目的 探讨难治性肺炎支原体肺炎（refractory Mycoplasma pneumoniae pneumonia, RMPP）患儿并发闭塞性细支气管炎（bronchiolitis obliterans, BO）风险预测模型的建立。 方法 回顾性纳入2021年6月—2023年12月湘雅常德医院儿科收治的116例RMPP患儿为研究对象，按照7∶3的比例，81例分到训练集，35例分到验证集。其中训练集发生BO 26例，未发生BO 55例。采用多因素logistic回归筛选变量构建BO的风险预测模型，并绘制列线图。使用受试者操作特征曲线（receiver operating characteristic curve, ROC曲线）评估预测模型的区分度，采用校准度曲线和Hosmer-Lemeshow检验评估预测模型的校准度。 结果 多因素logistic回归分析显示，住院时间、发热持续时间、肺不张、中性粒细胞百分比（neutrophil percentage, NEUT%）、乳酸脱氢酶（lactate dehydrogenase, LDH）峰值、铁蛋白、C反应蛋白（C reactive protein, CRP）峰值、氧合指数（oxygenation index, PaO₂/FiO₂）、≥2/3肺叶实变、胸腔积液、支气管黏液栓、支气管黏膜坏死、动脉血氧分压（arterial oxygen partial pressure, PaO₂）与RMPP患儿并发BO密切相关（P<0.05）。多因素logistic回归模型预测训练集RMPP患儿并发BO的ROC曲线分析显示曲线下面积为0.904，灵敏度为88%，特异度为83%；验证集RMPP患儿并发BO的ROC曲线分析显示曲线下面积为0.823，灵敏度为76%，特异度为93%。多因素logistic回归模型预测训练集和验证集RMPP患儿并发BO的Hosmer-Lemeshow检验的卡方统计量分别为2.17、1.92，P值分别为0.221、0.196。 结论 基于logistic回归模型构建的RMPP患儿并发BO的风险预测模型具有良好的性能；住院时间、发热持续时间、肺不张、LDH峰值、CRP峰值、NEUT%、铁蛋白、≥2/3肺叶实变、胸腔积液、支气管黏液栓、支气管黏膜坏死、PaO₂/FiO₂、PaO₂等指标可作为预测变量。

Objective To explore the establishment of a risk prediction model for concurrent bronchiolitis obliterans (BO) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods A retrospective study included 116 RMPP children treated in the Department of Pediatrics of Xiangya Changde Hospital from June 2021 to December 2023. Eighty-one cases were allocated to the training set and thirty-five cases to the validation set based on a 7:3 ratio. Among them, 26 cases in the training set developed BO, while 55 did not. The multivariate logistic regression was used to select variable factors for constructing the BO risk prediction model. Nomograms were drawn, and the receiver operating characteristic (ROC) curve was used to assess the discriminative ability of the model, while calibration curves and Hosmer-Lemeshow tests evaluated the model's calibration. Results Multivariate logistic regression analysis indicated that several factors were significantly associated with concurrent BO in RMPP children, including length of hospital stay, duration of fever, atelectasis, neutrophil percentage (NEUT%), peak lactate dehydrogenase (LDH), ferritin, peak C reactive protein (CRP), oxygenation index (PaO₂/FiO₂), ≥2/3 lung lobe consolidation, pleural effusion, bronchial mucous plugs, bronchial mucosal necrosis, and arterial oxygen partial pressure (PaO₂) (P<0.05). ROC curve analysis for the training set indicated an area under the curve of 0.904 with 88% sensitivity and 83% specificity; the validation set showed an area under the curve of 0.823 with 76% sensitivity and 93% specificity. The Hosmer-Lemeshow test's Chi-square values for the training and validation sets were 2.17 and 1.92, respectively, with P values of 0.221 and 0.196, respectively. Conclusions The risk prediction model for BO in RMPP children based on logistic regression has good performance. Variables such as length of hospital stay, duration of fever, atelectasis, peak LDH, peak CRP, NEUT%, ferritin, ≥2/3 lung lobe consolidation, pleural effusion, bronchial mucous plugs, bronchial mucosal necrosis, PaO₂/FiO₂, and PaO₂ can be used as predictors.