Correlation between Mycoplasma pneumoniae pneumonia and blood lipid levels in children
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摘要:目的 探讨儿童肺炎支原体肺炎（MPP）与血脂水平的相关性。方法 采用横断面研究设计方法，将340例MPP患儿根据病情严重程度分为轻症组（n=204）和重症组（n=136）。比较2组患儿临床资料与实验室检查结果。结果 重症组患儿年龄、身高、体质量、血清肌酐（Scr）水平小于、低于轻症组，住院时间、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）长于、高于轻症组，差异均有统计学意义（P < 0.05）。Spearman相关分析及Pearson相关分析结果显示，年龄、身高、体质量、Scr水平与MPP严重程度及住院时间呈显著负相关（P < 0.05或P < 0.01），而TC、LDL-C与MPP严重程度及住院时间呈显著正相关（P < 0.01）。Logistic回归方程结果显示，年龄、体质量、TC、高密度脂蛋白胆固醇（HDL-C）是发生重症MPP的独立影响因素（P < 0.05）。受试者工作特征（ROC）曲线分析结果显示，TC诊断重症MPP的最佳截断值为2.935 mmol/L，曲线下面积为0.787（95%CI为0.725~0.851，P=0.001），约登系数为0.29，敏感度为92.90%，特异度为36.10%。当患儿血清TC水平>2.935 mmol/L时，罹患重症MPP的风险升高8.71倍。结论 患儿血脂水平与MPP病情进展程度显著相关，且对重症MPP具有一定的预测价值。Abstract:Objective To explore the correlation between blood lipid levels and Mycoplasma pneumoniae pneumonia (MPP) in children.Methods A cross-sectional study design was adopted, and 340 children with MPP were divided into mild group (n=204) and severe group (n=136) according to the severity of the disease. The clinical data and laboratory results were compared between the two groups.Results The age, height, body mass and serum creatinine (Scr) level of children in the severe group were significantly smaller and lower than those in the mild group, and the hospital stay, total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were significantly longer and higher than those in the mild group (P < 0.05). Spearman correlation analysis and Pearson correlation analysis showed that age, height, body mass and Scr level were significantly negatively correlated with severity of MPP and hospital stay (P < 0.05 or P < 0.01), while TC and LDL-C were significantly positively correlated with severity of MPP and hospital stay (P < 0.01). Logistic regression equation showed that age, body mass, TC and high density lipoprotein cholesterol (HDL-C) were the independent risk factors for incidence of severe MPP (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the best cut-off value of TC in the diagnosis of severe MPP was 2.935 mmol/L, the area under the curve was 0.787 (95%CI, 0.725~0.851, P=0.001), the Youden index was 0.29, the sensitivity was 92.90%, and the specificity was 36.10%. When the serum TC level of children was higher than 2.935 mmol/L, the risk of suffering severe MPP increased by 8.71 times.Conclusion Level of blood lipids in children is significantly related to the progression of MPP, and it has a certain predictive value for severe pneumonia.
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表 1 2组患儿临床特征与实验室指标比较(x±s)
指标 轻症组(n=204) 重症组(n=136) 年龄/岁 4.21±2.64 3.07±2.17* 身高/cm 110.23±19.40 98.30±19.94* 体质量/kg 19.46±8.12 15.94±6.86* 住院时间/d 8.45±2.51 14.89±1.51* FPG/(mmol/L) 5.68±1.31 6.17±1.37 TC/(mmol/L) 3.15±0.56 3.87±0.77* TG/(mmol/L) 0.94±0.43 0.99±0.52 HDL-C/(mmol/L) 1.83±0.59 1.11±0.32 LDL-C/(mmol/L) 2.14±0.96 2.72±0.68* Scr/(μmol/L) 30.85±14.60 27.69±8.91* BUN/(μmol/L) 3.28±0.88 3.13±1.08 FPG: 空腹血糖; TC: 总胆固醇; TG: 甘油三酯;
HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇;
Scr: 血清肌酐; BUN: 尿素氮。与轻症组比较, * P < 0.05。
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表 2 MPP严重程度与住院时间的相关因素分析
指标 MPP严重程度 住院时间 r P r P 年龄 -0.317 < 0.001 -0.342 < 0.001 身高 -0.297 < 0.001 -0.331 < 0.001 体质量 -0.271 < 0.001 -0.279 < 0.001 FPG 0.019 0.773 0.009 0.884 TC 0.489 < 0.001 0.392 < 0.001 TG 0.031 0.662 0.042 0.549 HDL-C -0.034 0.629 0.001 0.984 LDL-C 0.803 < 0.001 0.700 < 0.001 Scr -0.133 0.039 -0.136 0.035 BUN -0.122 0.058 -0.097 0.132 FPG: 空腹血糖; TC: 总胆固醇; TG: 甘油三酯;
HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇;
Scr: 血清肌酐; BUN: 尿素氮; MPP: 肺炎支原体肺炎。
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表 3 重症MPP的独立危险因素
指标 B SE Wald P 年龄 0.77 0.08 9.84 < 0.01 体质量 0.50 0.33 4.31 0.04 TC 8.43 0.36 35.18 < 0.01 HDL-C 0.21 0.61 6.31 0.01 TC: 总胆固醇; HDL-C: 高密度脂蛋白胆固醇。
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