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.	Søndergaard 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.	中华医学会儿科学分会呼吸学组, 《中华实用儿科临床杂志》编辑委员会. 儿童肺炎支原体肺炎诊治专家共识(2015 年版). 中华实用儿科临床杂志, 2015, 30(17): 1304-1308.
4.	方晓丹, 王爱珍, 王有成. 儿童难治性肺炎支原体肺炎危险因素分析. 中国妇幼保健, 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.	杨蓓蕾. 苏州地区儿童难治性肺炎支原体肺炎与坏死性肺炎临床特征及危险因素分析. 苏州: 苏州大学, 2020.
7.	崔小健, 张嘉懿, 郭文伟, 等. 儿童难治性肺炎支原体肺炎的临床特征和高危因素预测. 重庆医学, 2020, 49(17): 2905-2908, 2912.
8.	林新春, 郭燕军. 难治性肺炎支原体肺炎患儿的临床特点及相关危险因素. 河南医学研究, 2020, 29(36): 6758-6759.
9.	王松, 何玲. 儿童难治性肺炎支原体肺炎的危险因素分析. 临床检验杂志(电子版), 2020, 9(3): 78-80.
10.	苏丽萍. 小儿难治性支原体肺炎的危险因素. 深圳中西医结合杂志, 2020, 30(2): 147-148.
11.	张建芳. 儿童难治性肺炎支原体感染临床观察及相关因素分析. 青岛医药卫生, 2019, 51(5): 330-334.
12.	高建龙, 潘根丽. 重症支原体肺炎临床特征及危险因素分析. 全科医学临床与教育, 2019, 17(12): 1137-1139.
13.	陈方, 陈全景. 血清乳酸脱氢酶同工酶对儿童难治性肺炎支原体肺炎的诊断价值. 中国医师进修杂志, 2019, 42(7): 634-638.
14.	常春霞. 难治性肺炎支原体肺炎患儿实验室指标及临床特点分析. 中国妇幼保健, 2019, 34(5): 1085-1088.
15.	林国栋, 李春华, 王芳. 难治性肺炎支原体肺炎患儿发病的危险因素分析. 内科, 2019, 14(5): 551-553.
16.	朱影, 王婧. 儿童难治性肺炎支原体肺炎高危因素 logsitic 回归分析. 河北医学, 2018, 24(5): 760-763.
17.	赵静. 小儿重症支原体肺炎高危因素分析. 中国保健营养, 2018, 28(26): 14.
18.	陆妹, 傅美娇, 董鸿捌, 等. 儿童难治性肺炎支原体肺炎的临床特点及相关因素分析. 中国妇幼保健, 2018, 33(2): 335-337.
19.	李俊梅, 郑成中, 张曼, 等. 儿童难治性肺炎支原体肺炎的临床特点及血清 IL-4, IL-6, IL-10, IFN-γ的变化分析. 现代生物医学进展, 2018, 18(24): 4768-4772.
20.	葛柳源. 呼和浩特市地区小儿重症肺炎支原体肺炎临床相关因素分析. 呼和浩特: 内蒙古医科大学, 2018.
21.	刘雪梅, 徐飞, 谈华, 等. 进展为难治性支原体肺炎的危险因素分析. 山东医药, 2018, 58(28): 80-82.
22.	刘学胜, 杨会方, 班丹丹, 等. 影响儿童难治性支原体肺炎临床治疗的危险因素分析. 黑龙江医学, 2018, 42(9): 885-886.
23.	翟佳羽, 林烈桔, 麦朗君, 等. 难治性肺炎支原体肺炎患儿临床特点及危险因素分析. 临床儿科杂志, 2017, 35(8): 569-574.
24.	王婷, 严永东. 难治性肺炎支原体肺炎的临床特征及危险因素分析. 中国医药指南, 2016, 14(9): 191-192, 193.
25.	周兰芝. 儿童难治性肺炎支原体肺炎临床危险因素分析. 长春: 吉林大学, 2016.
26.	肖水平. 小儿重症支原体肺炎的发病危险因素分析. 医学信息, 2015, (44): 80-81.
27.	梅玉霞, 蒋瑾瑾, 蔡斌, 等. 儿童难治性支原体肺炎临床危险因素分析. 临床儿科杂志, 2014, 32(12): 1138-1140.
28.	王冠, 刘杰, 李开为, 等. 小儿重症支原体肺炎高危因素分析. 现代生物医学进展, 2014, 14(22): 4332-4335.
29.	陆爱珍, 杨皓伟, 王传凯, 等. 上海地区单中心住院儿童难治性肺炎支原体肺炎相关因素分析. 中国循证儿科杂志, 2014, (6): 411-415.
30.	杨勇, 崔巍, 王利东, 等. 小儿难治性肺炎支原体肺炎高危因素分析. 陕西医学杂志, 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.	舒林华. 小儿肺炎链球菌坏死性肺炎肺组织坏死机制及其治疗的探索与思考. 山东医药, 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. Søndergaard 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. 中华医学会儿科学分会呼吸学组, 《中华实用儿科临床杂志》编辑委员会. 儿童肺炎支原体肺炎诊治专家共识(2015 年版). 中华实用儿科临床杂志, 2015, 30(17): 1304-1308.
4. 方晓丹, 王爱珍, 王有成. 儿童难治性肺炎支原体肺炎危险因素分析. 中国妇幼保健, 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. 杨蓓蕾. 苏州地区儿童难治性肺炎支原体肺炎与坏死性肺炎临床特征及危险因素分析. 苏州: 苏州大学, 2020.
7. 崔小健, 张嘉懿, 郭文伟, 等. 儿童难治性肺炎支原体肺炎的临床特征和高危因素预测. 重庆医学, 2020, 49(17): 2905-2908, 2912.
8. 林新春, 郭燕军. 难治性肺炎支原体肺炎患儿的临床特点及相关危险因素. 河南医学研究, 2020, 29(36): 6758-6759.
9. 王松, 何玲. 儿童难治性肺炎支原体肺炎的危险因素分析. 临床检验杂志(电子版), 2020, 9(3): 78-80.
10. 苏丽萍. 小儿难治性支原体肺炎的危险因素. 深圳中西医结合杂志, 2020, 30(2): 147-148.
11. 张建芳. 儿童难治性肺炎支原体感染临床观察及相关因素分析. 青岛医药卫生, 2019, 51(5): 330-334.
12. 高建龙, 潘根丽. 重症支原体肺炎临床特征及危险因素分析. 全科医学临床与教育, 2019, 17(12): 1137-1139.
13. 陈方, 陈全景. 血清乳酸脱氢酶同工酶对儿童难治性肺炎支原体肺炎的诊断价值. 中国医师进修杂志, 2019, 42(7): 634-638.
14. 常春霞. 难治性肺炎支原体肺炎患儿实验室指标及临床特点分析. 中国妇幼保健, 2019, 34(5): 1085-1088.
15. 林国栋, 李春华, 王芳. 难治性肺炎支原体肺炎患儿发病的危险因素分析. 内科, 2019, 14(5): 551-553.
16. 朱影, 王婧. 儿童难治性肺炎支原体肺炎高危因素 logsitic 回归分析. 河北医学, 2018, 24(5): 760-763.
17. 赵静. 小儿重症支原体肺炎高危因素分析. 中国保健营养, 2018, 28(26): 14.
18. 陆妹, 傅美娇, 董鸿捌, 等. 儿童难治性肺炎支原体肺炎的临床特点及相关因素分析. 中国妇幼保健, 2018, 33(2): 335-337.
19. 李俊梅, 郑成中, 张曼, 等. 儿童难治性肺炎支原体肺炎的临床特点及血清 IL-4, IL-6, IL-10, IFN-γ的变化分析. 现代生物医学进展, 2018, 18(24): 4768-4772.
20. 葛柳源. 呼和浩特市地区小儿重症肺炎支原体肺炎临床相关因素分析. 呼和浩特: 内蒙古医科大学, 2018.
21. 刘雪梅, 徐飞, 谈华, 等. 进展为难治性支原体肺炎的危险因素分析. 山东医药, 2018, 58(28): 80-82.
22. 刘学胜, 杨会方, 班丹丹, 等. 影响儿童难治性支原体肺炎临床治疗的危险因素分析. 黑龙江医学, 2018, 42(9): 885-886.
23. 翟佳羽, 林烈桔, 麦朗君, 等. 难治性肺炎支原体肺炎患儿临床特点及危险因素分析. 临床儿科杂志, 2017, 35(8): 569-574.
24. 王婷, 严永东. 难治性肺炎支原体肺炎的临床特征及危险因素分析. 中国医药指南, 2016, 14(9): 191-192, 193.
25. 周兰芝. 儿童难治性肺炎支原体肺炎临床危险因素分析. 长春: 吉林大学, 2016.
26. 肖水平. 小儿重症支原体肺炎的发病危险因素分析. 医学信息, 2015, (44): 80-81.
27. 梅玉霞, 蒋瑾瑾, 蔡斌, 等. 儿童难治性支原体肺炎临床危险因素分析. 临床儿科杂志, 2014, 32(12): 1138-1140.
28. 王冠, 刘杰, 李开为, 等. 小儿重症支原体肺炎高危因素分析. 现代生物医学进展, 2014, 14(22): 4332-4335.
29. 陆爱珍, 杨皓伟, 王传凯, 等. 上海地区单中心住院儿童难治性肺炎支原体肺炎相关因素分析. 中国循证儿科杂志, 2014, (6): 411-415.
30. 杨勇, 崔巍, 王利东, 等. 小儿难治性肺炎支原体肺炎高危因素分析. 陕西医学杂志, 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. 舒林华. 小儿肺炎链球菌坏死性肺炎肺组织坏死机制及其治疗的探索与思考. 山东医药, 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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