儿童腺病毒肺炎危重症早期识别量表的建立与验证  

Establishment and verification of early identification scale for critically ill children with adenovirus pneumonia

作　　者：夏明农 程云 李文博 张帆 张子轩[2] XIA Mingnong;CHENG Yun;LI Wenbo;ZHANG Fan;ZHANG Zixuan(Lu'an Hospital Affiliated to Anhui Medical University(People's Hospital of Lu'an),Lu'an,Anhui 237000,China;Anhui West Health Vocational College,Lu'an,Anhui 237000,China)

机构地区：[1]安徽医科大学附属六安医院(六安市人民医院),安徽六安237000 [2]皖西卫生职业学院,安徽六安237000

出　　处：《国际检验医学杂志》2025年第7期845-849,共5页International Journal of Laboratory Medicine

基　　金：安徽高校自然科学研究重点项目(KJ2021A1369)。

摘　　要：目的 探究儿童腺病毒肺炎危重症的临床特征、实验室检查指标及辅助检查结果,筛选对腺病毒肺炎危重症患儿具有预警作用的相关指标,以此构建儿童腺病毒肺炎危重症早期识别量表。方法 回顾性分析2021年5月至2023年9月该院收治的86例重症腺病毒肺炎患儿的临床资料,采用多因素Logistic回归分析筛选早期识别危重症儿童腺病毒肺炎的候选指标,采用受试者工作特征(ROC)曲线分析灵敏度及特异度;经专家对各因素进行权重分值量化评议,最终形成儿童腺病毒肺炎危重症的早期识别量表。结果 86例重症腺病毒肺炎患儿中,腺病毒肺炎危重症患儿有34例。危重症组呼吸困难、呼吸衰竭、意识行为障碍、呼吸系统症状、心血管系统症状、神经系统症状发生率均高于重症组(P<0.05)。重症组和危重症组白细胞计数、血小板计数、红细胞动态沉降率、血清铁蛋白、血清铁蛋白/红细胞动态沉降率、R-谷氨酰基转移酶、丙氨酸氨基转移酶、乳酸脱氢酶比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,白细胞计数、血小板计数、丙氨酸氨基转移酶、血清铁蛋白/红细胞动态沉降率及乳酸脱氢酶均是重症腺病毒肺患儿进展为危重症的影响因素(P<0.05),而ROC曲线结果显示,白细胞计数、血小板计数、丙氨酸氨基转移酶、血清铁蛋白/红细胞动态沉降率及乳酸脱氢酶组成的诊断模型诊断危重症的曲线下面积为0.864,灵敏度和特异度分别为86.42%和82.76%。经25位同行专家对各项临床表现及检查项目进行权重分值量化评议最终形成儿童腺病毒肺炎危重症的早期识别量表。结论 临床治疗期间可根据腺病毒肺炎患儿的临床表现并结合相关辅助检查结果,利用早期识别量表判断腺病毒肺炎患儿是否有进展为危重症的风险。Objective To explore the clinical characteristics,laboratory examination indicators,and auxiliary examination results of critically ill children with adenovirus pneumonia,screen relevant indicators with warning effects for critically ill children with adenovirus pneumonia,and construct an early identification scale for critically ill children with adenovirus pneumonia.Methods The clinical data of totally 86 children with adenovirus pneumonia admitted in the hospital from May 2021 to September 2023 were retrospectively analyzed,and multivariate Logistic regression analysis was used to screen relevant indicators for the early identification of severe adenovirus pneumonia in children.The sensitivity and the specificity were analyzed using the receiver operating characteristic(ROC) curve.Experts conducted a quantitative evaluation of the weight scores of each factor,and finally an early identification scale for critically ill children with adenovirus pneumonia was developed.Results Among 86 children with severe adenovirus pneumonia,34 were critically ill with adenovirus pneumonia.There were statistically significant differences in the incidence of respiratory distress,respiratory distress,consciousness and behavior disorders,respiratory symptoms,cardiovascular symptoms,and neurological symptoms between the two groups(P<0.05).The differences of white blood cell count,platelet count,erythrocyte dynamic sedimentation rate,serum ferritin,serum ferritin/erythrocyte dynamic sedimentation rate,R-glutamyltransferase,alanine aminotransferase,lactate dehydrogenase between the severe group and the critically ill group were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that white blood cell count,platelet count,alanine aminotransferase,serum ferritin/erythrocyte dynamic sedimentation rate and lactate dehydrogenase were all influencing factors for the progression to critical illness in children with adenovirus pneumonia(P<0.05),and the ROC curve results showed that the area under the curve of

关 键 词：腺病毒肺炎 危重症 早期识别量表 

分 类 号：R563.1[医药卫生—呼吸系统]