儿童大环内酯类药物无反应性肺炎支原体肺炎合并塑型性支气管炎的危险因素分析及列线图构建

Risk factors for plastic bronchitis in children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia and establishment of a nomogram model

摘要:

目的 分析大环内酯类药物无反应性肺炎支原体肺炎（macrolide-unresponsive Mycoplasma pneumoniae pneumonia, MUMPP）患儿合并塑型性支气管炎（plastic bronchitis, PB）的危险因素，构建列线图预测模型。方法 回顾性纳入2023年1—12月接受支气管镜治疗的178例MUMPP患儿为研究对象，根据是否合并PB分为PB组（n=49）和非PB组（n=129），分析MUMPP患儿合并PB的预测因子，并构建列线图预测模型，以及对模型区分度、准确度及临床有效性进行检验。结果 多因素logistic回归分析显示年龄较大、高乳酸脱氢酶、高纤维蛋白原与MUMPP患儿发生PB密切相关（P<0.05）。纳入上述指标构建列线图模型，该模型曲线下面积为0.733（95%CI：0.651~0.816，P<0.001），有较好区分度；Hosmer-Lemeshow拟合优度检验显示该预测模型有较好的拟合度（P>0.05）；决策曲线分析表明模型具有良好的临床应用价值。结论 由年龄、乳酸脱氢酶、纤维蛋白原构建的预测MUMPP患儿发生PB的风险列线图模型具有较好的区分度与准确度，预测效能良好。

Abstract:

Objective To investigate the risk factors for plastic bronchitis (PB) in children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) and to establish a nomogram prediction model.Methods A retrospective analysis was conducted on 178 children with MUMPP who underwent bronchoscopy from January to December 2023. According to the presence or absence of PB, the children were divided into a PB group (49 children) and a non-PB group (129 children). The predictive factors for the development of PB in children with MUMPP were analyzed, and a nomogram prediction model was established. The model was assessed in terms of discriminatory ability, accuracy, and clinical effectiveness.Results The multivariate logistic regression analysis showed that older age and higher levels of lactate dehydrogenase and fibrinogen were closely associated with the development of PB in children with MUMPP (P<0.05). A nomogram model established based on these factors had an area under the receiver operating characteristic curve of 0.733 (95%CI: 0.651-0.816, P<0.001) and showed a good discriminatory ability. The Hosmer-Lemeshow goodness-of-fit test indicated that the predictive model had a good degree of fit (P>0.05), and the decision curve analysis showed that the model had a good clinical application value.Conclusions The risk nomogram model established based on age and lactate dehydrogenase and fibrinogen levels has good discriminatory ability, accuracy, and predictive efficacy for predicting the development of PB in children with MUMPP.