支原体肺炎行多次支气管镜下灌洗的影响因素分析及预测模型构建

Influencing factors of multiple bronchoscopic lavage therapy in Mycoplasma pneumoniae pneumonia and construction of prediction model

目的分析支原体肺炎(MPP)患儿行多次支气管镜下灌洗治疗的影响因素并构建预测模型。方法回顾性分析2018年6月至2020年6月入住徐州医科大学附属医院儿科的203例行支气管镜下灌洗治疗的MPP患儿的临床资料,根据支气管镜下灌洗次数分为单次灌洗组(150例)及多次灌洗组(53例)。比较2组患儿在一般情况、临床症状、实验室检查、合并症等方面的差异,分析MPP多次灌洗的危险因素,并构建预测模型。结果单因素分析发现:2组患儿性别、年龄、合并其他感染、炎症累及肺叶数、发病季节、白细胞计数、肌酸激酶同工酶水平的差异无统计学意义(P>0.05);在合并胸腔积液、合并肺外并发症、入院前发热和咳嗽持续时间、入院前最高体温、入院后第1~3天体温平均值(Tmean)、入院前使用大环内酯类抗生素≥5 d、纤维蛋白原降解产物、D-二聚体、C反应蛋白、谷丙转氨酶(ALT)、血清白蛋白(ALB)、血清前白蛋白、乳酸脱氢酶指标上的差异具有统计学意义(P<0.05)。进一步行多因素Logistic回归分析发现,Tmean升高,D-二聚体、ALT升高,ALB降低是影响支气管灌洗次数的危险因素,预测的准确率为90.6%。根据多因素回归分析结果进行联合预测因子的ROC曲线运算,联合预测因子的曲线下面积为0.885,34.885为临界点,敏感度为0.837,特异度为0.851。结论支气管镜下灌洗是治疗MPP的有效手段,早期识别可能需多次灌洗治疗的危险因素,对于合理医患沟通、改善预后有着积极的意义。

Objective To analyze the influencing factors of Mycoplasma pneumoniae pneumonia(MPP)child patients receiving multiple bronchoscopic lavage therapy and construct a prediction model.Methods A total of 203 MPP children who underwent bronchoscopic lavage therapy in the Affiliated Hospital of Xuzhou Medical University from June 2018 to June 2020 were enrolled and their clinical data were retrospectively analyzed.According to the times of bronchoscopic lavage therapy,they were divided into two groups:a single lavage group(n=150)and a multiple lavage group(n=53).Both groups were compared for the differences in general information,clinical symptoms,laboratory examination,and complications.Then,the risk factors of multiple lavage for treatment of MPP were analyzed,so as to construct a prediction model.Results According to univariate analysis,there were no significant differences in sex,age,other infections,the number of lung lobes involved in inflammation,onset seasons,white blood cell counts and creative kinase isoenzyme level(P>0.05).In the two groups,pleural effusion,extrapulmonary complications,fever before admission,duration of cough,the maximal body temperature before admission,the mean body temperature after admission of Days 1—3(Tmean),the use of macrolide antibiotics≥5 days before admission,fibrinogen degradation products,D-dimers,C-reactive protein,alanine aminotransferase(ALT),serum albumin(ALB),serum prealbumin,lactate dehydrogenase indexes were statistically different(P<0.05).Furthermore,multivariate logistic regression analysis showed that increases in Tmean,D-dimers and ALT,and decreases in ALB were risk factors influencing the times of bronchoscopic lavage therapy,with a predictive accuracy of 90.6%.According to multivariate regression analysis,the area under the curve of joint predictors was 0.885,and the cutoff value was 34.885,the sensitivity was 0.837,and the specificity was 0.851.Conclusions Bronchoscopy lavage is an effective method for the treatment of MPP.Early identification of risk factors that may require multiple lavage treatment is of positive significance for rational communication between doctors and patients and improvement of prognosis.