Risk factors for refractory mycoplasma pneumoniae pneumonia in children: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

HAN Qian ¹ , JIANG Kaixuan ² , WANG Yanxia ¹ , WANG Yongjun ¹ , LIU Wenbo ¹ , LI Wanyi ¹ ,  LIU Donghai ¹

1. Maternal and Child Health Hospital of Gansu Province, Lanzhou 730000, P.R.China;
2. The Second People's Hospital of Tianshui City, Tianshui 741000, P.R.China;

Corresponding?author：

LIU Donghai, Email: ldhai2005@163.com

Keywords：

Children; Refractory mycoplasma pnenumoniae pneumonia; Risk factor; Systematic review; Meta-analysis; Case-control study

DOI：

10.7507/1672-2531.202106161

Video：

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Objective To systematically review the risk factors of refractory mycoplasma pneumoniae pneumonia (RMPP) in children. Methods PubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP, and WanFang Data databases were electronically searched for case-control studies and cohort studies on the risk factors of RMPP in children from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 27 case-control studies involving 3 967 children with RMPP and 11 613 children with common MPP were included. The results of meta-analysis showed that heat course (OR=2.07, 95%CI 1.98 to 2.16, P<0.000 01), length of hospital stay (OR=1.42, 95%CI 1.14 to 1.69, P<0.000 01), recurrent respiratory tract infection (OR=8.51, 95%CI 6.15 to 11.77, P<0.000 01), level of IL-6 (OR=21.95, 95%CI 20.85 to 23.06, P<0.000 01), level of CRP (OR=2.41, 95%CI 1.94 to 2.87, P<0.000 01), level of LDH (OR=0.79, 95%CI 0.53 to 1.06, P<0.000 01), level of ESR (OR=2.65, 95%CI 1.13 to 4.18, P=0.000 6), combined pleural effusion (OR=9.42, 95%CI 3.65 to 24.31, P<0.000 01), combined with extrapulmonary complications (OR=3.33, 95%CI 2.42 to 4.58, P<0.000 01), large lung consolidation (OR=12.31, 95%CI 5.42 to 27.99, P<0.000 01) were the risk factors for RMPP. Conclusions Current evidence indicates that heat course, length of hospital stay, repeated respiratory tract infection, high level of IL-6, high level of CRP, high level of LDH, high level of ESR, combined pleural effusion, combined extrapulmonary complications, and large lung consolidation are risk factors for children with RMPP. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Citation： HAN Qian, JIANG Kaixuan, WANG Yanxia, WANG Yongjun, LIU Wenbo, LI Wanyi, LIU Donghai. Risk factors for refractory mycoplasma pneumoniae pneumonia in children: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(10): 1168-1173. doi: 10.7507/1672-2531.202106161 Copy

1.	S?ndergaard MJ, Friis MB, Hansen DS, et al. Clinical manifestations in infants and children with mycoplasma pneumoniae infection. PLoS One, 2018, 13(4): e0195288.
2.	Meyer Sauteur PM, van Rossum AM, Vink C. Mycoplasma pneumoniae in children: carriage, pathogenesis, and antibiotic resistance. Curr Opin Infect Dis, 2014, 27(3): 220-227.
3.	中華醫學會兒科學分會呼吸學組, 《中華實用兒科臨床雜志》編輯委員會. 兒童肺炎支原體肺炎診治專家共識(2015 年版). 中華實用兒科臨床雜志, 2015, 30(17): 1304-1308.
4.	方曉丹, 王愛珍, 王有成. 兒童難治性肺炎支原體肺炎危險因素分析. 中國婦幼保健, 2021, 36(6): 1368-1370.
5.	Huang X, Li D, Liu F, et al. Clinical significance of D-dimer levels in refractory mycoplasma pneumoniae pneumonia. BMC Infect Dis, 2021, 21(1): 14.
6.	楊蓓蕾. 蘇州地區兒童難治性肺炎支原體肺炎與壞死性肺炎臨床特征及危險因素分析. 蘇州: 蘇州大學, 2020.
7.	崔小健, 張嘉懿, 郭文偉, 等. 兒童難治性肺炎支原體肺炎的臨床特征和高危因素預測. 重慶醫學, 2020, 49(17): 2905-2908, 2912.
8.	林新春, 郭燕軍. 難治性肺炎支原體肺炎患兒的臨床特點及相關危險因素. 河南醫學研究, 2020, 29(36): 6758-6759.
9.	王松, 何玲. 兒童難治性肺炎支原體肺炎的危險因素分析. 臨床檢驗雜志(電子版), 2020, 9(3): 78-80.
10.	蘇麗萍. 小兒難治性支原體肺炎的危險因素. 深圳中西醫結合雜志, 2020, 30(2): 147-148.
11.	張建芳. 兒童難治性肺炎支原體感染臨床觀察及相關因素分析. 青島醫藥衛生, 2019, 51(5): 330-334.
12.	高建龍, 潘根麗. 重癥支原體肺炎臨床特征及危險因素分析. 全科醫學臨床與教育, 2019, 17(12): 1137-1139.
13.	陳方, 陳全景. 血清乳酸脫氫酶同工酶對兒童難治性肺炎支原體肺炎的診斷價值. 中國醫師進修雜志, 2019, 42(7): 634-638.
14.	常春霞. 難治性肺炎支原體肺炎患兒實驗室指標及臨床特點分析. 中國婦幼保健, 2019, 34(5): 1085-1088.
15.	林國棟, 李春華, 王芳. 難治性肺炎支原體肺炎患兒發病的危險因素分析. 內科, 2019, 14(5): 551-553.
16.	朱影, 王婧. 兒童難治性肺炎支原體肺炎高危因素 logsitic 回歸分析. 河北醫學, 2018, 24(5): 760-763.
17.	趙靜. 小兒重癥支原體肺炎高危因素分析. 中國保健營養, 2018, 28(26): 14.
18.	陸妹, 傅美嬌, 董鴻捌, 等. 兒童難治性肺炎支原體肺炎的臨床特點及相關因素分析. 中國婦幼保健, 2018, 33(2): 335-337.
19.	李俊梅, 鄭成中, 張曼, 等. 兒童難治性肺炎支原體肺炎的臨床特點及血清 IL-4, IL-6, IL-10, IFN-γ的變化分析. 現代生物醫學進展, 2018, 18(24): 4768-4772.
20.	葛柳源. 呼和浩特市地區小兒重癥肺炎支原體肺炎臨床相關因素分析. 呼和浩特: 內蒙古醫科大學, 2018.
21.	劉雪梅, 徐飛, 談華, 等. 進展為難治性支原體肺炎的危險因素分析. 山東醫藥, 2018, 58(28): 80-82.
22.	劉學勝, 楊會方, 班丹丹, 等. 影響兒童難治性支原體肺炎臨床治療的危險因素分析. 黑龍江醫學, 2018, 42(9): 885-886.
23.	翟佳羽, 林烈桔, 麥朗君, 等. 難治性肺炎支原體肺炎患兒臨床特點及危險因素分析. 臨床兒科雜志, 2017, 35(8): 569-574.
24.	王婷, 嚴永東. 難治性肺炎支原體肺炎的臨床特征及危險因素分析. 中國醫藥指南, 2016, 14(9): 191-192, 193.
25.	周蘭芝. 兒童難治性肺炎支原體肺炎臨床危險因素分析. 長春: 吉林大學, 2016.
26.	肖水平. 小兒重癥支原體肺炎的發病危險因素分析. 醫學信息, 2015, (44): 80-81.
27.	梅玉霞, 蔣瑾瑾, 蔡斌, 等. 兒童難治性支原體肺炎臨床危險因素分析. 臨床兒科雜志, 2014, 32(12): 1138-1140.
28.	王冠, 劉杰, 李開為, 等. 小兒重癥支原體肺炎高危因素分析. 現代生物醫學進展, 2014, 14(22): 4332-4335.
29.	陸愛珍, 楊皓偉, 王傳凱, 等. 上海地區單中心住院兒童難治性肺炎支原體肺炎相關因素分析. 中國循證兒科雜志, 2014, (6): 411-415.
30.	楊勇, 崔巍, 王利東, 等. 小兒難治性肺炎支原體肺炎高危因素分析. 陜西醫學雜志, 2010, 39(11): 1498-1500.
31.	Inchley CS, Berg AS, Vahdani Benam A, et al. Mycoplasma pneumoniae: a cross-sectional population-based comparison of disease severity in preschool and school-age children. Pediatr Infect Dis J, 2017, 36(10): 930-936.
32.	Zhang Y, Zhou Y, Li S, et al. The clinical characteristics and predictors of refractory mycoplasma pneumoniae pneumonia in children. PLoS One, 2016, 11(5): e0156465.
33.	Zhou Y, Zhang Y, Sheng Y, et al. More complications occur in macrolide-resistant than in macrolide-sensitive mycoplasma pneumoniae pneumonia. Antimicrob Agents Chemother, 2014, 58(2): 1034-1038.
34.	Kumar S. Mycoplasma pneumoniae: a significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections. Indian J Med Res, 2018, 147(1): 23-31.
35.	Huang L, Huang X, Jiang W, et al. Independent predictors for longer radiographic resolution in patients with refractory Mycoplasma pneumoniae pneumonia: a prospective cohort study. BMJ Open, 2018, 8(12): e023719.
36.	舒林華. 小兒肺炎鏈球菌壞死性肺炎肺組織壞死機制及其治療的探索與思考. 山東醫藥, 2011, 51(48): 5-6, 24.
37.	Chaudhry R, Ghosh A, Chandolia A. Pathogenesis of mycoplasma pneumoniae: an update. Indian J Med Microbiol, 2016, 34(1): 7-1.
38.	Narita M. Pathogenesis of extrapulmonary manifestations of mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother, 2010, 16(3): 162-169.

1. S?ndergaard MJ, Friis MB, Hansen DS, et al. Clinical manifestations in infants and children with mycoplasma pneumoniae infection. PLoS One, 2018, 13(4): e0195288.
2. Meyer Sauteur PM, van Rossum AM, Vink C. Mycoplasma pneumoniae in children: carriage, pathogenesis, and antibiotic resistance. Curr Opin Infect Dis, 2014, 27(3): 220-227.
3. 中華醫學會兒科學分會呼吸學組, 《中華實用兒科臨床雜志》編輯委員會. 兒童肺炎支原體肺炎診治專家共識(2015 年版). 中華實用兒科臨床雜志, 2015, 30(17): 1304-1308.
4. 方曉丹, 王愛珍, 王有成. 兒童難治性肺炎支原體肺炎危險因素分析. 中國婦幼保健, 2021, 36(6): 1368-1370.
5. Huang X, Li D, Liu F, et al. Clinical significance of D-dimer levels in refractory mycoplasma pneumoniae pneumonia. BMC Infect Dis, 2021, 21(1): 14.
6. 楊蓓蕾. 蘇州地區兒童難治性肺炎支原體肺炎與壞死性肺炎臨床特征及危險因素分析. 蘇州: 蘇州大學, 2020.
7. 崔小健, 張嘉懿, 郭文偉, 等. 兒童難治性肺炎支原體肺炎的臨床特征和高危因素預測. 重慶醫學, 2020, 49(17): 2905-2908, 2912.
8. 林新春, 郭燕軍. 難治性肺炎支原體肺炎患兒的臨床特點及相關危險因素. 河南醫學研究, 2020, 29(36): 6758-6759.
9. 王松, 何玲. 兒童難治性肺炎支原體肺炎的危險因素分析. 臨床檢驗雜志(電子版), 2020, 9(3): 78-80.
10. 蘇麗萍. 小兒難治性支原體肺炎的危險因素. 深圳中西醫結合雜志, 2020, 30(2): 147-148.
11. 張建芳. 兒童難治性肺炎支原體感染臨床觀察及相關因素分析. 青島醫藥衛生, 2019, 51(5): 330-334.
12. 高建龍, 潘根麗. 重癥支原體肺炎臨床特征及危險因素分析. 全科醫學臨床與教育, 2019, 17(12): 1137-1139.
13. 陳方, 陳全景. 血清乳酸脫氫酶同工酶對兒童難治性肺炎支原體肺炎的診斷價值. 中國醫師進修雜志, 2019, 42(7): 634-638.
14. 常春霞. 難治性肺炎支原體肺炎患兒實驗室指標及臨床特點分析. 中國婦幼保健, 2019, 34(5): 1085-1088.
15. 林國棟, 李春華, 王芳. 難治性肺炎支原體肺炎患兒發病的危險因素分析. 內科, 2019, 14(5): 551-553.
16. 朱影, 王婧. 兒童難治性肺炎支原體肺炎高危因素 logsitic 回歸分析. 河北醫學, 2018, 24(5): 760-763.
17. 趙靜. 小兒重癥支原體肺炎高危因素分析. 中國保健營養, 2018, 28(26): 14.
18. 陸妹, 傅美嬌, 董鴻捌, 等. 兒童難治性肺炎支原體肺炎的臨床特點及相關因素分析. 中國婦幼保健, 2018, 33(2): 335-337.
19. 李俊梅, 鄭成中, 張曼, 等. 兒童難治性肺炎支原體肺炎的臨床特點及血清 IL-4, IL-6, IL-10, IFN-γ的變化分析. 現代生物醫學進展, 2018, 18(24): 4768-4772.
20. 葛柳源. 呼和浩特市地區小兒重癥肺炎支原體肺炎臨床相關因素分析. 呼和浩特: 內蒙古醫科大學, 2018.
21. 劉雪梅, 徐飛, 談華, 等. 進展為難治性支原體肺炎的危險因素分析. 山東醫藥, 2018, 58(28): 80-82.
22. 劉學勝, 楊會方, 班丹丹, 等. 影響兒童難治性支原體肺炎臨床治療的危險因素分析. 黑龍江醫學, 2018, 42(9): 885-886.
23. 翟佳羽, 林烈桔, 麥朗君, 等. 難治性肺炎支原體肺炎患兒臨床特點及危險因素分析. 臨床兒科雜志, 2017, 35(8): 569-574.
24. 王婷, 嚴永東. 難治性肺炎支原體肺炎的臨床特征及危險因素分析. 中國醫藥指南, 2016, 14(9): 191-192, 193.
25. 周蘭芝. 兒童難治性肺炎支原體肺炎臨床危險因素分析. 長春: 吉林大學, 2016.
26. 肖水平. 小兒重癥支原體肺炎的發病危險因素分析. 醫學信息, 2015, (44): 80-81.
27. 梅玉霞, 蔣瑾瑾, 蔡斌, 等. 兒童難治性支原體肺炎臨床危險因素分析. 臨床兒科雜志, 2014, 32(12): 1138-1140.
28. 王冠, 劉杰, 李開為, 等. 小兒重癥支原體肺炎高危因素分析. 現代生物醫學進展, 2014, 14(22): 4332-4335.
29. 陸愛珍, 楊皓偉, 王傳凱, 等. 上海地區單中心住院兒童難治性肺炎支原體肺炎相關因素分析. 中國循證兒科雜志, 2014, (6): 411-415.
30. 楊勇, 崔巍, 王利東, 等. 小兒難治性肺炎支原體肺炎高危因素分析. 陜西醫學雜志, 2010, 39(11): 1498-1500.
31. Inchley CS, Berg AS, Vahdani Benam A, et al. Mycoplasma pneumoniae: a cross-sectional population-based comparison of disease severity in preschool and school-age children. Pediatr Infect Dis J, 2017, 36(10): 930-936.
32. Zhang Y, Zhou Y, Li S, et al. The clinical characteristics and predictors of refractory mycoplasma pneumoniae pneumonia in children. PLoS One, 2016, 11(5): e0156465.
33. Zhou Y, Zhang Y, Sheng Y, et al. More complications occur in macrolide-resistant than in macrolide-sensitive mycoplasma pneumoniae pneumonia. Antimicrob Agents Chemother, 2014, 58(2): 1034-1038.
34. Kumar S. Mycoplasma pneumoniae: a significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections. Indian J Med Res, 2018, 147(1): 23-31.
35. Huang L, Huang X, Jiang W, et al. Independent predictors for longer radiographic resolution in patients with refractory Mycoplasma pneumoniae pneumonia: a prospective cohort study. BMJ Open, 2018, 8(12): e023719.
36. 舒林華. 小兒肺炎鏈球菌壞死性肺炎肺組織壞死機制及其治療的探索與思考. 山東醫藥, 2011, 51(48): 5-6, 24.
37. Chaudhry R, Ghosh A, Chandolia A. Pathogenesis of mycoplasma pneumoniae: an update. Indian J Med Microbiol, 2016, 34(1): 7-1.
38. Narita M. Pathogenesis of extrapulmonary manifestations of mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother, 2010, 16(3): 162-169.

Chinese Journal of Evidence-Based Medicine

Risk factors for refractory mycoplasma pneumoniae pneumonia in children: a systematic review

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