儿童肺炎支原体肺炎后发生支气管哮喘的临床危险因素分析

摘要

Objective To investigate the clinical risk factors for bronchial asthma after Mycoplasma pneumoniae pneumonia ( MPP) in children.Methods Fifty-nine children with MPP who diagnosed as bronchial asthma during a 3-year follow-up were enrolled in the observation group.Sixty children with MPP who manifested without current cough,wheezing and chest distress after discharge were collected as control group.The histories of atopic dermatitis and allergy,family history of asthma,whether manifesting with wheezing,extra-pulmonary damage and large patchy shadow in lung,and eosinophilic granulocyte count,total serum IgE level when suffering MPP,the results of FEV1% and FEF25-75%3 months after discharge were retrospectively analyzed.The factors which might affect the incidence of bronchial asthma in children with MPP were assessed by univariate analysis and multivariate analysis.Results Univariate analysis revealed that the histories of atopic dermatitis and allergies,family history of asthma,FEF25-75%and total serum IgE level were related with the incidence of bronchial asthma in children with MPP(P<0.05).Multivariable logistic regression analysis revealed that the histories of atopic dermatitis and allergies, family history of asthma and total serum IgE level when suffered from MPP were the risk factors for the incidence of bronchial asthma in children with MPP,and FEF25-75%3 months after discharge was the protective factor(P<0.05).Conclusion The histories of atopic dermatitis and allergies,family history of asthma and total serum IgE level when suffer from MPP are the independent risk factors for the incidence of bronchial asthma in children with MPP,and FEF25-75%3 months after discharge is the protective factor.%目的 探讨儿童肺炎支原体肺炎( MPP)后发生支气管哮喘的临床危险因素. 方法 选择MPP且随访3年内诊断为支气管哮喘的患儿59例为观察组,另选取MPP患儿出院后无反复咳嗽、气喘、胸闷表现的60例为对照组. 回顾性分析两组患儿既往有无特异性皮炎、过敏史、家族哮喘史,MPP时有无喘息、肺外多系统损害、肺部大片状阴影、嗜酸性粒细胞计数及血清总IgE水平、出院后3个月时肺功能第1秒量占预计值百分数( FEV1%)、用力呼出肺活量25%~75%的平均流速( FEF25-75%)的结果. 对可能影响MPP患儿发生支气管哮喘的因素进行单因素及多因素分析. 结果 单因素分析结果显示,既往特异性皮炎史、家族哮喘史、个人过敏史、FEF25-75%以及血清总IgE水平与MPP患儿发生支气管哮喘有关( P<0.05). 多因素logistic回归分析结果显示,既往特异性皮炎史、个人过敏史、家族哮喘史及患病时血清总IgE水平是MPP患儿发生支气管哮喘的危险因素,出院后3个月时FEF25-75% 是其保护因素(P<0.05). 结论 MPP患儿既往有特异性皮炎、个人过敏史、家族哮喘史以及患病时血清总 IgE 水平是发生支气管哮喘的独立危险因素,出院后3 个月时的FEF25-75%是其保护因素.