肺炎支原体感染患儿合并支气管黏液堵塞的危险因素及其列线图模型构建与验证  

Risk factors combined bronchial mucus blockage in children with Mycoplasma pneumoniae infection and construction and validation of nomogram model

作　　者：乜明金 刘丽娟[1] 李莉[1] 孙慧生[1] NIE Ming-jin;LIU Li-juan;LI Li;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19期3009-3012,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：目的分析肺炎支原体(MPP)感染患儿合并支气管黏液堵塞的危险因素,建立预测模型,并对其进行验证.方法选择衡水市人民医院儿科2018年8月-2021年8月因MPP入院接受治疗患儿186例为研究对象,观察患儿支气管结构和黏膜情况,明确黏液栓位置和堵塞情况,根据支气管镜检查结果将其分为黏液栓堵塞组(n=43)和未堵塞组(n=143);通过医院患儿管理系统调查患儿临床资料,检测白细胞计数(WBC)、C-反应蛋白(CRP)、D-二聚体、免疫球蛋白A(IgA)、IgM、IgG,归纳MPP患儿发生支气管黏液堵塞的危险因素,构建预测模型,采用受试者工作特征(ROC)曲线进行验证.结果黏液栓堵塞组合并肺不张占比、肺实变面积>2/3占比、CRP、D-二聚体和IgA高于未堵塞组(P<0.05);以是否发生支气管黏液堵塞作为结局,多因素Logistic回归分析结果显示肺实变面积>2/3、CRP、D-二聚体和IgA为MPP患儿发生支气管黏液堵塞的危险因素(P<0.05);据此建立预测模型,拟合优度检验结果显示模型与实际情况拟合度良好;ROC曲线分析结果显示,所建立预测模型对MPP患儿发生支气管黏液堵塞预测曲线下面积为0.865(95%CI:0.799~0.865).结论以肺实变面积>2/3、CRP、D-二聚体和IgA建立的MPP患儿发生支气管黏液堵塞预测模型具有较好的预测价值.OBJECTIVE To analyze the risk factors for combined bronchial mucus blockage in children with Mycoplasma pneumoniae pneumonia(MPP)infection,and to develop a predictive model to validated it.METHODS Totally 186 children admitted to Hengshui People's Hospital for treatment due to MPP from Aug.2018 to Aug.2021 were selected as the research subjects,and the bronchial structure and mucous membrane of the children were observed to clarify the location and blockage of the mucus plug.They were divided into the mucus blockage group(43 cases)and the non-blockage group(143 cases)according to the results of bronchoscopy,the clinical data of children admitted to the hospital were surveyed through the hospital children management system.White blood cell count(WBC),C-reactive protein(CRP),D-dimer,immunoglobulin A(IgA),IgM,and IgG were detected.The risk factors for bronchial mucus blockage in children with MPP were summarized.and a prediction model was constructed,and validated using the receiver operating characteristic(ROC)curve.RESULTS The number of patients with atelectasis,pulmonary consolidation area>2/3,CRP,D-dimer and IgA in the combination in the mucus blockage group were higher than those in the non blockage group(P<o.o05).With bronchial mucus blockage as the outcome,the results of multifactor Logistic regression analysis showed that pulmonary consolidation area>2/3,CRP,D-dimer and IgA were the risk factors for the occurrence of bronchial mucus blockage in children with MPP(P<0.05);the prediction model was established based on the risk factors,the goodness-of-fit test results showed that the model fitted well with the actual situation.The ROC curve analysis results showed that the area under the curve of the established prediction model for predicting the occurrence of bronchial mucus blockage in children with MPP was 0.865(95%CI:0.799-0.865).CONCLUSION The prediction model for the development of bronchial mucus blockage in children with MPP established with lung consolidation area>2/3,CRP,D-dimer and IgAhad good predic

关 键 词：肺炎支原体 支气管黏液堵塞 危险因素 预测模型 列线图 

分 类 号：R563.1[医药卫生—呼吸系统]