难治性肺炎支原体肺炎患儿合并栓塞的危险因素分析及列线图预测模型的构建

谢利娜; 冯特; 郭燕军; 张玉会; 李远哲; 张万存

doi:10.7499/j.issn.1008-8830.2311146

PDF(736 KB)

HTML

中国当代儿科杂志 ›› 2024, Vol. 26 ›› Issue (5) : 486-492. DOI: 10.7499/j.issn.1008-8830.2311146

论著·临床研究

难治性肺炎支原体肺炎患儿合并栓塞的危险因素分析及列线图预测模型的构建

谢利娜, 冯特, 郭燕军, 张玉会, 李远哲, 张万存

作者信息 +

Risk factors for embolism in children with refractory Mycoplasma pneumoniae pneumonia and construction of a nomogram model for prediction of embolism

XIE Li-Na, FENG Te, GUO Yan-Jun, ZHANG Yu-Hui, LI Yuan-Zhe, ZHANG Wan-Cun

Author information +

文章历史 +

摘要

目的分析难治性肺炎支原体肺炎（refractory Mycoplasma pneumoniae pneumonia, RMPP）患儿合并栓塞的危险因素，并构建列线图预测模型。方法回顾性纳入2019年1月—2023年10月在郑州大学附属儿童医院确诊为RMPP的175例患儿，根据是否合并栓塞，分为栓塞组（n=62）和非栓塞组（n=113），采用多因素logistic回归分析筛选RMPP患儿合并栓塞的危险因素，并应用R软件构建列线图预测模型。结果多因素logistic回归分析显示，高D-二聚体、高白细胞介素-6、高中性粒细胞与淋巴细胞比值、肺坏死、胸腔积液是RMPP合并栓塞的危险因素（P<0.05）。根据上述危险因素构建列线图模型的曲线下面积为0.912（95%CI：0.871~0.952，P<0.05）。Hosmer-Lemeshow拟合优度检验结果表明，该模型与实际情况拟合较好（P<0.05）。校准曲线和决策曲线结果显示，该模型的预测效能和临床应用价值较高。结论高D-二聚体、高白细胞介素-6、高中性粒细胞与淋巴细胞比值、肺坏死、胸腔积液是RMPP合并栓塞的危险因素，根据上述危险因素构建列线图模型用于预测RMPP合并栓塞具有较高的临床价值。

Abstract

Objective To study the risk factors for embolism in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and to construct a nomogram model for prediction of embolism. Methods This retrospective study included 175 children diagnosed with RMPP at Children's Hospital Affiliated to Zhengzhou University from January 2019 to October 2023. They were divided into two groups based on the presence of embolism: the embolism group (n=62) and the non-embolism group (n=113). Multivariate logistic regression analysis was used to screen for risk factors of embolism in children with RMPP, and the R software was applied to construct the nomogram model for prediction of embolism. Results Multivariate logistic regression analysis indicated that higher levels of D-dimer, interleukin-6 (IL-6) and neutrophil to lymphocyte ratio (NLR), lung necrosis, and pleural effusion were risk factors for embolism in children with RMPP (P<0.05). The area under the curve of the nomogram model for prediction of embolism constructed based on the aforementioned risk factors was 0.912 (95%CI: 0.871-0.952, P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good fit with the actual situation (P<0.05). Calibration and decision curve analysis indicated that the model had high predictive efficacy and clinical applicability. Conclusions Higher levels of D-dimer, IL-6 and NLR, lung necrosis, and pleural effusion are risk factors for embolism in children with RMPP. The nomogram model based on these risk factors has high clinical value for predicting embolism in children with RMPP.

导出引用

谢利娜, 冯特, 郭燕军, 张玉会, 李远哲, 张万存. 难治性肺炎支原体肺炎患儿合并栓塞的危险因素分析及列线图预测模型的构建[J]. 中国当代儿科杂志. 2024, 26(5): 486-492 https://doi.org/10.7499/j.issn.1008-8830.2311146

XIE Li-Na, FENG Te, GUO Yan-Jun, ZHANG Yu-Hui, LI Yuan-Zhe, ZHANG Wan-Cun. Risk factors for embolism in children with refractory Mycoplasma pneumoniae pneumonia and construction of a nomogram model for prediction of embolism[J]. Chinese Journal of Contemporary Pediatrics. 2024, 26(5): 486-492 https://doi.org/10.7499/j.issn.1008-8830.2311146

参考文献

1 Fu Y, Zhang TQ, Dong CJ, et al. Clinical characteristics of 14 pediatric Mycoplasma pneumoniae pneumonia associated thrombosis: a retrospective study[J]. BMC Cardiovasc Disord, 2023, 23(1): 1. PMID: 36600223. PMCID: PMC9811738. DOI: 10.1186/s12872-022-03030-9.
2 Li M, Wei X, Zhang SS, et al. Recognition of refractory Mycoplasma pneumoniae pneumonia among Myocoplasma pneumoniae pneumonia in hospitalized children: development and validation of a predictive nomogram model[J]. BMC Pulm Med, 2023, 23(1): 383. PMID: 37817172. PMCID: PMC10566172. DOI: 10.1186/s12890-023-02684-1.
3 马瑞, 裴亮. 儿童难治性肺炎支原体肺炎早期临床预测因素[J]. 中国医科大学学报, 2023, 52(11): 1015-1017. DOI: 10.12007/j.issn.0258-4646.2023.11.010.
4 Chilet F, Iqbal AM, Mitzov N, et al. Acute saddle pulmonary embolism: a rare complication of Mycoplasma pneumonia[J]. Respir Med Case Rep, 2020, 30: 101033. PMID: 32368484. PMCID: PMC7190873. DOI: 10.1016/j.rmcr.2020.101033.
5 Sheng CQ, Yang CF, Ao Y, et al. Mycoplasma pneumoniae pneumonia with pulmonary embolism: a study on pediatric cases in Jilin province of China[J]. Exp Ther Med, 2021, 21(3): 201. PMID: 33574906. PMCID: PMC7818525. DOI: 10.3892/etm.2021.9634.
6 赵顺英, 陈志敏, 刘瀚旻, 等. 国家卫生健康委员会《儿童肺炎支原体肺炎诊治指南（2023年版）》重点解读[J]. 临床儿科杂志, 2023, 41(3): 224-228. DOI: 10.12372/jcp.2023.22e0475.
7 Zhu Z, Zhang T, Guo W, et al. Clinical characteristics of refractory Mycoplasma pneumoniae pneumonia in children treated with glucocorticoid pulse therapy[J]. BMC Infect Dis, 2021, 21(1): 126. PMID: 33509121. PMCID: PMC7844890. DOI: 10.1186/s12879-021-05830-4.
8 Chen S, Ding Y, Vinturache A, et al. Pulmonary embolism associated with Mycoplasma in a child[J]. Lancet Infect Dis, 2020, 20(11): 1347. PMID: 33098782. DOI: 10.1016/S1473-3099(20)30253-X.
9 van Es N, Kraaijpoel N, Klok FA, et al. The original and simplified Wells rules and age-adjusted D-dimer testing to rule out pulmonary embolism: an individual patient data meta-analysis[J]. J Thromb Haemost, 2017, 15(4): 678-684. PMID: 28106338. DOI: 10.1111/jth.13630.
10 Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19[J]. J Thromb Haemost, 2020, 18(6): 1324-1329. PMID: 32306492. PMCID: PMC7264730. DOI: 10.1111/jth.14859.
11 Wen J, Su Y, Sun H, et al. The combination of initial markers to predict refractory Mycoplasma pneumoniae pneumonia in Chinese children: a case control study[J]. Respir Res, 2021, 22(1): 89. PMID: 33752670. PMCID: PMC7983087. DOI: 10.1186/s12931-020-01577-9.
12 Mirijello A, La Marca A, D'Errico MM, et al. Venous thromboembolism during Mycoplasma pneumoniae infection: case report and review of the literature[J]. Eur Rev Med Pharmacol Sci, 2020, 24(19): 10061-10068. PMID: 33090413.DOI: 10.26355/eurrev_202010_23223.
13 张炯, 王利华, 余晓凡, 等. 氨基末端B型利钠肽前体与D-二聚体和肌钙蛋白I在急性肺栓塞患者中的应用价值[J]. 中国临床保健杂志, 2021, 24(1): 129-132. DOI: 10.3969/J.issn.1672-6790.2021.01.033.
14 余国雄, 伍丹丹. 肺栓塞患者预后不良的影响因素及其风险预测列线图模型构建[J]. 实用心脑肺血管病杂志, 2023, 31(11): 45-49. DOI: 10.12114/j.issn.1008-5971.2023.00.289.
15 Liu J, He R, Wu R, et al. Mycoplasma pneumoniae pneumonia associated thrombosis at Beijing children's hospital[J]. BMC Infect Dis, 2020, 20(1): 51. PMID: 31948402. PMCID: PMC6966865. DOI: 10.1186/s12879-020-4774-9.
16 Han C, Zhang T, Zheng J, et al. Analysis of the risk factors and clinical features of Mycoplasma pneumoniae pneumonia with embolism in children: a retrospective study[J]. Ital J Pediatr, 2022, 48(1): 153. PMID: 35987653. PMCID: PMC9391649. DOI: 10.1186/s13052-022-01344-0.
17 Huang X, Li D, Liu F, et al. Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia[J]. BMC Infect Dis, 2021, 21(1): 14. PMID: 33407216. PMCID: PMC7787414. DOI: 10.1186/s12879-020-05700-5.
18 Xing H, Liu X, Li A, et al. Increased peripheral TFH cells and serum interleukin-21 in childhood Mycoplasma pneumoniae pneumonia[J]. J Coll Physicians Surg Pak, 2021, 30(5): 605-607. PMID: 34027881. DOI: 10.29271/jcpsp.2021.05.605.
19 蔡辰, 胡培培, 陆敏, 等. 肺泡灌洗液中细胞因子及细胞学水平与重症肺炎支原体肺炎的相关性[J]. 中华实用儿科临床杂志, 2020, 35(18): 1421-1424. DOI: 10.3760/cma.j.cn101070-20190621-00558.
20 Gong H, Sun B, Chen Y, et al. The risk factors of children acquiring refractory Mycoplasma pneumoniae pneumonia: a meta-analysis[J]. Medicine (Baltimore), 2021, 100(11): e24894. PMID: 33725960. PMCID: PMC7982158. DOI: 10.1097/MD.0000000000024894.
21 朱晓晨, 付迎新, 赵淑青, 等. 血清D-二聚体、IL-6、IL-18对儿童难治性肺炎支原体肺炎的预测价值[J]. 临床与病理杂志, 2022, 42(2): 376-381. DOI: 10.3978/j.issn.2095-6959.2022.02.018.
22 付彬彬, 钟兰兰, 叶婷婷, 等. Autotaxin对儿童难治性肺炎支原体肺炎的预测价值及其与炎性细胞因子的相关性[J]. 中国当代儿科杂志, 2022, 24(7): 765-770. PMID: 35894191. PMCID: PMC9336629. DOI: 10.7499/j.issn.1008-8830.2203030.
23 Zhang Y, Zhang Z, Wei R, et al. IL (interleukin)-6 contributes to deep vein thrombosis and is negatively regulated by miR-338-5p[J]. Arterioscler Thromb Vasc Biol, 2020, 40(2): 323-334. PMID: 31852218. PMCID: PMC6975520. DOI: 10.1161/ATVBAHA.119.313137.
24 Zhou X, Cheng Z, Hu Y. COVID-19 and venous thromboembolism: from pathological mechanisms to clinical management[J]. J Pers Med, 2021, 11(12): 1328. PMID: 34945800. PMCID: PMC8706381. DOI: 10.3390/jpm11121328.
25 Mucha SR, Dugar S, McCrae K, et al. Coagulopathy in COVID-19: manifestations and management[J]. Cleve Clin J Med, 2020, 87(8): 461-468. PMID: 32409435. DOI: 10.3949/ccjm.87a.ccc024.
26 Song M, Graubard BI, Rabkin CS, et al. Neutrophil-to-lymphocyte ratio and mortality in the United States general population[J]. Sci Rep, 2021, 11(1): 464. PMID: 33431958. PMCID: PMC7801737. DOI: 10.1038/s41598-020-79431-7.
27 Sharma DJ Sr, Nath HJ, Batta A, et al. Neutrophil-to-lymphocyte ratio (NLR) useful as a cost-effective preliminary prognostic marker in ST-elevation myocardial infarction (STEMI): an observational study from a tertiary care hospital in Northeast India[J]. Cureus, 2023, 15(3): e36885. PMID: 37128536. PMCID: PMC10147565. DOI: 10.7759/cureus.36885.
28 Dr?goescu AN, P?dureanu V, St?nculescu AD, et al. Neutrophil to lymphocyte ratio (NLR): a useful tool for the prognosis of sepsis in the ICU[J]. Biomedicines, 2021, 10(1): 75. PMID: 35052755. PMCID: PMC8772781. DOI: 10.3390/biomedicines10010075.
29 Buonacera A, Stancanelli B, Colaci M, et al. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases[J]. Int J Mol Sci, 2022, 23(7): 3636. PMID: 35408994. PMCID: PMC8998851. DOI: 10.3390/ijms23073636.
30 Ling Y, Ning J, Xu Y. Explore the predictive value of peripheral blood cell parameters in refractory Mycoplasma pneumoniae pneumonia in children over 6 years old[J]. Front Pediatr, 2021, 9: 659677. PMID: 34869089. PMCID: PMC8633951. DOI: 10.3389/fped.2021.659677.
31 Mareev VY, Orlova YA, Pavlikova EP, et al. Steroid pulse -therapy in patients With coronAvirus Pneumonia (COVID-19), sYstemic inFlammation And Risk of vEnous thRombosis and thromboembolism (WAYFARER Study)[J]. Kardiologiia, 2020, 60(6): 15-29. PMID: 32720612. DOI: 10.18087/cardio.2020.6.n1226.