基于定量CT对难治型支原体肺炎预测价值的研究

Study on Predictive Value of Refractory Mycoplasma Pneumonia Based on Quantitative CT

目的探讨定量CT指标对实验室指标模型预测难治型支原体肺炎(RMPP)能力的提升价值。方法回顾性搜集2019年1月至2021年5月在延安大学附属医院确诊的肺炎支原体肺炎(MPP)患儿197例,其中RMPP患儿60例和普通型支原体肺炎(GMPP)患儿137例,所有患儿均在入院后行CT扫描及实验室检查,利用计算机肺部感染辅助诊断分析软件对患儿胸部CT进行定量分析。采用χ^(2)检验或Mann-Whitney U检验分析实验室指标及定量CT指标,采用重分类改善指标(NRI)和综合判别改善指数(IDI)及受试者工作特征曲线(ROC)评价定量CT指标对实验室指标预测RMPP患儿能力的提升价值。结果两组临床症状差异分析显示RMPP组较GMPP组年龄较大、住院时间较长、临床症状较重(P<0.05)。实验室指标差异分析显示RMPP组患儿外周血清中的C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、中性粒细胞比值高于GMPP组患儿,淋巴细胞比值则低于GMPP组患儿(P<0.01)。RMPP患儿免疫球蛋白M(IgM)高于GMPP患儿,IgG则低于GMPP(P>0.05)。CT定量参数中RMPP患儿病变区域面积(LeV)、病变体积的百分比(LeV%)、病变平均密度(MLeD)、病变质量(LM)均高于GMPP组(P<0.05),低于-300 HU的低密度区[GGO(-300)]则低于GMPP组。加入定量CT指标后RMPP患儿临床模型的预测效能得到提升,含有LeV%模型的NRI为0.9515,IDI为0.1615,含有GGO(-300)模型的NRI为0.7886,IDI为0.1199;含有所有定量CT指标的模型的NRI为1.1004,IDI为0.2583,P均<0.01。结论定量CT指标能显著提升RMPP患儿临床模型的预测效能及鉴别能力。

Objective To explore the value of quantitative CT index in the prediction of refractory mycoplasma pneumonia by laboratory index model.Methods A total of 197 children with mycoplasma pneumoniae pneumonia(MPP)diagnosed in the affiliated Hospital of Yan'an University from January 2019 to May 2021 were enrolled retrospectively,including 60 children with refractory type and 137 children with common type.All children underwent CT scan and laboratory examination after admission.The chest CT was quantitatively analyzed by computer aided diagnosis and analysis software of pulmonary infection.The laboratory index and quantitative CT index were analyzed by Mann-Whitney U test orχ^(2)test,and the reclassification improvement index(NRI),comprehensive discriminant improvement index(IDI)and ROC were used to evaluate the value of quantitative CT index in predicting the ability of children with refractory mycoplasma pneumonia.Results The difference analysis of clinical symptoms between the two groups showed that RMPP group was older,had longer hospital stay and had more severe clinical symptoms than GMPP group(P<0.05).The difference analysis of laboratory indexes showed that the ratio of CRP,LDH and neutrophils in peripheral serum of RMPP group was higher than that of GMPP group,while the lymphocyte ratio was lower than that of GMPP group.The IgM of RMPP was higher than that of GMPP,while IgG was lower than that of GMPP.The quantitative parameters of LeV,LeV%,MLeD,LM and GGO in CT group were higher than those in GMPP group.The GGO(-300)was lower than GMPP group.With the addition of quantitative CT index,the predictive efficiency of the clinical model of refractory children was improved.The NRI of the LeV%model was 0.9515,the NRI of the GGO model was 0.7886,and the IDI of the model with all quantitative CT indexes was 0.1199.the NRI of the model with all quantitative IDI indexes was 1.1004 and 0.2583(P<0.01).Conclusion Quantitative CT can significantly improve the predictive efficiency and differential ability of clinical models in children with RMPP.