基于肺炎支原体DNA和外周血炎症指标构建儿童肺炎支原体肺炎预后评估模型

Prognosis evaluation model of children with Mycoplasma pneumoniae pneumonia based on MP DNA and peripheral blood inflammation indicators

目的探讨基于肺炎支原体(MP)DNA和外周血炎症指标构建的儿童肺炎支原体肺炎(MPP)预后评估模型的临床应用价值。方法选取2023年11—12月复旦大学附属金山医院MPP患儿139例,收集其一般临床资料,检测治疗前MP DNA、C反应蛋白(CRP)、降钙素原(PCT)和血常规指标,计算中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、单核细胞/淋巴细胞比值(MLR)。根据治疗1个月的预后情况将139例MPP患儿分为预后不良组(33例)和预后良好组(106例)。采用Spearman相关分析评估各项指标与MPP患儿不良预后的相关性。采用多因素Logistic回归分析评估MPP患儿预后不良的影响因素。采用受试者工作特征(ROC)曲线评价各项指标单项检测和联合检测判断MPP患儿预后不良的效能。结果预后不良组MP DNA和CRP、NLR、PLR水平均高于预后良好组(P<0.05),2个组PCT、MLR水平差异无统计学意义(P>0.05)。MPP患儿MP DNA、CRP、NLR、PLR与预后不良呈正相关(r值分别为0.313、0.225、0.277、0.262,P<0.05)。MP DNA、CRP、NLR、PLR升高是MPP患儿预后不良的危险因素(P<0.05)。MP DNA、CRP、NLR、PLR单项和联合检测判断MPP患儿预后不良的曲线下面积(AUC)分别为0.799、0.724、0.775、0.732、0.935。结论MPP患儿治疗前MP DNA和炎症指标均呈异常变化,基于相关指标构建的预后评估模型有较高的临床应用价值。

Objective To evaluate the clinical value of a model for the prognosis of children with Mycoplasma pneumoniae(MP)pneumonia(MPP)based on MP DNA and peripheral blood inflammation indicators.Methods Totally,139 children with MMP were enrolled from Jinshan Hospital of Fudan University from November to December 2023.The general clinical data were collected,and MP DNA,C-reactive protein(CRP),procalcitonin(PCT)and blood routine test indicators were determined before treatment.Neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and monocyte-to-lymphocyte ratio(MLR)were calculated.According to the prognosis after 1 month of treatment,they were classified into poor prognosis group(33 cases)and good prognosis group(106 cases).Spearman correlation analysis was used to evaluate the correlation between various indicators and poor prognosis of MPP.Multivariate Logistic regression analysis was used to evaluate the influence factors of poor prognosis in children with MPP.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of single and combined determinations of each indicator in determining poor prognosis of children with MPP.Results The levels of MP DNA,CRP,NLR and PLR in poor prognosis group were higher than those in good prognosis group(P<0.05),but there was no statistical significance in PCT and MLR between the 2 groups(P>0.05).MP DNA,CRP,NLR and PLR were positively correlated with poor prognosis in MPP children(r values were 0.313,0.225,0.277 and 0.262,P<0.05).MP DNA,CRP,NLR and PLR were all risk factors for poor prognosis in MPP children(P<0.05).The areas under curves(AUC)of single determinations of MP DNA,CRP,NLR and PLR and combined determination to determine the poor prognosis of MPP children were 0.799,0.724,0.775,0.732 and 0.935,respectively.Conclusions Both MP DNA and inflammation indicators of MPP children show abnormal changes before treatment,and the prognosis evaluation model has good clinical application value.