肺炎支原体合并EB病毒感染患儿的预后预测模型构建

Prognosis prediction model for children with Mycoplasma pneumoniae complicated with Epstein-Barr virus infection

摘要

目的 探究肺炎支原体(MP)合并EB病毒(EBV)感染患儿预后的风险因素,并构建对应的预测模型。方法 选取2021年12月至2023年12月期间于廊坊市人民医院就诊的132例MP合并EBV感染患儿为研究对象,以2∶1的比例随机分为学习集88例、验证集44例.入院后随访28天,根据预后情况将学习集患儿分为不良结局组、良好结局组,比较两组一般资料,Logistic回归模型分析MP合并EBV感染预后不良的影响因素;R软件构建列线图预测模型;用受试者工作特征(ROC)曲线、Calibration曲线验证模型效能、校准能力。结果 学习集患儿预后不良率为29.55%;Logistic回归分析显示,MP-DNA载量、EBV-DNA载量、发热持续时间、白介素-2(IL-2)是MP合并EBV感染患儿预后不良的危险因素(OR值介于2.278~3.469之间,P<0.05),年龄是其保护性因素(OR=0.435,P<0.05);ROC曲线显示,模型预测学习集、验证集病例预后不良的曲线下面积(AUC)分别为0.930、0.907,灵敏度分别为96.15%、92.31%,特异度分别为90.32%、80.65%;学习集、验证集的Calibration曲线经Hosmer-Lemeshow检验,差异均无统计学意义(P>0.05);Bootstrap法内部验证结果显示,学习集、验证集的C-index指数分别为0.923、0.905。结论 MP-DNA载量、EBV-DNA载量、发热持续时间、IL-2是MP合并EBV感染患儿预后不良的危险因素,年龄是其保护性因素,据此建立的模型预测MP合并EBV感染患儿预后的效能良好.

Abstract

Objective To explore the prognostic risk factors of children with Mycoplasma pneumoniae (MP) complicated with Epstein-Barr virus (EBV) infection, and to construct a corresponding prediction model. Methods A total of 132 children with MP combined with EBV infection who visited Langfang People's Hospital from December 2021 to December 2023 were selected for this study. The children were randomly divided into a learning set of 88 cases and a validation set of 44 cases at a 2:1 ratio. After 28 days of follow-up after admission, the children in the study group were divided into adverse outcome group and good outcome group according to the prognosis, and the general data of the two groups were compared, and the influencing factors of poor prognosis of MP complicated with EBV infection were analyzed by logistic regression model. R software constructs nomogram prediction model; The receiver operating characteristic (ROC) curve and Calibration curve were used to verify the model performance and calibration ability. Results The incidence of poor prognosis in the learning set was 29.55%. Logistic regression analysis showed that MP-DNA load, EBV-DNA load, duration of fever, and interleukin-2 (IL-2) levels were risk factors for poor prognosis in children with MP combined with EBV infection (OR values ranging from 2.278 to 3.469, P<0.05), while age was a protective factor (OR=0.435, P<0.05). ROC curves showed that the area under the curve (AUC) for predicting poor prognosis in the learning and validation sets was 0.930 and 0.907, respectively, with sensitivities of 96.15% and 92.31%, and specificities of 90.32% and 80.65%. The calibration curves for both the learning and validation sets showed no statistically significant difference in the Hosmer-Lemeshow test (P>0.05). Bootstrap internal validation showed a C-index of 0.923 for the learning set and 0.905 for the validation set. Conclusion MP-DNA load, EBV-DNA load, duration of fever, and IL-2 are risk factors for poor prognosis in children with MP and EBV infection, and age is their protective factor.

关键词

儿童 / 肺炎支原体 / EB病毒 / 预后 / 列线图预测模型

Key words

child / Mycoplasma pneumoniae / Epstein-Barr virus / prognosis / nomogram predictive model

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基金资助

廊坊市科技支撑计划项目(2023013060)