儿童肺炎支原体肺炎并发肺外急性肝损害的影响因素及其预测模型  

Influencing factors and predictive model of Mycoplasma pneumoniae infection complicated with extrapulmonary acute liver damage pneumonia in children

作　　者：乜明金 李莉[1] 刘丽娟[1] 孙慧生[1] NIE Ming-jin;LI Li;LIU Li-juan;SUN Hui-sheng(Hengshui People's Hospital(Harrison International Peace Hospital),Hengshui,Hebei 053000,China)

机构地区：[1]衡水市人民医院(哈励逊国际和平医院)小儿内科,河北衡水053000

出　　处：《中华医院感染学杂志》2023年第8期1263-1266,共4页Chinese Journal of Nosocomiology

基　　金：衡水市科技计划基金资助项目(2020014063Z)。

摘　　要：目的探讨儿童肺炎支原体肺炎(MPP)并发肺外急性肝损害影响因素,并以此建立预测模型。方法选择衡水市人民医院儿科2018年7月-2021年7月收治的MPP患儿为研究对象,将符合纳入标准的200例MPP患儿分为并发肝损害组和未并发组。患儿入院后次日清晨抽取外周静脉血3 ml加入促凝胶管中,检测肝生化指标谷丙转氨酶(ALT)、AST(谷草转氨酶)、总胆红素(TB)、总蛋白(TP)、清蛋白(ALB)、碱性磷酸酶(ALP)、y谷氨酰肽转移酶(GGT)和乳酸脱氢酶(LDH)。检测血液指标C-反应蛋白、D-二聚体、淋巴细胞、中性粒细胞、单核细胞、白细胞计数水平,通过患者管理系统收集临床资料。结果并发肝损害组患儿肝生化指标ALT、AST和ALP水平高于未并发组(P<0.05);并发肝损害组平均年龄小于未并发组,MP抗体滴度>1∶16人数多于未并发组,院前病程长于未并发组,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果显示年龄、MP抗体滴度>1∶16和院前病程均为MPP患儿并发急性肝损害的独立危险因素(P<0.05);根据多因素Logistic回归分析结果建立预测模型并绘制受试者工作特征(ROC)曲线,结果显示预测模型用于预测MPP患儿并发急性肝损害曲线下面积为0.859,标准误为0.035,95%CI值为0.791~0.927。结论以年龄、MP抗体滴度>1∶16和院前病程建立的预测模型对于MPP患儿并发急性肝损害有较好的预测价值,值得推广应用。OBJECTIVE To explore the influencing factors for extrapulmonary acute liver injury in children with Mycoplasma pneumoniae pneumonia(MPP)and to establish a predictive model.METHODS The children with MPP admitted to the department of pediatrics of Hengshui People′s Hospital from Jul 2018 to Jul 2021 were enrolled.Total of 200 children with MPP who met the criteria for inclusion were divided into the concurrent liver damage group and non-complicated group.On the morning after the child was admitted,3 mL of peripheral venous blood was drawn into coagulant tube and detect liver biochemical indicators ALT,AST,total bilirubin(TB),total protein(TP),albumin(ALB),alkaline phosphate Enzyme(ALP),gamma glutamyl peptide transferase(GGT)and lactate dehydrogenase(LDH).Blood indicators including C-reactive protein,D-dimer,lymphocytes,neutrophils,monocytes and white blood cell count levels were detected,and clinical data were collected by the patient management system.RESULTS The levels of liver biochemical indexes ALT,AST and ALP in children of the concurrent liver damage group were higher than those in the non-complicated group(P<0.05).The average age of the complicated liver damage group was lower than that of the non-complicated group;the number of patients with MP antibody titer1∶16 was larger than that of the non-complicated group;the pre-hospital disease course was longer than that in the non-complicated group.The difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that age,MP antibody titer 1∶16 and pre-hospital course were all independent risk factors for acute liver damage in children with MPP(P<0.05).Prediction model was established and receiver operating characteristic(ROC)curve analysis showed that the area under the curve for predicting acute liver damage in children with MPP is 0.859,with the standard error of 0.035 and 95%CI of 0.791-0.927.CONCLUSION The prediction model is established based on age,MP antibody titer1∶16 and pre-hospital disease course,which show

关 键 词：儿童 肺炎支原体肺炎 急性肝损害 预测模型 生存曲线 影响因素 

分 类 号：R725.6[医药卫生—儿科]