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目的:探讨儿童重症肺炎支原体肺炎（SMPP）发生塑形性支气管炎（PB）的临床特征及预测因素。方法:回顾性队列研究。选取2018年1月1日至2023年10月31日天津市儿童医院马场院区呼吸科收治的SMPP合并PB的142例患儿为PB组，选取同期住院的274例未发生PB的SMPP患儿为非PB组，分析两组临床表现、实验室指标、影像学特征及治疗情况。采用Mann-Whitney U检验及 χ2检验分析组间差异，采用Logistic回归分析SMPP患儿发生PB的危险因素，采用受试者操作特征（ROC）曲线分析对PB的预测价值。 结果:416例SMPP患儿中男197例、女219例，PB组142例，就诊年龄（6.9±2.9）岁，非PB组274例，就诊年龄（6.6±2.8）岁。PB组出现喘息、低氧血症、热峰值>40 ℃比例、发热持续时间、中性粒细胞计数、平均血小板体积、C反应蛋白、降钙素原、白细胞介素-6、丙氨酸转氨酶、天冬氨酸转氨酶、铁蛋白水平均高于非PB组［16例（11.3%）比15例（5.5%）、14例（9.9%）比12例（4.4%）、57例（40.1%）比67例（24.5%）、10（8，12）比9（8，12）d、6.1（4.1，13.1）×10 9比5.0（3.7，6.8）×10 9/L、10.2（9.6，10.8）比9.4（8.9，10.1）fl、33.4（16.0，67.5）比23.0（10.4，56.1）mg/L、0.24（0.12，0.48）比0.16（0.09，0.31）μg/L、39.9（25.1，81.4）比31.3（18.3，59.3）ng/L、16.0（12.0，29.0）比14.0（10.0，24.3）U/L、38.5（28.0，52.5）比33.0（25.0，44.0）U/L、233（136，488）比156（110，293）μg/L， χ2=4.55、4.79、11.00， Z=2.25、4.00、6.64、2.76、2.98、3.09、2.22、2.62、4.18，均 P<0.05］。多因素Logistic回归分析结果示，呼吸困难（ OR=2.97，95% CI 1.35~6.55， P=0.007）、呼吸音减低（ OR=2.40，95% CI 1.27~4.52， P=0.006）、中性粒细胞/淋巴细胞（NLR）（ OR=2.07，95% CI 1.71~2.51， P<0.001）、乳酸脱氢酶（LDH）（ OR=1.01，95% CI 1.00~1.01， P<0.001）、平均血小板体积/血小板计数（MPV/PLT）（ OR=1.39，95% CI 1.13~1.71， P=0.002）、胸腔积液（ OR=2.23，95% CI 1.21~4.13， P=0.011）、≥2/3肺叶实变（ OR=1.84，95% CI 1.04~3.00， P=0.039）、肺不张（ OR=1.98，95% CI 1.02~3.48， P=0.044）是儿童SMPP发生PB的危险因素。ROC曲线分析显示，NLR诊断PB的界值为2.79，灵敏度为0.89，特异度为0.69，曲线下面积（area under the curve，AUC）=0.86， P<0.001；LDH诊断PB的界值为474 U/L，灵敏度为0.63，特异度为0.65，AUC=0.70， P=0.003；MPV/PLT诊断PB的临界值为0.04，灵敏度为0.75，特异度为0.53，AUC=0.68， P=0.005。PB组患儿住院时间、糖皮质激素使用时间、使用糖皮质激素治疗及气管镜检查治疗≥2次患儿的比例均高于非PB组［9（8，12）比8（6，10）d、7（5，8）比 6（5，7）d、128例（90.1%）比218例（79.6%）、106例（74.6%）比54例（19.7%）， Z=6.70、5.06， χ2=7.48、119.27，均 P<0.05］。 结论:SMPP患儿呼吸困难、呼吸音减低、NLR值升高（>2.79）及胸腔积液是其发生PB的重要预测指标，有助于早期识别。

Objective:To explore the clinical characteristics and predictive factors for plastic bronchitis (PB) in children with severe Mycoplasma pneumoniae pneumonia (SMPP). Methods:A retrospective cohort enrolled children with a clinical diagnosis of SMPP who were treated at the Department of Respiratory Medicine of Tianjin Children′s Hospital Machang District from January 1, 2018, to October 31, 2023. According to the bronchoscopy and pathological examination results, the patients were divided into 142 cases in the PB group and 274 cases in the non-PB group. The clinical manifestations, laboratory data, imaging findings, and treatments were analyzed.Mann-Whitney U test and Chi-square test were used to analyze the differences between the two groups, and multivariate Logistic regression was used to analyze the risk factors. The receiver operating characteristic (ROC) curve was used to explore the predictive value of PB in SMPP. Results:Among 416 SMPP children, there were 197 males and 219 females; PB group 142 cases, non-PB group 274 cases, the age of disease onset was (6.9±2.9) years and (6.6±2.8) years in the PB group and the non-PB group respectively. The incidence of wheezing symptoms, hypoxemia, heat peak >40 ℃, the duration of fever, neutrophil-lymphocyte ratio, mean platelet volume, C-reactive protein, procalcitonin, interleukin-6, alanine transaminase, aspartate aminotransferase and ferritin were higher in the PB group (16 cases (11.3%) vs. 15 cases (5.5%), 14 cases (9.9%) vs. 12 cases (4.4%), 57 cases (40.1%) vs. 67 cases (24.5%), 10 (8, 12) vs. 9 (8, 12) d, 6.1 (4.1, 13.1)×10 9vs. 5.0 (3.7, 6.8)×10 9/L, 10.2 (9.6, 10.8) vs. 9.4 (8.9, 10.1) fl, 33.4 (16.0, 67.5) vs. 23.0 (10.4, 56.1) mg/L, 0.24 (0.12, 0.48) vs. 0.16 (0.09, 0.31) μg/L, 39.9 (25.1, 81.4) vs. 31.3 (18.3, 59.3) ng/L, 16.0 (12.0, 29.0) vs. 14.0 (10.0, 24.3) U/L, 38.5 (28.0, 52.5) vs. 33.0 (25.0, 44.0) U/L, 233 (136, 488) vs. 156 (110, 293) μg/L, χ2=4.55, 4.79, 11.00, Z=2.25, 4.00, 6.64, 2.76, 2.98, 3.09, 2.22, 2.62, 4.18, all P<0.05). Multivariate Logistic regression analysis showed that the dyspnea ( OR=2.97, 95% CI 1.35-6.55, P=0.007), the diminution of respiration ( OR=2.40, 95% CI 1.27-4.52, P=0.006), neutrophil-lymphocyte ratio (NLR) ( OR=2.07, 95% CI 1.71-2.51, P<0.001), lactate dehydrogenase (LDH) ( OR=1.01, 95% CI 1.00-1.01, P<0.001), mean platelet volume/platelet count (MPV/PLT) ( OR=1.39, 95% CI 1.13-1.71, P=0.002), pleural effusion ( OR=2.23, 95% CI 1.21-4.13, P=0.011),≥2/3 lobe consolidation ( OR=1.84, 95% CI 1.04-3.00, P=0.039) and atelectasis ( OR=1.98, 95% CI 1.02-3.48, P=0.044) were independent predictors of PB in children with SMPP. ROC curve analysis showed that the cut-off values for NLR, LDH and MPV/PLT in the diagnosis of PB were 2.79 (sensitivity 0.89, specificity 0.69, area under the curve (AUC)=0.86, P<0.001), 474 U/L (sensitivity 0.63, specificity 0.65, AUC=0.70, P=0.003) and 0.04 (sensitivity 0.75, specificity 0.53, AUC=0.68, P=0.005) respectively. Children in the PB group had longer hospital stays and corticosteroid treatment course than those in the non-PB group, the proportion of children in the PB group who received bronchoscopy treatment twice or more was higher (9 (8, 12) vs. 8 (6, 10) d, 7 (5, 8) vs. 6 (5, 7) d, 128 cases (90.1%) vs. 218 cases (79.6%), 106 cases (74.7%) vs. 54 cases (19.7%), Z=6.70, 5.06, χ2=7.48, 119.27, all P<0.05). Conclusions:The dyspnea, respiration diminution, NLR level elevation (>2.79) and pleural effusion were predictive factors for PB in children with SMPP. This provides a basis for the early identification of PB in children with SMPP.