肺炎支原体肺炎患儿并发大叶性肺炎的影响因素分析及列线图预测模型的构建  

Analysis of influencing factors of lobar pneumonia in children with Mycoplasma pneumoniae pneumonia and construction of nomogram prediction model

作　　者：梁俊杰 陈亚宾 LIANG Junjie;CHEN Yabin(Department of Pediatric,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Province,Guangzhou510405,China)

机构地区：[1]广州中医药大学第一附属医院儿科,广东广州510405

出　　处：《中国当代医药》2025年第10期25-29,共5页China Modern Medicine

摘　　要：目的通过对外周血炎症标志物分析,探讨肺炎支原体肺炎(MPP)患儿并发大叶性肺炎的风险因素,并构建MPP患儿并发大叶性肺炎相关的列线图预测模型。方法选取2023年1月至2024年1月广州中医药大学第一附属医院收治的224例MPP患儿作为研究对象,根据是否并发大叶性肺炎分为观察组(108例)和对照组(116例)。比较两组的一般资料与外周血炎症标志物,采用多因素logistic回归模型分析MPP患儿并发大叶性肺炎的影响因素,并使用R软件构建列线图预测模型,绘制ROC曲线评估列线图模型的预测效能,采用Hosmer-Lemeshow拟合优度检验评估列线图模型的拟合程度,并绘制校准曲线和决策曲线评估模型的校准度及临床净获益。结果两组患者的年龄、淋巴细胞计数(LYM)、单核细胞计数(MONO)、中性粒细胞与淋巴细胞比率(NLR)、血小板与淋巴细胞比率(PLR)比较,差异有统计学意义(P<0.05)。多因素logistic回归的分析结果显示,NLR(β=0.53,OR=1.70,95%CI:1.17~2.47)和PLR(β=0.01,OR=1.01,95%CI:1.00~1.01)是MPP患儿并发大叶性肺炎的危险因素,而LYM(β=-0.69,OR=0.50,95%CI:0.32~0.80)是MPP患儿并发大叶性肺炎的保护因素(P<0.05)。将以上3个影响因素作为预测指标构建的列线图预测模型,其曲线下面积为0.793(95%CI:0.735~0.850),灵敏度为62.07%,特异度为84.26%。列线图预测模型的Hosmer-Lemeshow拟合优度检验结果表明,该模型与实际情况拟合较好(χ^(2)=14.523,P=0.069);校准曲线和决策曲线结果表明,该模型具有较高的预测效能和临床应用价值。结论基于MPP患儿并发大叶性肺炎的影响因素LYM、NLR、PLR构建列线图预测模型,能够早期预测MPP患儿并发大叶性肺炎的风险,为临床治疗提供更有力的指导。Objective To explore the risk factors for lobar pneumonia in children with Mycoplasma pneumoniae pneumonia(MPP)by analyzing peripheral blood inflammatory markers,and to construct a nomogram prediction model for MPP children with lobar pneumonia.Methods A total of 224 children with MPP admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2023 to January 2024 were selected as the research objects.According to whether they were complicated with lobar pneumonia,they were divided into observation group(108 cases)and control group(116 cases).The general data and peripheral blood inflammatory markers of the two groups were compared,and the multivariate logistic regression model was used to analyze the influencing factors of MPP children with lobar pneumonia.The R software was used to construct a nomogram prediction model,and the ROC curve was drawn to evaluate the predictive efficacy of the nomogram model.The Hosmer-Lemeshow goodness of fit test was used to evaluate the fit degree of the nomogram model,and the calibration curve and decision curve were drawn to evaluate the calibration degree of the model and the net clinical benefit.Results There were statistically significant differences between the two groups in the age,lymphocyte count(LYM),monocyte count(MONO),neutrophil-lymphocyte ratio(NLR),and platelet-lymphocyte ratio(PLR)(P<0.05).Multivariate logistic regression analysis indicated that NLR(β=0.53,OR=1.70,95%CI:1.17-2.47),PLR(β=0.01,OR=1.01,95%CI:1.00-1.01)were independent risk factors for lobar pneumonia in children with MPP,and LYM(β=-0.69,OR=0.50,95%CI:0.32-0.80)was a protective factor for lobar pneumonia in children with MPP(P<0.05).The above three influencing factors were used as the prediction indexes to construct the risk prediction nomogram model with an area under the curve was 0.793(95%CI:0.735-0.850),the sensitivity was 62.07%,and the specificity was 84.26%.The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good fit with the actual sit

关 键 词：肺炎支原体肺炎 大叶性肺炎 炎症标志物 列线图 预测模型 

分 类 号：R725.6[医药卫生—儿科]