难治性肺炎支原体肺炎患儿合并栓塞的危险因素分析及列线图预测模型的构建

Risk factors for embolism in children with refractory Mycoplasma pneumoniae pneumonia and construction of a nomogram model for prediction of embolism

摘要:

目的 分析难治性肺炎支原体肺炎（refractory Mycoplasma pneumoniae pneumonia, RMPP）患儿合并栓塞的危险因素，并构建列线图预测模型。方法 回顾性纳入2019年1月—2023年10月在郑州大学附属儿童医院确诊为RMPP的175例患儿，根据是否合并栓塞，分为栓塞组（n=62）和非栓塞组（n=113），采用多因素logistic回归分析筛选RMPP患儿合并栓塞的危险因素，并应用R软件构建列线图预测模型。结果 多因素logistic回归分析显示，高D-二聚体、高白细胞介素-6、高中性粒细胞与淋巴细胞比值、肺坏死、胸腔积液是RMPP合并栓塞的危险因素（P<0.05）。根据上述危险因素构建列线图模型的曲线下面积为0.912（95%CI：0.871~0.952，P<0.05）。Hosmer-Lemeshow拟合优度检验结果表明，该模型与实际情况拟合较好（P<0.05）。校准曲线和决策曲线结果显示，该模型的预测效能和临床应用价值较高。结论 高D-二聚体、高白细胞介素-6、高中性粒细胞与淋巴细胞比值、肺坏死、胸腔积液是RMPP合并栓塞的危险因素，根据上述危险因素构建列线图模型用于预测RMPP合并栓塞具有较高的临床价值。

Abstract:

Objective To study the risk factors for embolism in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and to construct a nomogram model for prediction of embolism.Methods This retrospective study included 175 children diagnosed with RMPP at Children's Hospital Affiliated to Zhengzhou University from January 2019 to October 2023. They were divided into two groups based on the presence of embolism: the embolism group (n=62) and the non-embolism group (n=113). Multivariate logistic regression analysis was used to screen for risk factors of embolism in children with RMPP, and the R software was applied to construct the nomogram model for prediction of embolism.Results Multivariate logistic regression analysis indicated that higher levels of D-dimer, interleukin-6 (IL-6) and neutrophil to lymphocyte ratio (NLR), lung necrosis, and pleural effusion were risk factors for embolism in children with RMPP (P<0.05). The area under the curve of the nomogram model for prediction of embolism constructed based on the aforementioned risk factors was 0.912 (95%CI: 0.871-0.952, P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good fit with the actual situation (P<0.05). Calibration and decision curve analysis indicated that the model had high predictive efficacy and clinical applicability.Conclusions Higher levels of D-dimer, IL-6 and NLR, lung necrosis, and pleural effusion are risk factors for embolism in children with RMPP. The nomogram model based on these risk factors has high clinical value for predicting embolism in children with RMPP.