大环内酯类耐药肺炎支原体肺炎患儿发展为重症肺炎的危险因素分析及预测模型构建
Risk factors of severe pneumonia in children with macrolide-resistant Mycoplasma pneumoniae pneumonia and the construction of prediction model
目的 探索早期预测大环内酯类耐药肺炎支原体肺炎（Macrolide-Resistant Mycoplasma Pneumoniae Pneumonia，MRMP）患儿发展为重症肺炎的方法。方法 回顾性分析2023年1月至2024年1月在我院住院治疗的117例MRMP患儿的临床资料，根据病情严重程度分为耐药重症组和耐药轻症组，比较两组间的临床特征，分析影响耐药患儿发生重症肺炎支原体肺炎（severe Mycoplasma pneumoniae pneumonia，SMPP）的危险因素。结果 纳入117例MRMP患儿，分为耐药重症组63例，男35例、女28例，年龄7.0 （5.0~8.0） 岁；耐药轻症组54例，男29例、女25例，年龄7.0（6.0~9.3）岁。耐药重症组患儿发热时间、咳嗽时间、白细胞计数（white blood cell，WBC）、C-反应蛋白（C-reactive protein，CRP）、乳酸脱氢酶（lactic dehydrogenase，LDH）均高于耐药轻症组，差异均有统计学意义(均P<0.05)。Logistic回归结果显示发热时间(OR=3.407，95%CI 1.821~6.374)、CRP(mg/L) (OR=1.258，95%CI 1.116~1.417)、LDH(U/L) (OR=1.04，95%CI 1.021~1.059)(均P<0.05)是MRMP发展为SMPP的独立危险因素，预测概率P=exp-23.916+1.226×发热时间(days)+0.229×CRP(mg/L)+0.039×LDH(U/L)/1+exp-23.916+1.226×发热时间(days)+0.229×CRP(mg/L)+0.039×LDH(U/L)，3项联合检测的ROC曲线下面积为0.963（95%CI 0.935~0.991，P＜0.01)。结论 可根据首次就诊时的发热时间、CRP、LDH水平计算大环内酯类耐药肺炎支原体肺炎进展为重症肺炎的预测概率，以期达到早期预测目的。
Objective To explore potential predictors of macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMP) to severe pneumonia in early stage. Methods A retrospective analysis was conducted on 117 cases of macrolide-resistant Mycoplasma pneumoniae pneumonia hospitalized in our hospital from January 2023 to January 2024. According to the severity of the disease, the patients were divided into two groups, macrolide-resistant severe group and macrolide-resistant mild group. The clinical characteristics of the two groups were compared, and the risk factors affecting the occurrence of severe Mycoplasma pneumoniae pneumonia (SMPP) were analyzed. Results A total of 117 patients with MRMP finished the study and divided into two groups. There were 63 patients in the severe drug-resistant group, including 35 boys and 28 girls, aged 7.0 (5.0~8.0) years. There were 54 patients in the drug-resistant mild group, including 29 boys and 25 girls, aged 7.0(6.0~9.3) years. The duration of fever, cough, white blood cell count (WBC), C-reactive protein (CRP) and lactate dehydrogenase (LDH) in the macrolide-resistant severe group were higher than those in the macrolide-resistant mild group, and the differences were statistically significant (all P<0.05). Logistic regression analysis showed that the duration of fever (OR=3.407, 95% CI 1.821 to 6.374) and CRP(mg/L) (OR=1.258, 95% CI 1.116~1.417), LDH (U/L) (OR=1.04, 95%CI 1.021~1.059) (all P<0.05) were independent risk factors for the development of MRMP to SMPP. The prediction probability P=exp-23.916+1.226×duration of fever (days)+0.229×CRP(mg/L)+0.039×LDH(U/L)/1+exp-23.916+1.226×duration of fever (days)+0.229×CRP(mg/L)+0.039×LDH(U/L). The area under ROC curve of the three combined tests was 0.963 (95%CI 0.935~0.991, P<0.01). Conclusions The predictive probability of macrolide-resistant severe Mycoplasma pneumoniae pneumonia in children can be calculated according to the duration of fever, CRP and LDH levels at the first visit, to achieve the purpose of early prediction.
叶洪舟、袁琛、施明杰
儿科学临床医学
肺炎支原体耐药重症肺炎预测儿童
Mycoplasma pneumoniaeMacrolide-resistantSevere pneumoniaForecastinghild
叶洪舟,袁琛,施明杰.大环内酯类耐药肺炎支原体肺炎患儿发展为重症肺炎的危险因素分析及预测模型构建[EB/OL].(2024-05-29)[2025-08-02].https://www.biomedrxiv.org.cn/article/doi/bmr.202409.00021.点此复制
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