存在肺实变的肺炎支原体肺炎患儿行支气管肺泡灌洗术的预测模型构建

Construction of a predictive model for performing bronchoalveolar lavage in children with Mycoplasma pneumoniae pneumonia and pulmonary consolidation

目的分析存在肺实变的肺炎支原体性肺炎(Mycoplasmapneumoniaepneumonia,MPP)患儿行支气管肺泡灌洗术(bronchoalveolar lavage,BAL)的危险因素,构建肺实变MPP患儿行BAL的预测模型。方法回顾性分析2019年8月-2022年9月在南京医科大学附属常州第二人民医院儿科住院的202例MPP患儿的临床资料,根据是否行BAL,分为BAL组(100例)和非BAL组(102例)。采用多因素logistic回归分析寻找存在肺实变的MPP患儿行BAL的危险因素,采用Rstudio(R4.2.3)软件制作预测模型,采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)、C-指数和校准曲线评价模型的预测效能。结果多因素logistic回归分析显示,发热时间长、C反应蛋白高、D-二聚体高、合并胸腔积液与存在肺实变的MPP患儿行BAL密切相关(P<0.05)。基于多因素logistic回归分析结果建立列线图预测模型,ROC曲线分析显示,训练集的曲线下面积为0.915(95%CI:0.827~0.938),灵敏度和特异度分别为0.826和0.875;验证集的曲线下面积为0.983(95%CI:0.912~0.996),灵敏度和特异度分别为0.879和1.000。Bootstrap校正后的C-指数为0.952(95%CI:0.901~0.986),校准曲线显示模型预测概率与实际发生概率之间的一致性较好。结论该研究制定的预测模型可根据患儿发热时间、C反应蛋白、D-二聚体、胸腔积液评估存在肺实变的MPP患儿行BAL的概率,且预测效能良好。

Objective To investigate the risk factors for performing bronchoalveolar lavage(BAL)in children with Mycoplasma pneumoniae pneumonia(MPP)and pulmonary consolidation,and to construct a predictive model for performing BAL in these children.Methods A retrospective analysis was performed for the clinical data of 202 children with MPP who were hospitalized in the Department of Pediatrics,Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University,from August 2019 to September 2022.According to whether BAL was performed,they were divided into BAL group with 100 children and non-BAL group with 102 children.A multivariate logistic regression analysis was used to identify the risk factors for performing BAL in MPP children with pulmonary consolidation.Rstudio software(R4.2.3)was used to establish a predictive model for performing BAL,and the receiver operator characteristic(ROC)curve,C-index,and calibration curve were used to assess the predictive performance of the model.Results The multivariate logistic regression analysis demonstrated that the fever duration,C-reactive protein levels,D-dimer levels,and presence of pleural effusion were risk factors for performing BAL in MPP children with pulmonary consolidation(P<0.05).A nomogram predictive model was established based on the results of the multivariate logistic regression analysis.In the training set,this model had an area under the ROC curve of 0.915(95%CI:0.827-0.938),with a sensitivity of 0.826 and a specificity of 0.875,while in the validation set,it had an area under the ROC curve of 0.983(95%CI:0.912-0.996),with a sensitivity of 0.879 and a specificity of 1.000.The Bootstrap-corrected C-index was 0.952(95%CI:0.901-0.986),and the calibration curve demonstrated good consistency between the predicted probability of the model and the actual probability of occurrence.Conclusions The predictive model established in this study can be used to assess the likelihood of performing BAL in MPP children with pulmonary consolidation,based on factors such as fever duration,C-reactive protein levels,D-dimer levels,and the presence of pleural effusion.Additionally,the model demonstrates good predictive performance.