儿童肺炎支原体肺炎进展为重症肺炎支原体肺炎的危险因素预测分析

Predictive analysis of risk factors for the progression of mycoplasma pneumoniae pneumonia to severe mycoplasma pneumoniae pneumonia in children

摘要

目的 探讨肺炎支原体肺炎(MPP)患儿进展为重症肺炎支原体肺炎(SMPP)的危险因素。方法 选择2021年12月至2023年12月在佛山市第一人民医院住院治疗的259例MPP患儿为研究对象,根据相关诊断准将其分为非重症组216人(未进展为SMPP)与重症组43人(进展为SMPP).比较两组治疗前一般资料、胸肺部影像学资料及静脉血指标的差异,采用多因素Logistic回归及受试者工作特征(ROC)曲线分析危险因素和诊断价值。结果 入院时重症组的白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、乳酸脱氢酶(LDH)高于非重症组,血小板(PLT)、血红蛋白浓度(HGB)、总蛋白(TP)、白蛋白(ALB)低于非重症组,差异均有统计学意义(t值介于2.626~8.049之间,P<0.05);两组的一般资料与胸部影像学资料差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示高水平WBC、D-D是预测患儿进展为SMPP的独立危险因素(OR值分别为1.132、1.268,P<0.05),高水平PLT、TP是预测患儿进展为SMPP的独立保护因素(OR值分别为0.994、0.850,P<0.05);WBC、D-D、PLT和TP独立预测SMPP的截断值分别为11.46×10⁹/L、0.77mg/L、302×10⁹/L、58.72g/L,曲线下面积(AUC)分别为0.627、0.602、0.699、0.787,联合预测的AUC为0.851。结论 白细胞增多、D-二聚体增高、血小板降低和总蛋白降低可作为肺炎支原体肺炎患儿进展为重症肺炎支原体肺炎的预测指标.

Abstract

Objective To explore the risk factors for children with mycoplasma pneumoniae pneumonia (MPP) progressing to severe mycoplasma pneumoniae pneumonia (SMPP). Methods A total of 259 hospitalized children with MPP who were hospitalized in the First People's Hospital of Foshan from December 2021 to December 2023 were selected as the research subjects. Based on diagnostic criteria, they were divided into a non-severe group (n=216, without progression to SMPP) and a severe group (n=43, progressed to SMPP). Baseline demographic characteristics, chest imaging findings, and venous blood parameters before treatment were compared between the two groups. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were conducted to identify risk factors and assess diagnostic performance. Results At admission, the severe group showed significantly higher levels of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), activated partial thromboplastin time (APTT), D-dimer (D-D), and lactate dehydrogenase (LDH), whereas platelet count (PLT), hemoglobin (HGB), total protein (TP), and albumin (ALB) were significantly lower than those in the non-severe group (t=2.626-8.049, P<0.05). There were no significant differences in baseline characteristics or chest imaging findings between the two groups (P>0.05). Multivariate logistic regression revealed that elevated WBC and D-D levels were independent risk factors for progression to SMPP (OR=1.132 and 1.268, respectively, P<0.05), while higher PLT and TP levels were independent protective factors (OR=0.994 and 0.850, respectively, P<0.05). The cut-off values of WBC, D-D, PLT, and TP for predicting SMPP were 11.46×10⁹/L, 0.77mg/L, 302×10⁹/L, and 58.72g/L, respectively. The corresponding areas under the curve (AUC) were 0.627, 0.602, 0.699, and 0.787, respectively, and the AUC of the combined prediction was 0.851. Conclusion Increased WBC and D-D levels, along with decreased PLT and TP levels, can serve as predictive indicators for the progression of MPP to SMPP in children.

关键词

儿童 / 肺炎支原体肺炎 / 重症肺炎支原体肺炎 / 静脉血指标 / 预测分析 / 危险因素

Key words

child / mycoplasma pneumoniae pneumonia / severe mycoplasma pneumoniae pneumonia / venous blood index / predictive analysis / risk factor

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基金资助

佛山市科学技术局自筹经费类科技创新项目(2220001003870)