重症支原体肺炎后闭塞性细支气管炎的危险因素及预测模型建立  

Risk factors and prediction models for bronchiolitis obliterans after severe mycoplasma pneumoniae pneumonia

作　　者：严秋丽 施金金 钮文思 张方园 陈颖青 张媛媛 李刚 YAN Qiuli;SHI Jinjin;NIU Wensi;ZHANG Fangyuan;CHEN Yingqing;ZHANG Yuanyuan;LI Gang(Department of Pediatrics,Wujiang District Children′s Hospital,Suzhou,Jiangsu 215200,China;Department of Laboratory Medicine,Wujiang District Children′s Hospital,Suzhou,Jiangsu 215200,China;Department of Pediatrics,The Fourth People′s Hospital of Wujiang District,Suzhou,Jiangsu 215231,China)

机构地区：[1]苏州市吴江区儿童医院儿内科,江苏苏州215200 [2]苏州市吴江区儿童医院检验科,江苏苏州215200 [3]苏州市吴江区第四人民医院儿科,江苏苏州215231

出　　处：《临床肺科杂志》2025年第3期329-336,共8页Journal of Clinical Pulmonary Medicine

基　　金：江苏省苏州市卫生青年骨干人才“全国导师制”培训计划(Qngg2023059);苏州市医学重点扶持学科项目(SZFCXK202134);苏州市吴江区“科教兴卫”(WWK202111)。

摘　　要：目的分析重症支原体肺炎(SMPP)患儿感染后闭塞性细支气管炎(PIBO)发生的相关危险因素,建立并验证列线图模型。方法选取我院2022年6月至2023年12月住院的200例SMPP患儿,根据是否进展为PIBO,分为PIBO组和非PIBO组。采用LASSO回归分析、Logistics多因素回归模型筛选PIBO的影响因素,建立PIBO风险列线图预测模型,采用ROC曲线评价模型区分度。结果单因素分析显示:特应性体质、住院时间、发热、热程、低氧血症、乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、中性粒细胞(NEU)%、肺实变、腺病毒感染、粘液栓、病程7d内使用大环内酯类抗生素、病程2w内使用糖皮质激素是PIBO的影响因素(P<0.05)。多因素logistics回归分析发现:热程(OR=1.572,95%CI=1.227~2.015)、LDH(OR=1.014,95%CI=1.006~1.023)、合并腺病毒感染(OR=8.051,95%CI=1.097~59.055)、黏液栓(OR=8.088,95%CI=1.280~51.099)、病程2w内使用糖皮质激素(OR=0.087,95%CI=0.014~0.549)为PIBO的独立影响因素(P<0.05)。构建列线图模型,ROC曲线下面积为0.973(95%CI=0.94~1.00),通过DCA曲线,模型展现了比“全治疗”或“无治疗”策略更优的净获益。结论热程长、高水平的LDH、黏液栓、合并腺病毒感染、是否2w内使用糖皮质激素可较准确的预测儿童SMPP后PIBO发生风险,基于上述影响因素建立的列线图预测模型具有良好的区分度与准确度,可为预防PIBO的发生提供一定参考价值。Objective To analyze the risk factors of post infectious bronchiolitis obliterans(PIBO)in children after severe Mycoplasma pneumoniae pneumonia(SMPP),and to establish and verify the nomogram model.Methods A total of 200 children with SMPP hospitalized in our hospital from June 2022 to December 2023.According to the progression to PIBO,they were divided into PIBO and non-PIBO groups.LASSO regression analysis and logistic multifactor regression model were used to screen the influencing factors of PIBO,and a nomogram model for PIBO risk prediction was established.The discrimination of the model was evaluated by ROC curve.Results Univariate analysis showed that atopic constitution,length of stay,fever,fever duration,hypoxemia,LDH,CRP,NEU%,lung consolidation,adenovirus infection,mucous plug,use of macrolide antibiotics within 7 days of illness,and use of glucocorticoids within two weeks of the disease course were influencing factors of PIBO(P<0.05).Multivariate logistic regression analysis revealed that fever duration(OR=1.572,95%CI=1.227~2.015),LDH levels(OR=1.014,95%CI=1.006~1.023),co-infection with adenovirus(OR=8.051,95%CI=1.097~59.055),mucous plug(OR=8.088,95%CI=1.28~51.099),and the use of glucocorticoids within two weeks of the disease course(OR=0.087,95%CI=0.014~0.549)were independent factors affecting the development of PIBO(P<0.05).A nomogram model was constructed,with the area under the ROC curve was 0.973(95%CI=0.94~1.00).According to the DCA,the model demonstrated a net benefit superior to both“full treatment”and“no treatment”strategies.Conclusion Long fever duration,high levels of LDH,mucous plug,co-infection with adenovirus,and the use of glucocorticoids within two weeks of the disease course can accurately predict the risk of PIBO after SMPP in children.The nomogram prediction model established based on the above factors has good discrimination and accuracy and can provide reference value for the prevention of PIBO.

关 键 词：感染后闭塞性细支气管炎 重症支原体肺炎 腺病毒 危险因素 列线图 

分 类 号：R72[医药卫生—儿科]