重症肺炎合并支原体感染患儿预后情况及影响因素分析^*

Prognostic Outcomes and Influencing Factors in Children With Severe Pneumonia Complicated by Mycoplasma Infection

摘要

目的 探究重症肺炎合并支原体感染患儿血清淀粉样蛋白A、凝血指标水平变化及其与患儿预后的关系。方法 回顾性选取我院于2022年7月-2024年12月儿科收治的300例重症肺炎患儿为研究对象。以患儿是否发生支原体感染为分组依据，将其分为非支原体感染组（n=180）和合并支原体感染组（n=120），根据重症肺炎合并支原体感染患儿预后分为预后良好组（n=85）和预后不良组（n=35），收集所有患儿的一般资料。通过Logistic回归分析确定年龄、血清淀粉样蛋白A（serum amyloid-A, SAA）、纤维蛋白原（fibrinogen, Fib）、肺部超声（lung ultrasound, LUS）评分等是否为影响患儿预后的影响因素，并利用受试者工作特征（ROC）曲线评估其诊断效能。结果 合并支原体感染组患儿血清SAA、Fib指标水平以及LUS评分均高于非支原体感染组（均P<0.05）。Spearman分析显示，重症肺炎患儿血清SAA、Fib指标水平和LUS评分与其发生支原体感染、支原体感染后预后不良均呈正相关关系（均P<0.05），ROC曲线显示三者评分联合预测重症肺炎患儿发生支原体感染的AUC为0.928〔95%置信区间（confidence interval, CI）：0.899～0.957〕。多因素Logistic分析发现：年龄〔比值比（OR）=0.053，95%CI：0.003~0.997〕、SAA（OR=1.045，95%CI：1.003~1.085）、Fib（OR=1.757，95%CI：1.378~8.158）、LUS评分（OR=3.538，95%CI：1.480~8.457）是合并支原体感染患儿预后的影响因素（P<0.05）。ROC曲线发现，年龄、SAA、Fib以及LUS评分预测合并支原体感染患儿预后的AUC分别为0.837（95%CI：0.764～0.856）、0.792（95%CI：0.701～0.884）、0.755（95%CI：0.655～0.909）、0.917（95%CI：0.828～1.000），四者联合的AUC为0.997（95%CI：0.992～1.000）。结论 年龄、SAA、Fib、LUS评分可作为重症肺炎合并支原体感染患儿预后的诊断指标，其中以联合诊断的效能最高，有助于临床提高对该疾病预后的诊断。

Abstract

Objective To investigate changes in the levels of serum amyloid-A (SAA) and coagulation indicators in children with severe pneumonia complicated by mycoplasma infection and their relationship with the prognosis. Methods A total of 300 children with severe pneumonia were retrospectively enrolled. All the participants were admitted to the Department of Pediatrics of our hospital and received treatment there between July 2022 and December 2024. The patients were divided into a non–mycoplasma infection group (n = 180) and a mycoplasma infection group (n = 120) according to the presence or absence of mycoplasma infection. Then, children with severe pneumonia complicated by mycoplasma infection were further divided into a favorable prognosis subgroup (n = 85) and a poor prognosis subgroup (n = 35). Demographic and clinical data were collected for all participants. Logistic regression analysis was performed to determine whether age, SAA, fibrinogen (Fib), lung ultrasound (LUS) score, and other variables were influencing factors associated with prognosis, and their diagnostic performance was evaluated using receiver operating characteristic (ROC) curve. Results The SAA Fib levels and LUS scores of the participants in the mycoplasma infection group were all higher than those in the non-mycoplasma group (all P < 0.05). Spearman correlation analysis showed that serum SAA levels, Fib levels, and LUS scores were positively correlated with both the occurrence of mycoplasma infection and poor prognosis after mycoplasma infection in children with severe pneumonia (all P < 0.05). The ROC curve analysis showed that the combined use of SAA, Fib, and LUS score predicted mycoplasma infection with an area under the curve (AUC) of 0.928 (95% CI, 0.899-0.957). Through multivariate logistic regression analysis, age (odds ratio [OR], 0.053; 95% CI, 0.003-0.997), SAA (OR, 1.045; 95% CI, 1.003-1.085), Fib (OR, 1.757; 95% CI, 1.378-8.158), and LUS score (OR, 3.538; 95% CI, 1.480-8.457) were identified as influencing factors associated with prognosis in children with severe pneumonia complicated by mycoplasma infection (all P < 0.05). ROC curve analysis demonstrated that the AUC of age, SAA, Fib, and LUS score for predicting prognosis were 0.837 (95% CI, 0.764-0.856), 0.792 (95% CI, 0.701-0.884), 0.755 (95% CI, 0.655-0.909), and 0.917 (95% CI, 0.828-1.000), respectively. The combined model incorporating the 4 parameters achieved an AUC of 0.997 (95% CI, 0.992-1.000). Conclusion Age, SAA, Fib, and LUS scores can be used as diagnostic indicators for assessing the prognosis of children with severe pneumonia complicated by mycoplasma infections. The combined model demonstrates the highest predictive performance and may contribute to improved clinical prognostic assessment.

关键词

重症肺炎 / 支原体感染 / 小儿 / 血清淀粉样蛋白A / 凝血指标 / 预后

Key words

Severe pneumonia / Mycoplasma infection / Children / Serum amyloid protein A / Coagulation indicators / Prognosis

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基金资助

*中华国际医学交流基金会基金项目(Z-2019-41-2101-02)