呈大叶性肺炎改变的儿童肺炎支原体肺炎的影响因素及列线图预测模型构建与验证  

Influencing factors of Mycoplasma pneumoniae pneumonia in children with lobar pneumonia changes and construction and validation of a nomogram prediction model

作　　者：田继萍 吴明赴[1] 孟令玲 TIAN Jiping;WU Mingfu;MENG Linging(Department of Pediatrics,Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu 225000,China)

机构地区：[1]扬州大学附属医院儿科,江苏扬州225000

出　　处：《安徽医药》2024年第4期718-722,共5页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省卫生健康委员会妇幼健康科研项目(F201858)。

摘　　要：目的 预测呈大叶性肺炎改变的儿童肺炎支原体肺炎的列线图模型构建及验证。方法 选取扬州大学附属医院2016年1月至2019年6月接收的170例MPP病儿为建模组。选取该院2019年7月至2021年12月接收的150例MPP病儿为验证组。根据是否表现为大叶性肺炎将建模组病儿分为呈大叶性肺炎组(n=70)和未呈大叶性肺炎组(n=100)。对建模组病儿采用logistic回归法筛选呈大叶性肺炎改变的儿童MPP的危险因素;采用R软件构建预测呈大叶性肺炎改变的儿童MPP的列线图模型,绘制校准曲线评估预测呈大叶性肺炎改变的儿童MPP列线图模型的一致性,绘制受试者操作特征(ROC)曲线验证列线图模型准确性。结果 logistic分析显示建模组中呈大叶性肺炎组年龄、热程、大环内酯类药使用时间、中性粒细胞百分比、C反应蛋白(CRP)水平、乳酸脱氢酶(LDH)水平、丙氨酸转氨酶(ALT)、红细胞沉降率(ESR)、D-二聚体高于未呈大叶性肺炎组(P<0.05),其中热程更高(10.10±2.72比6.36±1.91)、大环内酯类药使用时间更高(5.20±1.59比3.50±1.02)、CRP更高(35.46±9.73比13.92±4.06)、D-二聚体更高(0.69比0.44)。logistic分析显示,热程、大环内酯类药使用时间、CRP、D-二聚体是呈大叶性肺炎改变的儿童MPP的危险因素(P<0.05)。基于危险因素用R软件建立列线图模型,建模组ROC曲线下面积为0.94[95%CI:(0.90,0.98)],验证组ROC曲线下面积为0.95[95%CI:(0.92,0.98)];列线图模型的Hosmer-Lemeshow拟合优度检验显示,建模组χ^(2)=6.81,P=0.557;验证组χ^(2)=6.50,P=0.591。结论 构建的预测呈大叶性肺炎改变的儿童MPP的列线图模型具有较大临床价值,可指导个体化治疗。Objective To construct and validate a nomogram model for predicting lobar pneumonia changes in children with Myco-plasma pneumoniae pneumonia(MPP).Methods A total of 170 children with MPP admitted to Affiliated Hospital of Yangzhou Uni-versity from January 2016 to June 2019 were taken as the modeling group.A total of 150 children with MPP admitted to this hospital from July 2019 to December 2021 were taken as the validation group.According to whether the children presented with lobar pneumo-nia,the children in the modeling group were assigned into lobar pneumonia group(n=70)and non-lobar pneumonia group(n=100).Lo-gistic regression was used to screen the risk factors of lobar pneumonia changes in children with MPP in the modeling group;R software was used to construct a nomogram model for predicting lobar pneumonia changes in children with MPP,the calibration curve was drawn to evaluate the consistency of MPP nomogram model in children with lobar pneumonia,and ROC curve was drawn to verify the accura-cy of the nomogram model.Results Logistic analysis showed that the age,duration of fever,duration of macrolide use,neutrophil per-centage,C-reactive protein(CRP)level,lactate dehydrogenase(LDH)level,alanine aminotransferase(ALT)level,erythrocyte sedimen-tation rate(ESR)level,D-dimer in the lobar pneumonia group of the modeling group were higher than those in the non-lobar pneumonia group(P<0.05).Among them,the duration of fever(10.10±2.72 vs.6.36±1.91),the use time of macrolides(5.20±1.59 vs.3.50±1.02),CRP(35.46±9.73 vs.13.92±4.06),and D-dimer(0.69 vs.0.44)were higher.Logistic analysis showed that duration of fever,duration of macrolide use,CRP and D-dimer were risk factors for lobar pneumonia changes in children with MPP(P<0.05).Based on the risk fac-tors,a nomogram model was established with R software,the area under the ROC curve of the modeling group was 0.94[95%CI:(0.90,0.98)],and the area under the ROC curve of the validation group was 0.95[95%CI:(0.92,0.98)].The Hosmer-Lemeshow goodness of fit test of the

关 键 词：肺炎支原体肺炎 大环内酯类 大叶性肺炎 危险因素 预测模型 儿童 

分 类 号：R725.6[医药卫生—儿科]