EB病毒传染性单核细胞增多症合并肺炎支原体感染的预测模型建立  

Establishment of a predictive model for Epstein-Barr virus infectious mononucleosis combined with Mycoplasma pneumoniae infection

作　　者：郑桂凤 吴琼 董小婉 诸白美 ZHENG Guifeng;WU Qiong;DONG Xiaowan;ZHU Baimei(Department of Emergency Medicine,Nanjing Children’s Hospital,Nanjing Medical University,Nanjing Jiangsu 210003,China)

机构地区：[1]南京医科大学附属儿童医院急诊科,江苏南京210003

出　　处：《中国急救复苏与灾害医学杂志》2025年第4期507-511,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省自然科学基金面上项目(BK2021121203)。

摘　　要：目的 构建EB病毒传染性单核细胞增多症患者合并肺炎支原体感染的预测模型。方法 回顾性分析2020年2月—2024年2月,南京医科大学附属儿童医院287例确诊为EB病毒传染性单核细胞增多症患儿的临床数据。通过收集患者的临床表现、实验室检查结果及合并肺炎支原体感染的情况,使用多因素Logistic回归分析确定合并肺炎支原体感染的独立预测因素,并构建预测模型。模型的准确性通过受试者操作特征(ROC)曲线分析进行评估。结果 287例患儿中,95例(33.10%)合并肺炎支原体感染。合并感染组患者的年龄较低,病程更短,发热和高热的比例显著高于未合并感染组,且热程更长(均P<0.05)。临床表现方面,合并感染组在胸腔积液、抽搐、肺外和胃肠表现等方面的比例显著高于未合并感染组,而在皮疹和季节性检测上差异无统计学意义(均P>0.05)。合并感染组的C反应蛋白、白细胞计数、单核细胞比例及血小板分布宽度显著增高,嗜酸性粒细胞(EOS)比例及血小板计数降低(均P<0.05)。多因素分析结果显示,病程(OR=0.093,95%CI:0.021~0.402)、高热(OR=2.655,95%CI:1.123~6.278)、胸腔积液(OR=2.918,95%CI:1.249~6.817)、夜咳评分(OR=4.023,95%CI:1.252~12.931)、丙氨酸氨基转移酶(ALT)(OR=8.411,95%CI:2.685~26.343)、EOS(OR=0.095,95%CI:0.020~0.458)、单核细胞比例(OR=3.858,95%CI:1.146~12.991)、血小板分布宽度(OR=13.332,95%CI:1.993~89.197)是肺炎支原体感染的风险因子,通过列线图和ROC曲线构建和验证的预测模型显示,模型的灵敏度和特异度极高,曲线下面积(AUC)值为0.982,表明模型具有优良的预测性能和校准度。结论 构建的预测模型可以有效预测EB病毒传染性单核细胞增多症患者合并肺炎支原体感染的风险,有助于临床医生在早期诊断和选择适当的治疗方案方面做出更准确的决策。Objective To establish a predictive model for determining the presence of mycoplasma pneumonia infection in patients with Epstein-Barr virus(EBV)virus infectious mononucleosis.Methods A retrospective analysis was conducted on the clinical data of 287 children diagnosed with EBV infectious mononucleosis from February 2020 to February 2024 at Nanjing Medical University Affiliated Children's Hospital.Data on clinical symptoms,laboratory findings,and instances of co-infection with Mycoplasma pneumonia were collected.Multivariate Logistic regression analysis was used to identify independent predictors of Mycoplasma pneumonia co-infection,leading to the development of a predictive model.The efficacy of the model was evaluated through receiver operating characteristic(ROC) curve analysis.Results Of the 287 children,95(33.10%) were complicated with Mycoplasma pneumoniae infection.Patients in the coinfected group had lower age,shorter disease duration,significantly higher proportions of fever and high fever than in the uncoinfected group,and a longer heat course(allP<0.05).Clinical manifestations,the coinfected group had a significantly higher proportion of pleural effusion,convulsions,extrapulmonary and gastrointestinal manifestations than the uncoinfected group,however,there was no significant difference in rash and seasonality(allP>0.05).The C-reactive protein,WBC count,monocyte proportion,and platelet distribution width were significantly higher in the co-infected group,eosinphils(EOS)and platelet count were decreased(allP<0.05).The results of the multivariate analysis showed that,disease course(OR=0.093,95%CI:0.021-0.402),high fever(OR=2.655,95%CI:1.123-6.278),pleural effusion(OR=2.918,95%CI:1.249-6.817),night cough score(OR=4.023,95%CI:1.252-12.931),alanine aminotransferase(ALT)(OR=8.411,95%CI:2.685-26.343),EOS(OR=0.095,95%CI:0.020-0.458),proportion of monocytes(OR= 3.858,95%CI:1.146-12.991),platelet distribution width(OR=13.332,95%CI:1.993-89.197) are the risk factors for Mycoplasma pneumoniae infection,predictive

关 键 词：EB病毒传染性单核细胞增多症 肺炎支原体感染 儿童 预测模型 因素 

分 类 号：R725.6[医药卫生—儿科]