大环内酯类耐药肺炎支原体肺炎患儿发展为重症肺炎支原体肺炎的危险因素分析及预测模型构建

Risk factors of severe Mycoplasma pneumoniae pneumonia in children with macrolide-resistant Mycoplasma pneumoniae pneumonia and the construction of prediction model

目的探索早期预测大环内酯类耐药肺炎支原体肺炎(macrolide-resistant Mycoplasma pneumoniae pneumonia,MRMP)患儿发展为重症肺炎支原体肺炎(severe Mycoplasma pneumoniae pneumonia,SMPP)的方法。方法回顾性分析2023年1月至2024年1月于湖州市第一人民医院住院治疗的117例MRMP患儿的临床资料。根据患儿病情严重程度分为重症组和轻症组,比较两组患儿的临床特征,进一步分析导致耐药患儿发展为SMPP的危险因素。结果117例MRMP患儿中重症组63例,轻症组54例。重症组患儿的发热持续时间、咳嗽持续时间、白细胞计数、C反应蛋白(C-reactive protein,CRP)、乳酸脱氢酶(lactatede hydrogenase,LDH)均高于轻症组(P<0.05)。Logistic回归分析显示发热持续时间、CRP、LDH是MRMP发展为SMPP的独立危险因素,3项联合检测的曲线下面积达0.963(95%CI:0.935~0.991,P<0.001)。结论根据患儿首次就诊时的发热持续时间、CRP、LDH水平可预测MRMP发展为SMPP的概率,进而实现早诊断、早治疗。

Objective To explore potential predictors of macrolide-resistant Mycoplasma pneumoniae pneumonia(MRMP)to severe Mycoplasma pneumoniae pneumonia(SMPP)in early stage.Methods A retrospective analysis was conducted on 117 cases of MRMP that were hospitalized in the First People’s Hospital of Huzhou between January 2023 and January 2024.The children were divided into severe group and mild group based on the severity of their disease.A comparison of the clinical characteristics between two groups was conducted,along with an analysis of the risk factors contributing to the occurrence of SMPP.Results Among 117 children with MRMP,there were 63 in severe group and 54 in mild group.The duration of fever,cough,white blood cell count,C-reactive protein(CRP),and lactate dehydrogenase(LDH)in severe group were all higher than those in mild group(P<0.05).Logistic regression analysis showed that the duration of fever,CRP,and LDH were independent risk factors for the development of SMPP from MRMP.Area under the curve of the three combined tests was 0.963(95%CI:0.935-0.991,P<0.001).Conclusion The probability of MRMP developing into SMPP can be predicted based on the duration of fever,CRP,and LDH levels at the first visit of the patient,thereby achieving early diagnosis and treatment.