中国实用儿科杂志

中国实用儿科杂志 ›› 2025, Vol. 40 ›› Issue (12): 1044-1048.DOI: 10.19538/j.ek2025120615

• 论著 • 上一篇    下一篇

儿童肺炎衣原体肺炎合并呼吸道黏液栓病例对照研究

  

  1. 1.南京医科大学附属苏州医院  苏州市立医院儿科，江苏  苏州  215000；2.浙江省金华市浦江县人民医院儿科，浙江  金华  321000；3.浙江大学医学院附属儿童医院呼吸科，浙江  杭州  310000
  • 出版日期:2025-12-06 发布日期:2026-01-08
  • 通讯作者: 唐兰芳，电子信箱：tanglanfangzju@163.com
  • 基金资助:
    浙江省中医药创新团队（11）资助项目

Chlamydia pneumoniae pneumonia with mucous plug in children： a case-control study

  1. *Department of Pediatrics，the Affiliated Suzhou Hospital of Nanjing Medical University，Suzhou Municipal Hospital，Suzhou  215000，China
  • Online:2025-12-06 Published:2026-01-08

摘要： 目的　对肺炎衣原体肺炎（chlamydia pneumoniae pneumonia，CPP）患儿有或无呼吸道黏液栓形成的临床特征进行对照研究，探讨黏液栓形成的危险因素。方法　回顾性纳入2024年6月至2025年6月间在浙江大学医学院附属儿童医院确诊CPP且行纤维支气管镜检查的患儿，依据支气管镜下有无黏液栓堵塞呼吸道分为黏液栓组和无黏液栓组。收集患儿的临床资料、实验室及影像学检查结果，比较两组患儿临床特征。结果　共有110患儿被纳入研究，其中男68例，女42例，年龄（10.3±2.7）岁。黏液栓组33例，无黏液栓组77例。单因素分析显示，与无黏液栓组相比，黏液栓组白细胞及血小板计数高，合并低钾血症及肺不张比例高，支气管镜检查前阿奇霉素应用比例高、应用天数长，差异均有统计学意义（P<0.05）。多因素Logistic回归分析显示，血小板计数（OR值=1.006，95% CI：1.000~1.011，P=0.049）和有低钾血症（OR值=7.743，95% CI：1.179~50.834，P=0.033）是CPP患儿形成气道黏液栓的独立危险因素。Hosmer-Lemeshow检验显示该模型具有较好的拟合优度（P=0.33）。结论　对于存在血小板升高及低钾血症的CPP患儿需警惕呼吸道黏液栓的形成，应积极行支气管镜干预治疗，同时纠正电解质紊乱和优化液体管理，以防止黏液栓形成。

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Abstract: Objective　A case-control study was conducted on the presence or absence of respiratory mucus thrombus formation in children with chlamydia pneumoniae pneumonia（CPP）， and the risk factors for mucus thrombus formation were explored. Methods　Children diagnosed with CPP and undergoing fiberoptic bronchoscopy at the Children’s Hospital Affiliated to Zhejiang University School of Medicine from June 2024 to June 2025 were retrospectively included. They were divided into the mucus thrombus group and the non-mucus thrombus group based on whether there was mucus thrombus blocking the airway under bronchoscopy. Clinical features， laboratory data， and imaging findings were compared between the two groups. Results　Of the 110 enrolled children （68 boys，42 girls；mean age 10.3 years），33（30 %） had mucous plugs. Compared with the non-plug group，these children exhibited higher white blood cell and platelet counts，a greater incidence of hypokalemia and atelectasis，and had received macrolide therapy more frequently and for a longer duration before BAL（P<0.05）. Multivariable logistic regression identified platelet count（OR=1.006，95% CI：1.000-1.011，P=0.049） and hypokalemia（OR=7.743，95% CI：1.179-50.834，P=0.033） as independent predictors of plug formation. The Hosmer-Lemeshow test confirmed good model fit（P=0.33）. Conclusion　Elevated platelet count and hypokalemia are readily available early markers of impending mucous plug formation in pediatric CPP. Prompt correction of electrolyte imbalance and early BAL should be considered to prevent obstructive complications.

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