目的 探究难治性肺炎支原体肺炎（refractory Mycoplasma pneumoniae pneumonia, RMPP）患儿闭塞性细支气管炎（bronchiolitis obliterans, BO）发生的影响因素及其预测价值。 方法 回顾性分析2020年5月—2024年3月间收治的156例RMPP患儿的病历资料，根据BO诊断标准将RMPP患儿分成BO组（76例）和非BO组（80例）。采用logistic回归模型进行影响因素分析，采用ROC曲线评价模型对BO的预测价值。 结果 与非BO组比较，BO组RMPP患儿热程长，白细胞计数高，白蛋白水平低（P<0.05）。BO组RMPP患儿大环内酯类抗生素治疗开始时间<5 d比例、糖皮质激素治疗开始时间<2周比例、支气管镜检查治疗开始时间<2周比例低于非BO组（P<0.05）。ROC曲线分析结果显示，由上述6个指标构建的logistic回归模型预测BO发生的曲线下面积为0.901（P<0.001，95%CI：0.849~0.953），当预测概率取最佳截断值0.341时，模型预测的灵敏度为0.893，特异度为0.827。 结论 由热程、白细胞计数、白蛋白、大环内酯类抗生素治疗开始时间<5 d、糖皮质激素治疗开始时间<2周、支气管镜检查治疗开始时间<2周等因素构建的logistic回归模型预测RMPP患儿发生BO的灵敏度和特异度均较高。
Abstract
Objective To investigate the risk factors for the occurrence of bronchiolitis obliterans (BO) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and their predictive value of the factors. Methods A retrospective analysis was performed for the medical records of 156 children with RMPP who were admitted to the hospital from May 2020 to March 2024. According to the diagnostic criteria for BO, they were divided into a BO group (n=76) and a non-BO group (n=80). A logistic regression analysis was used to investigate risk factors for the occurrence of BO, and the receiver operating characteristic (ROC) curve was used to assess the value of the model established based on the risk factors in predicting BO. Results Compared with the non-BO group, the BO group had a significantly longer duration of fever, a significantly higher leukocyte count, and a significantly lower albumin level (P<0.05). Compared with the non-BO group, the BO group had a significantly lower proportion of children with initiation of macrolide antibiotic therapy within 5 days, initiation of glucocorticoid therapy within 2 weeks, or initiation of bronchoscopic therapy within <2 weeks (P<0.05). The ROC curve analysis showed that the logistic regression model established based on the above six indicators had an area under the curve of 0.901 (95%CI: 0.849-0.953, P<0.001) in predicting the occurrence of BO, with a sensitivity of 0.893 and a specificity of 0.827 at the optimal cut-off value of 0.341. Conclusions The logistic regression model established based on duration of fever, leukocyte count, albumin, initiation of macrolide antibiotic therapy within 5 days, initiation of glucocorticoid therapy within 2 weeks, and initiation of bronchoscopic therapy within 2 weeks has relatively high sensitivity and specificity in predicting the occurrence of BO in children with RMPP.
关键词
难治性肺炎支原体肺炎 /
闭塞性细支气管炎 /
影响因素 /
预测价值 /
儿童
Key words
Refractory Mycoplasma pneumoniae pneumonia /
Bronchiolitis obliterans /
Risk factor /
Predictive value /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Ha EK, Jin JO, Kim JH, et al. Age-related effects of Mycoplasma pneumoniae infection and subsequent asthma exacerbation in children[J]. Pediatr Pulmonol, 2024, 59(6): 1569-1577. PMID: 38708969. DOI: 10.1002/ppul.26907.
2 Lu W, Wu X, Xu Y, et al. Predictive value of bronchoscopy combined with CT score for refractory Mycoplasma pneumoniae pneumonia in children[J]. BMC Pulm Med, 2024, 24(1): 251. PMID: 38778338. PMCID: PMC11110382. DOI: 10.1186/s12890-024-02996-w.
3 郭晓杰, 刘静, 申秋燕, 等. 山东省潍坊市2016-2019年儿童难治性肺炎支原体肺炎流行病学分析[J]. 中国热带医学, 2020, 20(9): 893-896. DOI: 10.13604/j.cnki.46-1064/r.2020.09.22.
4 Liu H, Song Q, Yi M, et al. Empowering caregivers of children with bronchiolitis obliterans: the effectiveness of an internet-based follow-up platform[J]. Respir Med, 2024, 229: 107673. PMID: 38763447. DOI: 10.1016/j.rmed.2024.107673.
5 中华医学会儿科学分会呼吸学组, 中国医师协会呼吸医师分会儿科呼吸工作委员会, 中国医药教育协会儿科专业委员会, 等. 儿童闭塞性细支气管炎的诊断和治疗专家共识（2023）[J]. 中华儿科杂志, 2023, 61(9): 786-793. PMID: 37650159. DOI: 10.3760/cma.j.cn112140-20230301-00146.
6 Zhang H, Yang J, Zhao W, et al. Clinical features and risk factors of plastic bronchitis caused by refractory Mycoplasma pneumoniae pneumonia in children: a practical nomogram prediction model[J]. Eur J Pediatr, 2023, 182(3): 1239-1249. PMID: 36633659. PMCID: PMC10023623. DOI: 10.1007/s00431-022-04761-9.
7 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.
8 中华人民共和国国家卫生健康委员会. 儿童肺炎支原体肺炎诊疗指南（2023年版）[J]. 国际流行病学传染病学杂志, 2023, 50(2): 79-85. DOI: 10.3760/cma.j.cn331340-20230217-00023.
9 Zhao F, Liu J, Xiao D, et al. Pathogenic analysis of the bronchoalveolar lavage fluid samples with pediatric refractory Mycoplasma pneumoniae pneumonia[J]. Front Cell Infect Microbiol, 2020, 10: 553739. PMID: 33194797. PMCID: PMC7655529. DOI: 10.3389/fcimb.2020.553739.
10 Tong L, Huang S, Zheng C, et al. Refractory Mycoplasma pneumoniae pneumonia in children: early recognition and management[J]. J Clin Med, 2022, 11(10): 2824. PMID: 35628949. PMCID: PMC9144103. DOI: 10.3390/jcm11102824.
11 Yuan H, Tian J, Wen L. Serum interleukin-6 and serum ferritin levels are the independent risk factors for pneumonia in elderly patients[J]. Crit Rev Immunol, 2024, 44(5): 113-122. PMID: 38618733. DOI: 10.1615/CritRevImmunol.2024051340.
12 Yanhong R, Shuai Z, Dan C, et al. Predictive value of lactate dehydrogenase for Mycoplasma pneumoniae necrotizing pneumonia in children based on decision curve analysis and dose: response analysis[J]. Sci Rep, 2024, 14(1): 9803. PMID: 38684810. PMCID: PMC11059402. DOI: 10.1038/s41598-024-60359-1.
13 Yi X, Jia W, Li W, et al. Diagnostic value of cytokines in severe childhood Mycoplasma pneumoniae pneumonia combined with adenovirus infection[J]. Ital J Pediatr, 2024, 50(1): 92. PMID: 38715105. PMCID: PMC11077701. DOI: 10.1186/s13052-024-01661-6.
14 刘建华, 刘金荣, 唐晓蕾, 等. 难治性肺炎支原体肺炎患儿遗留闭塞性支气管炎的预测因素分析[J]. 中华儿科杂志, 2023, 61(4): 317-321. PMID: 37011976. DOI: 10.3760/cma.j.cn112140-20220902-00775.
15 Wang L, Liu L, Cheng S, et al. In vitro and in vivo study of andrographolide nanoparticles for the treatment of Mycoplasma pneumoniae pneumonia[J]. Biochem Biophys Res Commun, 2024, 698: 149540. PMID: 38266313. DOI: 10.1016/j.bbrc.2024.149540.
16 Yang S, Lu S, Guo Y, et al. A comparative study of general and severe Mycoplasma pneumoniae pneumonia in children[J]. BMC Infect Dis, 2024, 24(1): 449. PMID: 38671341. PMCID: PMC11046970. DOI: 10.1186/s12879-024-09340-x.
PDF(586 KB)
