基于血清炎症标志物构建儿童肺炎支原体肺炎合并胸腔积液预后不良的预警模型

Construction of an early warning model for poor prognosis of mycoplasma pneumoniae pneumonia with pleural effusion in children based on serum inflammatory markers

目的基于血清炎症标志物构建儿童肺炎支原体肺炎(MPP)合并胸腔积液预后不良的预警模型。方法回顾性分析2021年7月至2023年12月商洛市中心医院收治的171例MPP合并胸腔积液患儿的临床资料,根据8∶2随机分成训练集(137例)与验证集(34例)。根据患儿住院期间预后分为预后不良组与预后良好组。对比训练集预后不良组与预后良好组临床资料及血清炎症标志物[白细胞介素-17A(IL-17A)、高迁移率族蛋白B1(HMGB1)、降钙素原(PCT)、血清淀粉样蛋白A(SAA)],分析MPP合并胸腔积液患儿预后不良的影响因素,基于血清炎症标志物构建并验证MPP合并胸腔积液患儿预后不良的预警模型。采用χ^(2)检验、独立样本t检验。结果训练集137例患儿中,预后不良发生率为35.77%(49/137);验证集34例患儿中,预后不良发生率为35.29%(12/34)。训练集中,预后不良组男29例,女20例,年龄(6.53±1.42)岁;预后良好组男45例,女43例,年龄(6.99±1.68)岁。训练集预后不良组住院时间、持续发热时间均长于预后良好组,血清D-二聚体、IL-17A、HMGB1、PCT、SAA水平均高于预后良好组(均P<0.05)。logistic回归分析结果显示,IL-17A(OR=3.951,95%CI:1.737~8.988)、HMGB1(OR=5.339,95%CI:2.347~12.145)、PCT(OR=4.084,95%CI:1.795~9.290)、SAA(OR=4.749,95%CI:2.088~10.804)均为MPP合并胸腔积液患儿预后不良的影响因素(均P<0.05)。以这4个影响因素为预测变量,构建列线图预测模型,模型预测训练集MPP合并胸腔积液患儿预后不良的灵敏度为89.80%(95%CI:76.99%~96.18%),特异度为92.05%(95%CI:83.77%~96.47%),曲线下面积为0.907(95%CI:0.762~0.969);模型预测验证集MPP合并胸腔积液患儿预后不良的灵敏度为83.33%(95%CI:50.88%~97.06%),特异度为90.91%(95%CI:69.38%~98.41%),曲线下面积为0.865(95%CI:0.717~0.935)。结论血清IL-17A、HMGB1、PCT、SAA与MPP合并胸腔积液患儿预后不良有关,基于血清IL-17A、HMGB1、PCT、SAA构建预警模型有助于早期甄别MPP合并胸腔积液患儿预后不良的风险。

Objective To construct an early warning model for poor prognosis of mycoplasma pneumoniae pneumonia(MPP)with pleural effusion in children based on serum inflammatory markers.Methods The clinical data of 171 children with MPP combined with pleural effusion admitted to Shangluo Central Hospital from July 2021 to December 2023 were retrospectively analyzed,and they were randomly divided into a training set(137 cases)and a validation set(34 cases)according to 8:2.According to the prognosis during hospitalization,the children were divided into a poor prognosis group and a good prognosis group.The clinical data and serum inflammatory markers[interleukin-17A(IL-17A),high mobility group box 1(HMGB1),procalcitonin(PCT),and serum amyloid A(SAA)]were compared between the poor prognosis group and the good prognosis group in the training set.The influencing factors of poor prognosis in children with MPP combined with pleural effusion were analyzed,and an early warning model for poor prognosis in children with MPP combined with pleural effusion was constructed and verified based on serum inflammatory markers.χ^(2) test and independent sample t test were used.Results Among the 137 children in the training set,the incidence of poor prognosis was 35.77%(49/137).Among the 34 children in the validation set,the incidence of poor prognosis was 35.29%(12/34).In the training set,there were 29 boys and 20 girls in the poor prognosis group,aged(6.53±1.42)years;there were 45 boys and 43 girls in the good prognosis group,aged(6.99±1.68)years.In the training set,the hospital stay and fever duration of the poor prognosis group were longer than those of the good prognosis group,and the levels of serum D-dimer,IL-17A,HMGB1,PCT,and SAA were higher than those of the good prognosis group(all P<0.05).Logistic regression analysis showed that IL-17A(OR=3.951,95%CI:1.737-8.988),HMGB1(OR=5.339,95%CI:2.347-12.145),PCT(OR=4.084,95%CI:1.795-9.290),and SAA(OR=4.749,95%CI:2.088-10.804)were the influencing factors for poor prognosis in children with MPP combined with pleural effusion(all P<0.05).Using these four influencing factors as predictive variables,a nomogram prediction model was constructed.The sensitivity and specificity of the model in predicting poor prognosis in children with MPP combined with pleural effusion in the training set were 89.80%(95%CI:76.99%-96.18%)and 92.05%(95%CI:83.77%-96.47%),and the area under the curve was 0.907(95%CI:0.762-0.969);the sensitivity and specificity of the model in predicting poor prognosis in children with MPP combined with pleural effusion in the validation set were 83.33%(95%CI:50.88%-97.06%)and 90.91%(95%CI:69.38%-98.41%),and the area under the curve was 0.865(95%CI:0.717-0.935).Conclusion Serum IL-17A,HMGB1,PCT,and SAA are associated with poor prognosis in children with MPP combined with pleural effusion.An early warning model constructed based on serum IL-17A,HMGB1,PCT,and SAA is helpful for early identification of the risk of poor prognosis in children with MPP combined with pleural effusion.