肺炎患儿治疗后喘息发生风险预测评分价值分析  

Value of score for predicting wheezing risk in children with pneumonia after treatment

作　　者：白敏 黄烈平 徐玉兰 李艳华 戴方娣 韩宜姚 BAI Min;HUANG Lie-ping;XU Yu-lan;LI Yan-hua;DAI Fang-di;HAN Yi-yao(Department of Pediatric,Zhoushan Women and Children Hospital,Zhoushan,Zhejiang 316000,China)

机构地区：[1]舟山市妇女儿童医院儿科,浙江舟山316000

出　　处：《中国妇幼保健》2024年第3期462-465,共4页Maternal and Child Health Care of China

基　　金：浙江省舟山市科技计划项目(2019C31108)。

摘　　要：目的 探讨肺炎患儿治疗后喘息发生风险预测评分价值。方法 选取2020年6月—2022年6月舟山市妇女儿童医院收治的肺炎患儿162例,参照《儿童社区获得性肺炎诊疗规范(2019年版)》予以治疗,并根据治疗后是否发生喘息分为喘息组(53例)和非喘息组(109例)。采用多因素logistic回归分析影响喘息风险的相关因素,根据比值比(OR)对每个风险因素进行赋分并构建喘息发生风险评分,绘制ROC曲线评价风险评分模型的预测价值。结果 喘息组特应性体质、支原体感染占比及嗜酸性粒细胞水平高于非喘息组,血红蛋白、用力呼气中段流速预计值(FEF25%~75%pred)低于非喘息组,差异均有统计学意义(P<0.05);多因素logistic回归分析结果显示:特应性体质(OR=2.593,95%CI:1.008~6.671)、支原体感染(OR=2.302,95%CI:1.035~5.119)及嗜酸性粒细胞(OR=2.012,95%CI:1.318~3.071)为肺炎患儿治疗后喘息发生风险的危险因素(P<0.05),血红蛋白(OR=0.961,95%CI:0.937~0.986)、FEF25%~75%pred(OR=0.921,95%CI:0.867~0.979)为肺炎患儿治疗后喘息发生风险的保护因素(P<0.05);上述因素于评分模型中所占分值分别为2、2、2、0、0分,总分>1分为喘息高危人群。模型验证结果显示:曲线下面积为0.788(95%CI:0.715~0.861),灵敏度为56.60%,特异度为90.83%,低风险组喘息发生率(37.27%)低于高风险组(46.34%),差异有统计学意义(χ^(2)=5.109,P=0.024)。结论 肺炎患儿治疗后喘息发生风险与特应性体质、支原体感染、高嗜酸性粒细胞、低血红蛋白及低肺功能有关。Objective To explore the value of score for predicting wheezing risk in children with pneumonia after treatment.Methods A total of 162 children with pneumonia admitted to Zhoushan Women and Children Hospital from June 2020 to June 2022 were selected and treated according to the"Norms for the Diagnosis and Treatment of Community Acquired Pneumonia in Children(2019 Edition)",and divided into 53 cases in the wheezing group and 109 cases in the non-wheezing group according to whether wheezing occurred after treatment.Multivariate logistic regression was used to analyze the related factors affecting the risk of wheezing.Each risk factor was scored according to odds ratio(OR)and wheezing risk score was constructed.ROC curve was drawn to evaluate the predictive value of the risk score model.Results The atopic body,the proportion of mycoplasma infection and the level of eosinophils in the wheezing group were higher than those in the non-wheezing group,and the predicted values of hemoglobin and forced expiratory middle flow velocity(FEF25%-75%pred)in the wheezing group were lower than those in the non-wheezing group,with statistical significance(P<0.05).The results of multivariate logistic regression analysis showed that:Atopic constitution(OR=2.593,95%CI:1.008-6.671),mycoplasma infection(OR=2.302,95%CI:1.035-5.119),eosinophils(OR=2.012,95%CI:1.318-3.071)were the risk factors of wheezing in children with pneumonia after treatment(P<0.05),hemoglobin(OR=0.961,95%CI:0.937-0.986),FEF25%-75%pred(OR=0.921,95%CI:0.867-0.979)were protective factors for the risk of wheezing in children with pneumonia after treatment(P<0.05).The above factors accounted for 2,2,2,0 and 0 points respectively in the scoring model,and the total score greater than 1 was classified as high-risk asthmatic group.The results of model verification showed that the area under the curve was 0.788(95%CI:0.715-0.861),the sensitivity was 56.60%,and the specificity was 90.83%.The incidence of wheezing in the low-risk group(37.27%)was lower than that in the high-ris

关 键 词：肺炎 喘息 特应性体质 嗜酸性粒细胞 

分 类 号：R725.6[医药卫生—儿科]