加味麻杏石甘汤联合阿奇霉素治疗MPP患儿肺不张风险预测模型的建立

Establishment of risk prediction model for atelectasis in children with MPP treated with modified maxing shigan decoction and azithromycin

目的建立加味麻杏石甘汤联合阿奇霉素治疗肺炎支原体肺炎(MPP)患儿肺不张风险预测模型。方法选取178例MPP患儿为研究对象,均给予阿奇霉素序贯疗法联合口服加味麻杏石甘汤治疗,根据预后情况分为肺不张组(33例)及无肺不张组(145例)。比较两组入院时第1秒用力呼气量与用力肺活量比、氧分压、二氧化碳分压(PaCO_(2))、血氧饱和度(SO_(2))、血清C-反应蛋白(CRP)、肿瘤坏死因子-α、白细胞介素-6(IL-6)、IL-10水平。采用多因素回归分析建立肺不张预后风险预测模型;采用ROC曲线检验该模型的预测能力。结果治疗后总有效率为69.10%(123/178)。Logistic回归分析显示,病程、PaCO_(2)、CRP是肺不张发生的独立危险因素,SO_(2)、IL-10是其保护性因素。回归模型为h(t)=0.355+0.576×病程+0.087×PaCO_(2)-0.184×SO_(2)+0.319×CRP-0.431×IL-10,风险预测模型具有较好的预测价值。结论PaCO_(2)、CRP是MPP患儿发生肺不张的独立危险因素,SO_(2)、IL-10是其保护性因素,成功建立的预后风险预测模型具有较好的预测价值。

Aim To establish a risk prediction model for atelectasis in children with mycoplasma pneumoniae pneumonia(MPP)treated with modified maxing shigan decoction and azithromycin.Methods 178 children with MPP were selected as the study objects,and all of them were treated with sequential therapy of azithromycin combined with oral jiawei maxing shigan decoction.According to the prognosis,they were divided into atelectasis group(33 cases)and non-atelectasis group(145 cases).The percentage of vital capacity occupied by forced expiratory volume in one second,partial pressure of oxygen,partial pressure of carbon dioxide(PaCO_(2)),blood oxygen saturation(SO_(2)),serum C-reaction protein(CRP),tumor necrosis factor-α,interleukin-6(IL-6),interleukin-10(IL-10)levels were compared between the two groups.Multivariate regression analysis was used to establish a prognostic risk prediction model for atelectasis;ROC curve was used to tested the predictive power of the model.Results The total effective rate after treatment was 69.10%(123/178).Logistic regression analysis showed that course of disease,PaCO_(2) and CRP were independent risk factors for atelectasis,while SO_(2) and IL-10 were protective factors.Logistic regression model was h(t)=0.355+0.576×duration+0.087×PaCO_(2)-0.184×SO_(2)+0.319×CRP-0.431×IL-10;Risk prediction model has good prediction value.Conclusion PaCO_(2) and CRP were independent risk factors for atelectasis in children with MPP,while SO_(2) and IL-10 were protective factors,the prognostic risk prediction model established successfully has good predictive value.