儿童重症支原体肺炎风险因素阈值与预测价值

Threshold and predictive values of risk factors for Severe mycoplasma pneumoniae pneumonia in children

目的重症支原体肺炎(severe mycoplasma pneumoniae pneumonia,SMPP)患病率正在上升,本文旨在研究儿童SMPP风险因素阈值及预测价值。方法回顾性分析陆军军医大学第二附属医院在2023年1月至2024年2月收治的224例肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)患儿的临床资料,分为重症组(114例)和非重症组(110例),比较两组患儿的C反应蛋白(C-reactive protein,CRP)、白细胞(white blood cell,WBC)、血小板计数(platelet,PLT)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、乳酸脱氢酶(lactate dehydrogenase,LDH)、D-二聚体水平,将差异有统计学意义的指标进行单因素logistic回归分析,并进一步将有意义的指标做多因素logistic回归分析,得到SMPP的独立风险因素,然后通过受试者工作特征曲线(ROC)分析找到各预测指标诊断阈值及预测价值。结果与非重症组比较,重症组CRP、LDH、D-二聚体水平更高,PLT水平更低,差异均有统计学意义(P<0.05);与非重症组比较,重症组WBC、AST、ALT差异均无统计学意义(P>0.05)。将差异有统计学意义的指标分别纳入单因素logistic回归分析,并进一步对有意义的指标进行多因素logistic回归分析,发现C-反应蛋白(OR=0.032,P=0.006),LDH(OR=0.006,P=0.044)、D-二聚体(OR=0.006,P<0.0013)是儿童SMPP的独立预测指标,ROC曲线下的面积分别为0.732、0.696、0.807,诊断阈值分别为10.35 mg/L、296.15 U/L、231.5 ng/ml。结论CRP≥10.35 mg/L、LDH≥296.15 U/L、D-二聚体≥231.5 ng/ml是SMPP的早期独立风险因素阈值,其中D-二聚体对SMPP预测价值最高。

Objective The prevalence of severe mycoplasma pneumoniae pneumonia is increasing,the purpose of this study was to investigate the threshold and predictive value of risk factors for severe mycoplasma pneumonia in children.Methods Retrospective analysis was conducted on 224 children who were hospitalized in the Second Affiliated Hospital of Army Medical University for MPP be⁃tween January 2023 and February 2024.The children were divided into severe group(114 cases)and non-severe group(110 cases),After comparing the laboratory tests of two groups,logistic stepwise regression analysis was carried out on the statistically significant in⁃dicators to obtain independent predictive indicators for severe mycoplasma pneumoniae pneumonia,and then,the threshold(cut off)value with the maximum diagnostic value for each predictive indicator was found through the analysis of the receiver operating character⁃istic curve(ROC).Results The SMPP group had higher levels of CRP,LDH and D-dimer,while PLT was significantly lower than that of the MPP group,and the differences were statistically significant(all P<0.05),and there were no significant differences in WBC,AST and ALT,with all P>0.05.Bringing them into univariate logistic regression analysis and multivariate logistic analysis,the results showed that CRP(OR=0.032,P=0.006),LDH(OR=0.006,P=0.044),and D-dimer(OR=0.006,P<0.001),were independent predictors of severe Mycoplasma pneumoniae pneumonia in children.The areas under the ROC curves of CRP,LDH,and D-dimer were 0.732、0.696、0.807,respectively.Cut-offs were 10.35 mg/L,296.15 U/L,and 231.5 ng/ml,respectively.Conclusion CRP≥10.35 mg/L,LDH≥296.15 U/L,D-dimer≥231.5 ng/ml were early independent warning indicators for severe mycoplasma pneumoniae pneumo⁃nia in children,among which D-dimer showed the greatest diagnostic value.