肺炎支原体感染患儿IgA水平与胸部CT影像特征的关系及其对预后的预测价值

The relationship between IgA level and chest CT imaging features in children with Mycoplasma pneumoniae infection and its predictive value for prognosis

目的探讨肺炎支原体(Mycoplasma pneumoniae,MP)感染患儿免疫球蛋白(immunoglobulin,Ig)A水平与胸部计算机断层成像(computerized tomography,CT)影像特征的关系及其对预后的预测价值。方法将2022年12月—2023年12月在淮南市妇幼保健院首次就诊的104例MP感染患儿作为研究对象。根据患儿就诊后3个月随访的预后情况将104例患儿分为预后良好组(73例)和预后不良组(31例)。比较2组患儿的临床资料和IgM、IgG、IgA等实验室指标水平。采用多元线性逐步回归分析IgA水平与MP感染患儿胸部CT影像特点的相关性。采用多因素Logistic回归分析MP感染患儿预后的独立风险预测因子。采用限制性立方样条法分析IgA水平与MP感染患儿预后不良发生风险的剂量反应关系。IgA水平与MP感染患儿预后分析用决策曲线分析(decision curve analysis,DCA)。结果IgA水平与胸部CT影像学变化呈正相关。多因素分析结果显示,年龄≤6岁、病情为重度、IgM、IgG、IgA、PCT水平上升、PLT水平下降、胸部CT表现为磨玻璃影、结节影和实变影均为MP感染患儿预后不良的危险因素。剂量反应关系结果显示,IgA水平与预后不良呈显著正相关。IgA水平与患儿预后的DCA曲线分析结果显示,高风险阈值为1%~70%时,净获益率>0,有临床意义,高风险阈值取值越小,净获益率越高,临床意义越大。结论MP感染患儿IgA水平与胸部CT影像特点具有显著相关性,并且IgA水平是影响患儿预后的独立危险因素,对患儿预后具有一定预测价值。

Objective Exploring the relationship between IgA level and chest CT imaging features in children with Mycoplasma pneumoniae(MP)infection and its predictive value for prognosis.Methods One hundred and four children with MP infection who first visited our hospital from December 2022 to December 2023 were selected as the research subjects.According to the prognosis of the patient after 3 months of follow-up,104 patients were divided into a good prognosis group(73 cases)and a poor prognosis group(31 cases).Compare the clinical data and immunoglobulin(IgM,IgG,IgA)levels between 2 groups of patients.Multiple linear stepwise regression analysis was used to investigate the correlation between IgA levels and ct imaging characteristics in children with MP infection.Multivariate logistic regression was used to analyze the independent risk predictors of prognosis in children with MP infection.The dose-response relationship between IgA level and the probability of adverse prognosis in children with MP infection was analyzed by using the restricted cubic spline method;The DCA curve of IgA level and prognosis of children with MP infection was analyzed.Results IgA levels are positively correlated with ground glass opacities,nodular opacities,and consolidation opacities,and have certain predictive value for the prognosis of children with MP infection.The results of multivariate analysis showed that age,severity of the disease,IgM,IgG,IgA,PLT,PCT,and ct manifestations were all independent risk factors for poor prognosis in children with MP infection(P<0.05).The results of stratified regression analysis of IgA levels with different influencing factors showed that clinical manifestations,laboratory test indicators,and prognosis did not have an impact on IgA levels;The severity of the condition and the characteristics of CT images will have a significant positive impact on IgA levels.The dose-response relationship results showed a significant positive correlation between IgA levels and poor prognosis.The DCA curve analysis of IgA levels and prognosis shows that when the high-risk threshold is between 1%and 70%,the net benefit rate is>0,indicating clinical significance.The smaller the high-risk threshold value,the higher the net benefit rate,and the greater the clinical significance.Conclusion There is a significant correlation between chest CT imaging characteristics and IgA levels in children with MP infection,and IgA levels are an independent risk factor affecting the prognosis of children,with cer tain predictive value for their prognosis.