儿童重症肺炎的免疫功能变化及预后危险因素

doi:10.3969/j.issn.1004-583X.2023.06.007

摘要/Abstract

摘要：

目的探讨儿童重症肺炎预后的相关影响因素。方法回顾性分析2019年12月-2021年12月福建医科大学附属泉州市第一医院PICU儿童重症肺炎患者152例。根据治疗后转归情况分为完全缓解组和未完全缓解组(部分缓解或死亡),比较两组性别、年龄、发病季节、儿童危重病例评分量表(Pediatric Critical Illness Score,PCIS)(入院后24小时内评分)、实验室检查、住院天数、血常规、C反应蛋白(C-reactive protein,CRP)、治疗与转归等临床资料,分析不同预后患儿的免疫水平变化,Logistic回归分析与预后相关的影响因素。结果两组在年龄、发病季节、住院天数、白细胞计数、CRP、PCIS评分等方面差异有统计学意义( P <0.05)。未完全缓解组的CD3⁺、CD4⁺、 CD8⁺T与B淋巴细胞及IgG、IgM与IgA低水平患儿占比较完全缓解组明显升高( P <0.05)。经Logistic回归分析显示,年龄、发病季节、PCIS评分、CD4⁺及IgG水平为影响预后的重要因素( P <0.05)。结论重症肺炎患儿若年龄小、发病季节为秋冬季、PCIS评分低,伴有较低水平的CD4⁺、IgG,往往提示预后较差。

关键词: 肺炎, 儿童, 免疫, 预后

Abstract:

Objective To investigate the prognostic factors of severe pneumonia in children. Methods It was a retrospective analysis involving 152 children with severe pneumonia in the pediatric intensive care unit (PICU), Quanzhou First Hospital affiliated to Fujian Medical University from December 2019 to December 2021. According to the outcome after treatment, the patients were allocated to complete remission group and incomplete remission group (partial remission or death). Clinical data like gender, age, onset season, pediatric critical illness score (PCIS) with in 24 hours after admission, laboratory examination, length of stay, blood routine, C-reactive protein (CRP), treatment and outcome were compared between groups. Immune levels in children with different prognosis were analyzed, and influencing factors for the prognosis were identified by Logistic regression analysis.Resultss There were significant differences in age, onset season, length of stay, white blood cell count, CRP, and PCIS scores between the both groups ( P <0.05). The proportion of children with low levels of CD3⁺, CD4⁺, CD8⁺T lymphocytes, B lymphocytes, IgG, IgM and IgA in the incomplete remission group was significantly higher than that in the complete remission group ( P <0.05). Logistic regression analysis showed that age, onset season, PCIS score, CD4⁺ and IgG levels were important factors affecting the prognosis of severe pneumonia in children ( P <0.05). Conclusion Children with severe pneumonia who are young, with the onset season of autumn and winter, low PCIS score, and accompanied by low levels of CD4⁺ and IgG have a poor prognosis.

Key words: pneumonia, children, immunity, prognosis

中图分类号:

R563.1

孙星星, 林海. 儿童重症肺炎的免疫功能变化及预后危险因素[J]. 临床荟萃, 2023, 38(6): 521-525.

Sun Xingxing, Lin Hai. Changes in immune function and prognostic risk factors for severe pneumonia in children[J]. Clinical Focus, 2023, 38(6): 521-525.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.06.007

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I6/521

图/表 4

表1 两组一般资料比较

Tab.1 Comparison of general data between groups

组别	例数	性别[例(%)]		年龄 (月)	住院天数 (天)	发病季节[例(%)]				白细胞计数 (×10⁹/L)	CRP (mg/L)
组别	例数	男	女	年龄 (月)	住院天数 (天)	春季	夏季	秋季	冬季	白细胞计数 (×10⁹/L)	CRP (mg/L)
完全缓解组	104	56(53.8)	48(46.2)	10.00(3.25,63.00)	6.18±3.90	9(8.6)	9(8.6)	31(29.8)	55(52.9)	11.16±5.76	8.30(0.55,20.58)
未完全缓解组	48	24(50.0)	24(50.0)	12.00(6.25,32.50)	8.19±5.93	6(12.5)	11(22.9)	16(33.3)	15(31.2)	14.21±8.77	34.63(0.90,91.17)
$t$ / $Z$ /χ²值		0.193		1.414	-2.479	6.632				-2.556	2.553
$P$ 值		0.661		0.037	0.014	0.029				0.012	<0.01

表1 两组一般资料比较

Tab.1 Comparison of general data between groups

组别	例数	性别[例(%)]		年龄 (月)	住院天数 (天)	发病季节[例(%)]				白细胞计数 (×10⁹/L)	CRP (mg/L)
组别	例数	男	女	年龄 (月)	住院天数 (天)	春季	夏季	秋季	冬季	白细胞计数 (×10⁹/L)	CRP (mg/L)
完全缓解组	104	56(53.8)	48(46.2)	10.00(3.25,63.00)	6.18±3.90	9(8.6)	9(8.6)	31(29.8)	55(52.9)	11.16±5.76	8.30(0.55,20.58)
未完全缓解组	48	24(50.0)	24(50.0)	12.00(6.25,32.50)	8.19±5.93	6(12.5)	11(22.9)	16(33.3)	15(31.2)	14.21±8.77	34.63(0.90,91.17)
$t$ / $Z$ /χ²值		0.193		1.414	-2.479	6.632				-2.556	2.553
$P$ 值		0.661		0.037	0.014	0.029				0.012	<0.01

表2 两组PCIS评分比较

Tab.2 Comparison of PCIS scores between groups

组别	例数	PCIS评分 (分)	PCIS分级[例(%)]
组别	例数	PCIS评分 (分)	危重	极危重
完全缓解组	104	85.11±2.87	104(100.0)	0
未完全缓解组	48	76.71±7.35	44(91.7)	4(8.3)
$t$ 值		10.14	-
$P$ 值		<0.01	0.009

表2 两组PCIS评分比较

Tab.2 Comparison of PCIS scores between groups

组别	例数	PCIS评分 (分)	PCIS分级[例(%)]
组别	例数	PCIS评分 (分)	危重	极危重
完全缓解组	104	85.11±2.87	104(100.0)	0
未完全缓解组	48	76.71±7.35	44(91.7)	4(8.3)
$t$ 值		10.14	-
$P$ 值		<0.01	0.009

表3 两组淋巴细胞及免疫球蛋白水平比较[例(%)]

Tab.3 Comparison of lymphocyte and immunoglobulin levels between groups [cases (%)]

组别	例数		CD3⁺			CD4⁺				CD8⁺			B
组别	例数		低水平	正常		低水平		正常		低水平	正常		低水平		正常
完全缓解组	104		0	104(100.0)		0		104(100.0)		0	104(100.0)		3(2.9)		101(97.1)
未完全缓解组	48		3(6.3)	45(93.7)		5(6.3)		43(93.7)		6(12.5)	42(87.5)		8(16.7)		40(83.3)
χ²值			7.048			11.900				14.375			8.515
$P$ 值			0.008			0.001				<0.01			0.004
组别		IgG					IgM					IgA
组别		低水平			正常		低水平		正常			低水平		正常
完全缓解组		12(11.5)			92(88.5)		5(4.8)		99(95.2)			5(4.8)		99(95.2)
未完全缓解组		12(25.0)			36(75.0)		8(16.7)		40(83.3)			10(20.8)		38(79.2)
χ²值		4.223					5.428					8.711
$P$ 值		0.040					0.020					0.003

表3 两组淋巴细胞及免疫球蛋白水平比较[例(%)]

Tab.3 Comparison of lymphocyte and immunoglobulin levels between groups [cases (%)]

组别	例数		CD3⁺			CD4⁺				CD8⁺			B
组别	例数		低水平	正常		低水平		正常		低水平	正常		低水平		正常
完全缓解组	104		0	104(100.0)		0		104(100.0)		0	104(100.0)		3(2.9)		101(97.1)
未完全缓解组	48		3(6.3)	45(93.7)		5(6.3)		43(93.7)		6(12.5)	42(87.5)		8(16.7)		40(83.3)
χ²值			7.048			11.900				14.375			8.515
$P$ 值			0.008			0.001				<0.01			0.004
组别		IgG					IgM					IgA
组别		低水平			正常		低水平		正常			低水平		正常
完全缓解组		12(11.5)			92(88.5)		5(4.8)		99(95.2)			5(4.8)		99(95.2)
未完全缓解组		12(25.0)			36(75.0)		8(16.7)		40(83.3)			10(20.8)		38(79.2)
χ²值		4.223					5.428					8.711
$P$ 值		0.040					0.020					0.003

表4 预后相关危险因素分析

Tab.4 Analysis of prognostic risk factors

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	-0.120	0.034	12.615	<0.01	0.888	0.830	0.948
发病季节	-0.844	0.421	4.029	0.045	0.430	0.189	0.980
PCIS评分	-0.749	0.168	19.854	<0.01	0.473	0.340	0.657
CD4⁺	-0.003	0.001	13.879	<0.01	0.997	0.996	0.999
IgG	0.639	0.244	6.856	0.009	1.894	1.174	3.055

表4 预后相关危险因素分析

Tab.4 Analysis of prognostic risk factors

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	-0.120	0.034	12.615	<0.01	0.888	0.830	0.948
发病季节	-0.844	0.421	4.029	0.045	0.430	0.189	0.980
PCIS评分	-0.749	0.168	19.854	<0.01	0.473	0.340	0.657
CD4⁺	-0.003	0.001	13.879	<0.01	0.997	0.996	0.999
IgG	0.639	0.244	6.856	0.009	1.894	1.174	3.055

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