儿童肺炎支原体大叶性肺炎并发塑型性支气管炎的临床特点及预测因素分析  

Clinical features and predictive factors of Mycoplasma pneumoniae lobar pneumonia with plastic bronchitis in children

作　　者：杨洁[1,2] 虎崇康 董蓓君 周欢 王宝西 江逊 肖延风 Yang Jie;Hu Chongkang;Dong Beijun;Zhou Huan;Wang Baoxi;Jiang Xun;Xiao Yanfeng(Department of Pediatrics,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Pediatrics,the Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]西安交通大学第二附属医院儿科,西安710004 [2]空军军医大学第二附属医院(空军军医大学唐都医院)儿科,西安710038

出　　处：《中国小儿急救医学》2025年第4期279-285,共7页Chinese Pediatric Emergency Medicine

摘　　要：目的分析患儿发生肺炎支原体(MP)大叶性肺炎并发塑型性支气管炎(PB)的危险因素,并建立风险列线图预测模型。方法收集2023年4月至2023年12月于空军军医大学第二附属医院儿科住院治疗,诊断MP大叶性肺炎并行支气管镜检查患儿的临床资料。依据支气管镜下表现分为PB组和非PB组,对其临床资料及辅助检查结果进行回顾性分析,应用多因素Logistic回归模型分析MP大叶性肺炎发生PB的独立危险因素。构建PB发生危险度的列线图模型,采用校正曲线及Hosmer-Lemeshow拟合优度检验评估列线图模型对MP大叶性肺炎并发PB的预测价值,并采用受试者工作特征曲线(ROC)进行诊断效能分析。结果共纳入MP大叶性肺炎患儿357例,PB组92例,非PB组265例,两组患儿在性别、年龄方面,差异无统计学意义(P>0.05)。PB组患儿发热持续时间、住院时间较非PB组更长;PB组患儿并发胸腔积液、单个肺叶实变面积≥2/3、肺不张的占比高于非PB组;PB组患儿中性粒细胞/淋巴细胞比值、C-反应蛋白、降钙素原、D-二聚体(D-D)、谷丙转氨酶(ALT)、谷草转氨酶、乳酸脱氢酶、α-羟丁酸脱氢酶、干扰素-γ(IFN-γ)、白细胞介素(IL)-6、IL-10和IFN-γ/IL-4比值水平高于非PB组;差异均有统计学意义(P<0.05)。Logistic回归分析显示,D-D、ALT、IFN-γ升高,胸腔积液、单个肺叶实变面积≥2/3是PB发生的独立危险因素。所构建的列线图预测模型拟合较好(χ^(2)=11.316,P=0.184),列线图预测风险阈值在0.09~0.65时,能提供明显意义的临床净收益。上述因素联合预测MP大叶性肺炎并发PB的曲线下面积为0.771(95%CI 0.716~0.826),敏感度为0.707、特异度为0.706。结论对于MP大叶性肺炎患儿,实验室指标D-D、ALT、IFN-γ升高,结合影像学改变胸腔积液、单个肺叶实变面积≥2/3,是早期诊断PB的重要预测指标,列线图预测模型可用于早期预测MP大叶性肺炎并发PB。Objective To analyze the risk factors of Mycoplasma pneumoniae(MP)lobar pneumonia with plastic bronchitis(PB)in pediatric patients,and to establish a risk nomogram prediction model.Methods The medical informations were collected from pediatric patients diagnosed with MP lobar pneumonia who performed bronchoscopy during hospitalization in the Department of Pediatrics at the Second Affiliated Hospital of Air Force Military Medical University from April 2023 to December 2023.According to the bronchoscopic findings,the patients were divided into PB group and non-PB group.The clinical medical records and ancillary diagnostic findings were retrospectively analyzed.A multivariate Logistic regression model was used to analyze the independent risk factors for children with MP lobar pneumonia complicated with PB.A nomogram model was constructed to predict the risk of PB occurrence.Calibration curves and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the predictive value of the nomogram model for MP lobar pneumonia with PB.The receiver operating characteristic(ROC)curve was used to assess the diagnostic efficacy.Results A total of 357 pediatric patients diagnosed with MP lobar pneumonia were included,with 92 cases in PB group and 265 cases in non-PB group.No statistically significant differences in gender and age were observed between the two groups(P>0.05).The duration of fever and the hospitalization time in PB group were longer than those in non-PB group.The incidences of pleural effusion,consolidation area of a single lung lobe≥2/3 and atelectasis on chest CT were higher in PB group compared to non-PB group.Additionally,the levels of neutrophil/lymphocyte ratio,C-reactive protein,procalcitonin,D-dimer(D-D),alanine aminotransferase(ALT),aspartate aminotransferase,lactate dehydrogenase,α-hydroxybutyrate dehydrogenase,interferon-γ(IFN-γ),interleukin(IL)-6,IL-10 and IFN-γ/IL-4 ratio in PB group were higher than those in non-PB group(all P<0.05).Logistic regression analysis showed elevated D-D,ALT and IFN-�

关 键 词：大叶性肺炎 肺炎支原体 塑型性支气管炎 预测因素 

分 类 号：R725.6[医药卫生—儿科]