探讨难治性肺炎支原体肺炎(RMPP)患儿病程早期血清炎性指标水平增高，对其RMPP的早期预测价值。

选择2019年10月至2020年3月，于西安市儿童医院住院治疗的304例肺炎支原体肺炎(MPP)患儿为研究对象。根据临床难治程度，将其分为RMPP组(n＝88)及MPP组(n＝216)。对2组患儿一般临床资料，临床表现，入院后24 h内的血清炎性指标、血常规等实验室检查结果，采用独立样本t检验及χ²检验进行统计学比较；对2组差异具有统计学意义的临床指标，采取受试者工作特征(ROC)曲线进行分析，根据曲线下面积(AUC)筛选对RMPP有预测意义的临床指标，并对这些指标进行非条件多因素logistic回归分析，判断RMPP的独立危险因素。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①2组患儿年龄、男性患儿占比、单侧及双侧肺实变发生率比较，差异均无统计学意义(P>0.05)。②RMPP组患儿发热及咳嗽时间，入院后24 h内血清降钙素原(PCT)、红细胞沉降率(ESR)、D-二聚体、乳酸脱氢酶(LDH)、肌酸激酶(CK)、丙氨酸转氨酶(ALT)、天冬氨酸氨基转移酶(AST)及C反应蛋白(CRP)水平，以及中性粒细胞计数，均长于、高于MPP组；而血清白蛋白水平及胆固醇浓度，则均低于MPP组，并且上述差异均有统计学意义(均为P<0.05)。③ROC曲线分析结果显示，11项临床指标对RMPP具有预测意义，均为AUC>0.5，并且P<0.05；各指标对RMPP的预测意义由高到低，以及最佳临界值依次为：D-二聚体(2.1 mg/L)、LDH(375.5 U/L)、CRP(43.08 mg/L)、ALT(16.5 U/L)、PCT(0.08 μg/L)、AST(36.5 U/L)、中性粒细胞计数(4.5×10⁹/L)、CK(130.5 U/L)、ESR (68.5 mm/h)、发热时间(7.5 d)及咳嗽时间(8.5 d)。④发生RMPP的非条件多因素logistic回归分析结果显示，D-二聚体>2.1 mg/L(OR＝1.163，95%CI：1.032～1.319，P＝0.026)及CRP> 43.08 mg/L(OR＝1.024, 95%CI：1.003～1.026，P＝0.013)，是MPP患儿发展为RMPP的独立危险因素。

MPP患儿早期病程中的血清炎性指标明显升高，提示可能发生RMPP。血清D-二聚体与CRP水平升高，是MPP患儿发展为RMPP的独立危险因素。

To explore value of early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP) as levels of serum inflammatory markers elevating in children with RMPP in early stage.

From October 2019 to March 2020, a total of 304 children with Mycoplasma pneumoniae pneumonia (MPP) who were hospitalized in Xi′an Children′s Hospital, were chosen as research subjects. According to degrees of clinical refractory, they were divided into RMPP group (n=88) and MPP group (n=216). The general clinical data, clinical manifestations, and laboratory results within 24 h after admission, including serum inflammatory indicators, blood routine, etc. between two groups of children were statistically compared by independent-samples t test and chi-square test. Clinical indicators with significant differences between two groups were analyzed by receiver operating characteristic (ROC) curves, and clinical indicators had predictive significance for RMPP were screened according to area under curve (AUC), then unconditioned multivariable logistic regression analysis was used to determine independent risk factors of RMPP. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

① There were no significant differences in age of children, proportion of male children, incidence of unilateral and bilateral lung consolidation between two groups (P>0.05). ② Fever and cough duration, serum levels within 24 h after admission including procalcitonin (PCT), erythrocyte sedimentation rate (ESR), D-dimer, lactate dehydrogenase (LDH), creatine kinase (CK), alanine transaminase (ALT), aspartate aminotransferase (AST), and C-reactive protein (CRP), also neutrophil count of children in RMPP group were longer or higher than those in MPP group, while serum albumin level and cholesterol concentration were lower than those in MPP group, and all the differences above were statistically significant (P all<0.05). ③ ROC curve analysis showed that 11 clinical indicators had predictive significance for RMPP, which with AUC>0.5 and P<0.05. The predictive significance of the indicators for RMPP ranged from high to low, and the cut-off values in turn were serum D-dimer (2.1 mg/L), LDH (375.5 U/L), CRP (43.08 mg/L), ALT (16.5 U/L), PCT (0.08 μg/L), AST (36.5 U/L), neutrophil count (4.5×10⁹/L), CK (130.5 U/L), ESR (68.5 mm/h), fever duration (7.5 d), cough duration (8.5 d). ④ Unconditioned multivariable logistic regression analysis results of RMPP occurrence showed that serum D-dimer>2.1 mg/L (OR=1.163, 95%CI: 1.032-1.319, P=0.026) and CRP>43.08 mg/L (OR=1.024, 95%CI: 1.003-1.026, P=0.013) were independent risk factors of MPP children developed to RMPP.

Serum levels of inflammatory indexes increased significantly in early course of MPP children, suggesting possibility of RMPP. Elevated serum D-dimer and CRP levels are independent risk factors of MPP children developed to RMPP.