CALLY指数联合NLR对儿童难治性肺炎支原体肺炎及机械通气的预测价值  

Predictive value of CALLY index combined with NLR for refractory Mycoplasma pneumoniae pneumonia and mechanical ventilation in children

作　　者：朱宇新 杨立 ZHU Yuxin;YANG Li(Department of Pediatrics,Tongzhou Maternal and Child Health Care Hospital of Beijing,Beijing 101100,China)

机构地区：[1]北京市通州区妇幼保健院儿科,北京101100

出　　处：《中国临床新医学》2025年第3期298-302,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：首都卫生发展科研专项常规项目(编号:ZD202172)。

摘　　要：目的探讨C反应蛋白-白蛋白-淋巴细胞(CALLY)指数联合中性粒细胞/淋巴细胞比值(NLR)对儿童难治性肺炎支原体肺炎(RMPP)及机械通气的预测价值。方法选择2023年1月至2024年6月在北京市通州区妇幼保健院儿科住院治疗的236例肺炎支原体肺炎患儿。根据RMPP发生情况将患儿分为RMPP组(82例)和非RMPP组(154例)。根据治疗过程中是否需要机械通气将患儿分为机械通气组(43例)和非机械通气组(193例)。采用多因素logistic回归分析RMPP发生的影响因素。通过受试者工作特征(ROC)曲线分析CALLY指数、NLR及两者联合对RMPP及机械通气的预测价值。结果RMPP组年龄大于非RMPP组,C反应蛋白、降钙素原、乳酸脱氢酶、白细胞计数、中性粒细胞计数、NLR高于非RMPP组,住院时间长于非RMPP组,白蛋白、淋巴细胞计数、CALLY指数低于非RMPP组,差异有统计学意义(P<0.05)。两组抗生素使用情况、机械通气率、治疗效果比较差异有统计学意义(P<0.05)。较大的年龄以及较高的NLR、乳酸脱氢酶、降钙素原水平是RMPP发生的独立危险因素(P<0.05),较高的CALLY指数是RMPP发生的独立保护因素(P<0.05)。CALLY指数、NLR均有助于预测RMPP(P<0.05),且两者联合的预测效能[AUC(95%CI)=0.927(0.886~0.957)]较单一指标更高(P<0.05),灵敏度为79.32%,特异度为92.91%。机械通气组NLR高于非机械通气组,CALLY指数低于非机械通气组,差异有统计学意义(P<0.05)。CALLY指数、NLR均有助于预测机械通气(P<0.05),且两者联合的预测效能[AUC(95%CI)=0.828(0.774~0.874)]较单一指标更高(P<0.05),灵敏度为83.71%,特异度为77.68%。结论CALLY指数联合NLR可作为预测儿童RMPP及机械通气的有效指标,两者联合检测有助于早期识别高危患儿,指导临床决策,改善预后。Objective To explore the predictive value of C-reactive protein-albumin-lymphocyte(CALLY)index combined with neutrophil-to-lymphocyte ratio(NLR)for refractory Mycoplasma pneumoniae pneumonia(RMPP)and mechanical ventilation in children.Methods A total of 236 pediatric patients with Mycoplasma pneumoniae pneumonia(MPP)who were hospitalized and treated in Department of Pediatrics,Tongzhou Maternal and Child Health Care Hospital of Beijing from January 2023 to June 2024 were selected.According to the occurrence of RMPP,the pediatric patients were divided into RMPP group(82 cases)and non-RMPP group(154 cases).The pediatric patients were divided into mechanical ventilation group(43 cases)and non-mechanical ventilation group(193 cases)according to whether mechanical ventilation was required for them during treatment.Multivariate logistic regression was used to analyze the influencing factors of RMPP.The value of CALLY index,NLR and their combination in predicting RMPP and mechanical ventilation was analyzed by using receiver operating characteristic(ROC)curve.Results The patients of the RMPP group were older than those of the non-RMPP group,and the levels of C-reactive protein,procalcitonin,lactate dehydrogenase,white blood cell count,neutrophil count and NLR in the RMPP group were higher than those in the non-RMPP group.The hospitalization time of the RMPP group was longer than that of the non-RMPP group,and the levels of albumin,lymphocyte count and CALLY index in the RMPP group were lower than those in the non-RMPP group.The above differences were statistically significant between the two groups(P<0.05).There were significant differences in antibiotic use,mechanical ventilation rate and treatment effect between the two groups(P<0.05).Older age and higher levels of NLR,lactate dehydrogenase and procalcitonin were independent risk factors for the occurrence of RMPP(P<0.05),and higher CALLY index was independent protective factor for the occurrence of RMPP(P<0.05).Both CALLY index and NLR were helpful in predicting RMPP

关 键 词：难治性肺炎支原体肺炎 C反应蛋白-白蛋白-淋巴细胞指数 中性粒细胞/淋巴细胞比值 机械通气 儿童 

分 类 号：R725.6[医药卫生—儿科]