| 田继萍,吴明赴,孟令玲.呈大叶性肺炎改变的儿童肺炎支原体肺炎的影响因素及列线图预测模型构建与验证[J].安徽医药,2024,28(4):718-722. |
| 呈大叶性肺炎改变的儿童肺炎支原体肺炎的影响因素及列线图预测模型构建与验证 |
| Influencing factors of Mycoplasma pneumoniae pneumonia in children with lobar pneumonia changes and construction and validation of a nomogram prediction model |
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| DOI：10.3969/j.issn.1009-6469.2024.04.017 |
| 中文关键词: 肺炎支原体肺炎 大环内酯类 大叶性肺炎 危险因素 预测模型 儿童 |
| 英文关键词: Mycoplasma pneumoniae pneumonia Macrolides Lobar pneumonia Risk factors Predictive model Child |
| 基金项目:江苏省卫生健康委员会妇幼健康科研项目( F201858) |
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| 中文摘要: |
| 目的预测呈大叶性肺炎改变的儿童肺炎支原体肺炎的列线图模型构建及验证。方法选取扬州大学附属医院 2016年 1月至 2019年 6月接收的 170例 MPP病儿为建模组。选取该院 2019年 7月至 2021年 12月接收的 150例 MPP病儿为验证组。根据是否表现为大叶性肺炎将建模组病儿分为呈大叶性肺炎组(n=70)和未呈大叶性肺炎组(n=100)。对建模组病儿采用 logistic回归法筛选呈大叶性肺炎改变的儿童 MPP的危险因素；采用 R软件构建预测呈大叶性肺炎改变的儿童 MPP的列线图模型，绘制校准曲线评估预测呈大叶性肺炎改变的儿童 MPP列线图模型的一致性，绘制受试者操作特征(ROC)曲线验证列线图模型准确性。结果 logistic分析显示建模组中呈大叶性肺炎组年龄、热程、大环内酯类药使用时间、中性粒细胞百分比、 C反应蛋白( CRP)水平、乳酸脱氢酶(LDH)水平、丙氨酸转氨酶(ALT)、红细胞沉降率(ESR)D-二聚体高于未呈大叶性肺炎组(P<0.05)其中热程更高(10.10±2.72比 6.36±1.91)大环内酯类药使用时间更高(5.20±1.59比 3.5、0±1.02)、CRP更高(35.46±9.73比 13.92±4.0，6)、D-二聚体更高(0.69比 0.44)。logistic分、析显示，热程、大环内酯类药使用时间、 CRP、D-二聚体是呈大叶性肺炎改变的儿童 MPP的危险因(P<0.05)。基于危险因素用 R软件建立列线图模型，建模组 ROC曲线下面积为 0.94［95%CI:(0.90，0.98)］，验证组 ROC曲线下面素积为 0.95［95%CI:(0.92，0.98)］；列线图模型的 Hosmer-Lemeshow拟合优度检验显示，建模组 χ2=6.81，P=0.557；验证组 χ2=6.50， P=0.591。结论构建的预测呈大叶性肺炎改变的儿童 MPP的列线图模型具有较大临床价值，可指导个体化治疗。 |
| 英文摘要: |
| Objective To construct and validate a nomogram model for predicting lobar pneumonia changes in children with Myco?plasma pneumoniae pneumonia (MPP).Methods A total of 170 children with MPP admitted to Affiliated Hospital of Yangzhou Uni?versity from January 2016 to June 2019 were taken as the modeling group. A total of 150 children with MPP admitted to this hospitalfrom July 2019 to December 2021 were taken as the validation group. According to whether the children presented with lobar pneumo?nia, the children in the modeling group were assigned into lobar pneumonia group (n=70) and non-lobar pneumonia group (n=100). Lo?gistic regression was used to screen the risk factors of lobar pneumonia changes in children with MPP in the modeling group; R softwarewas used to construct a nomogram model for predicting lobar pneumonia changes in children with MPP, the calibration curve was drawnto evaluate the consistency of MPP nomogram model in children with lobar pneumonia, and ROC curve was drawn to verify the accura?cy of the nomogram model.Results Logistic analysis showed that the age, duration of fever, duration of macrolide use, neutrophil per? centage, C-reactive protein (CRP) level, lactate dehydrogenase (LDH) level, alanine aminotransferase (ALT) level, erythrocyte sedimen?tation rate (ESR) level, D-dimer in the lobar pneumonia group of the modeling group were higher than those in the non-lobar pneumonia group (P<0.05). Among them, the duration of fever (10.10±2.72 vs. 6.36±1.91), the use time of macrolides (5.20±1.59 vs. 3.50±1.02), CRP (35.46±9.73 vs. 13.92±4.06), and D-dimer (0.69 vs. 0.44) were higher. Logistic analysis showed that duration of fever, duration of macrolide use, CRP and D-dimer were risk factors for lobar pneumonia changes in children with MPP (P<0.05). Based on the risk fac?tors, a nomogram model was established with R software, the area under the ROC curve of the modeling group was 0.94 [95%CI: (0.90, 0.98)], and the area under the ROC curve of the validation group was 0.95 [95%CI: (0.92, 0.98)]. The Hosmer-Lemeshow goodness of fit test of the nomogram model showed that the modeling group was (χ2=6.81, P=0.557) and verification group was (χ2=6.50, P=0.591). Conclusion The constructed nomogram model for predicting lobar pneumonia changes in children with MPP has great clinical valueand can guide individualized treatment. |
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