摘要
目的探究新生儿衣原体肺炎的临床资料、实验室指标及胸部X线特点,分析影响新生儿衣原体肺炎的危险因素,为临床诊治提供依据。方法根据纳入及排除标准,最终纳入116例新生儿肺炎病例,基于分子生物学方法的衣原体检测结果将入组病例分为衣原体阳性组(17例)和衣原体阴性组(99例)。比较两组临床资料、实验室指标、胸部X线特点,并采用多因素Logistic回归法分析影响新生儿衣原体肺炎的危险因素。结果一般情况方面:两组入院年龄、性别构成比较无统计学差异(P>0.05)。围生期情况方面:两组出生胎龄、出生体重、早产、胎膜早破、羊水混浊、胎盘早剥、脐带绕颈、脐带扭转、宫内窘迫、新生儿窒息比较无统计学差异(P>0.05);衣原体阳性组经阴道娩出率为100.00%,高于衣原体阴性组的61.62%(P<0.05)。临床表现方面:两组起病年龄、发热、鼻塞、咳嗽、痰鸣、气促、湿性啰音、干性啰音比较无统计学差异(P>0.05);衣原体阳性组重度肺炎、口吐泡沫、眼分泌物增多、吸气性三凹征发生率分别为58.82%、52.94%、35.29%、52.94%,高于衣原体阴性组的24.24%、27.27%、1.01%、24.24%(P<0.05)。实验室指标方面:两组外周血淋巴细胞计数、外周血单核细胞百分比、外周血嗜酸性粒细胞计数、外周血嗜酸性粒细胞百分比、外周血嗜碱性粒细胞计数、外周血嗜碱性粒细胞百分比、尿白细胞阳性比较无统计学差异(P>0.05);衣原体阳性组外周血白细胞计数(13.36±3.34)×10^(9)/L、外周血单核细胞计数(1.71±0.72)×10^(9)/L、外周血中性粒细胞计数(5.64±1.86)×10^(9)/L、外周血中性粒细胞百分比(42.23±9.44)%、血清C反应蛋白(CRP)5.70(1.56,15.50)mg/L、血清降钙素原(PCT)0.15(0.12,0.19)ng/ml均高于衣原体阴性组的(10.65±2.84)×10^(9)/L、(1.29±0.43)×10^(9)/L、(3.56±2.16)×10^(9)/L、(32.09±12.98)%、0.30(0.20,1.10)mg/L、0.11(0.09,0.15)ng/ml,外周血淋巴细胞百分比(41.44±7.81)%低于衣原体阴性组的(50.73±12.14)%(P<0.05)。胸部X线表现方面:两组弥漫性小结节影、小斑片状影、过度充气、大片渗出影检出率比较无统计学差异(P>0.05);衣原体阳性组磨玻璃影、网状影检出率分别为76.47%、58.82%,高于衣原体阴性组的39.39%、18.18%(P<0.05)。母亲情况方面:两组母亲年龄、体外受精-胚胎移植受孕、妊娠期呼吸道感染、自然流产史、眼部感染史、生殖道感染史、泌尿道感染史、产前阴道分泌物清洁度异常、产前阴道分泌物白细胞增多、产前尿白细胞阳性比较无统计学差异(P>0.05)。由于衣原体阳性组17例全部为经阴道分娩,因此不将经阴道分娩这一因素纳入回归分析,只将眼分泌物增多、外周血中性粒细胞计数、血清CRP、胸部X线网状影纳入多因素Logistic回归分析,结果显示:眼分泌物增多[OR=24.037,95%CI=(2.072,278.907)]、外周血中性粒细胞计数高[OR=1.412,95%CI=(1.038,1.920)]、胸部X线网状影[OR=5.283,95%CI=(1.084,25.744)]是新生儿衣原体肺炎的独立危险因素(P<0.05)。结论娩出方式、眼部症状、外周血象及胸部X线表现有助于新生儿衣原体肺炎的早期识别,临床应重视病史完整性在新生儿肺炎诊治中的重要性,以及新生儿结膜炎的综合诊治对预防新生儿肺炎的潜在价值。
Objective To explore the clinical data,laboratory indicators,and chest X-ray characteristics of neonatal chlamydial pneumonia,and analyze the risk factors of neonatal chlamydial pneumonia,so as to provide basis for clinical diagnosis and treatment.Methods According to the inclusion and exclusion criteria,116 cases of neonatal pneumonia were finally included,and the enrolled cases were categorized into chlamydia-positive group(17 cases)and chlamydia-negative group(99 cases)based on chlamydia detection results of molecular biology methods.The clinical data,laboratory indexes,chest X-ray characteristics of the two groups were compared,and the risk factors affecting neonatal chlamydial pneumonia were analyzed by multivariate Logistic regression.Results There was no statistically significant difference between the two groups in comparison of age of admission and gender composition(P>0.05).As for perinatal conditions:there was no statistical difference in comparison of gestational age at birth,birth weight,preterm labor,premature rupture of membranes,amniotic fluid turbidity,placental abruption,umbilical cord around the neck,umbilical cord torsion,intrauterine distress,and neonatal asphyxia between the two groups(P>0.05);the vaginal delivery rate of chlamydia-positive group was 100.00%,which was higher than 61.62%of chlamydia-negative group(P<0.05).As for clinical manifestations:there was no statistical difference in comparison of age of onset,fever,nasal congestion,cough,gurgling with sputum,shortness of breath,wet rales,and dry rales between the two groups(P>0.05);the incidence rates of severe pneumonia,foamy mouth,increased ocular secretions,and inspiratory triple concavity in chlamydia-positive group were 58.82%,52.94%,35.29%,and 52.94%,which were higher than 24.24%,27.27%,1.01%,and 24.24%in chlamydia-negative group(P<0.05).As for laboratory indexes:there was no statistical difference in comparison of peripheral blood lymphocyte count,percentage of peripheral blood monocytes,peripheral blood eosinophil count,percentage of peripheral blood eosinophils,peripheral blood basophil count,percentage of peripheral blood basophils,and urine leukocyte positivity between the two groups(P>0.05);in chlamydia-positive group,the peripheral blood leukocyte count was(13.36±3.34)×10^(9)/L,the peripheral blood monocyte count was(1.71±0.72)×10^(9)/L,the peripheral blood neutrophil count was(5.64±1.86)×10^(9)/L,the percentage of peripheral blood neutrophil was(42.23±9.44)%,the serum C-reactive protein(CRP)was 5.70(1.56,15.50)mg/L,and serum procalcitonin(PCT)was 0.15(0.12,0.19)ng/ml,which were higher than(10.65±2.84)×10^(9)/L,(1.29±0.43)×10^(9)/L,(3.56±2.16)×10^(9)/L,(32.09±12.98)%,0.30(0.20,1.10)mg/L,and 0.11(0.09,0.15)ng/ml in the chlamydia-negative group;the percentage of peripheral blood lymphocytes was(41.44±7.81)%,which was lower than(50.73±12.14)%in chlamydia-negative group(P<0.05).As for chest X-ray findings,there was no statistical difference in the detection rate of diffuse small nodular shadow,small patchy shadow,hyperinflation,and large exudate shadow between the two groups(P>0.05);the detection rate of ground glass shadow and reticular shadow in the chlamydia-positive group were 76.47%and 58.82%,which were higher than 39.39%and 18.18%in the chlamydia-negative group(P<0.05).As for maternal status,there was no statistical difference in comparison of the maternal age,in vitro fertilization-embryo transfer conception,respiratory tract infection during pregnancy,history of spontaneous abortion,history of eye infection,history of reproductive tract infection,history of urinary tract infection,abnormal cleanliness of prenatal vaginal secretions,leukocytosis of prenatal vaginal secretions,and prenatal urinary leukocytes positivity between the two groups(P>0.05).Since all 17 cases in the chlamydia-positive group were delivered vaginally,the factor of vaginal delivery was not included in the regression analysis,and only increased eye secretion,peripheral blood neutrophil count,serum CRP,and chest X-ray reticulography were included in the multivariate Logistic regression analysis.The results showed that increased eye secretion[OR=24.037;95%CI=(2.072,278.907)],high peripheral blood neutrophil count[OR=1.412;95%CI=(1.038,1.920)],and chest X-ray reticulography[OR=5.283;95%CI=(1.084,25.744)]were independent risk factors for neonatal chlamydial pneumonia(P<0.05).Conclusion The delivery mode,eye symptoms,peripheral blood picture,and chest X-ray findings are helpful for early identification of chlamydia associated neonatal pneumonia.The completeness of medical history is crucial for the diagnosis and treatment of neonatal pneumonia.The comprehensive diagnosis and treatment of neonatal conjunctivitis has potential value in preventing neonatal pneumonia.
作者
黄庆
雷俊杰
潘家龙
林冬云
HUANG Qing;LEI Jun-jie;PAN Jia-long(The Affiliated Qingyuan Hospital(Qingyuan People's Hospital),Guangzhou Medical University,Qingyuan 511500,China)
出处
《中国实用医药》
2025年第10期11-16,共6页
China Practical Medicine
关键词
衣原体
肺炎
新生儿
胸部X线表现
结膜炎
Chlamydia
Pneumonia
Neonatse
Chest X-ray findings
Conjunctivitis
