大学学报》
CAS
2023年第11期2723-2730,共8页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
深圳市三名工程项目(编号:SZSM201812064)。
关键词
肺炎支原体肺炎
混合感染
患儿
中医证型
危险因素
mycoplasma pneumoniae pneumonia
mixed infection
infected children
TCM syndrome types
risk factors
