检验医学与临床2024，Vol.21Issue(16)：2310-2314,2319,6.DOI:10.3969/j.issn.1672-9455.2024.16.002
肺炎支原体肺炎患儿并发大叶性肺炎的影响因素分析及列线图预测模型构建
Influencing factors analysis of children with Mycoplasma pneumonia complicated with lobar pneumonia and the construction of Nomogram prediction model
摘要
Abstract
Objective To analyze the influencing factors of children with mycoplasma pneumoniae pneumo-nia(MPP)complicated with lobar pneumonia(LP)and construct a Nomogram prediction model.Methods Clinical data of 280 MPP children attending Lu'an People's Hospital from February 2020 to August 2022 were collect-ed retrospectively,who were divided into LP group(n=173)and non-LP group(n=107)according to wheth-er they were complicated with LP or not.The clinical data of another 132 children with MPP attending Lu'an People's Hospital during the same period were collected for model validation.The best cut-off values of each factor were analyzed by subject operating characteristic(ROC)curves;multivariate Logistic regression model was used to analyze the independent risk factors influencing the concurrent LP in children with MPP;Nomo-gram models predicting concurrent LP in children with MPP were constructed,and the internal validation of Nomogram models was validated by calibration curves,and the predictive power of the Nomogram model was assessed with a decision curve.Results Age,duration of fever,time from onset to macrolide antibiotics(MAs)drug application,proportion of tachycardia,proportion of pleural effusion,proportion of extra-pulmo-nary complications,erythrocyte sedimentation rate(ESR)and LYM,NEU,lactate dehydrogenase(LDH),C-reactive protein(CRP)levels in the LP group were higher than those in the non-LP group(P＜0.05).The re-sults of ROC curve analysis showed that the AUC values of age,duration of fever,time from onset to MAs drug application,LYM,NEU,LDH,ESR and CRP were 0.868,0.886,0.801,0.662,0.747,0.702,0.868,and 0.892,respectively;the optimal cutoff values were 4 years,7 days,3 days,29.46％,53.72％,348.1 U/L,34 mm/h and 27.85 mg/L,respectively.Multivariate Logistic regression results showed that age＞4 years,dura-tion of fever＞7 days,time from onset to MAs drug application＞3 days,presence of pleural effusion,LDH＞348.1 U/L and CRP＞27.85 mg/L were independent risk factors for MPP children with LP.The internal val-idation results showed that the C-index of the Nomogram model for predicting concurrent LP in children with MPP was 0.884(95％CI:0.753-0.917),with good agreement between the observed and predicted values.The threshold for the Nomogram model to predict concurrent LP in MPP children was＞0.17,and the No-mogram model provided significant net clinical benefit.The model was also validated with 132 children,and the ROC curve analysis results showed a relatively good calibration agreement with an AUC of 0.854(95％CI:0.782-0.909).Conclusion Nomogram model constructed based on age,duration of fever,time from on-set to drug application of MAs,pleural effusion,LDH and CRP for predicting concurrent LP in MPP children has good predictive value for concurrent LP in children with MPP,and it can be used to identify children at high risk of concurrent LP.关键词
肺炎支原体肺炎/大叶性肺炎/实验室检查结果/Nomogram模型/影响因素Key words
mycoplasma pneumoniae pneumonia/lobar pneumonia/laboratory results/Nomogram model/influencing factors分类
医药卫生引用本文复制引用
朱跃文,周贝贝,韦红..肺炎支原体肺炎患儿并发大叶性肺炎的影响因素分析及列线图预测模型构建[J].检验医学与临床,2024,21(16):2310-2314,2319,6.基金项目
国家卫生计生委医药卫生科技发展研究中心项目(W2016EWAH15). （W2016EWAH15）
