目的 筛选可用于区分儿童支原体肺炎(MPP)及难治性支原体肺炎(RMPP)的危险因素,确定预测RMPP的联合因子,为RMPP患儿定制精准治疗和用药方案提供依据。方法 纳入2016年1月1日—2018年12月31日期间入住首都医科大学附属北京朝阳医院儿科的141例MPP患儿,收集临床资料及实验室检查数据。按照前3天治疗效果分为MPP组和RMPP组。通过单因素分析初步筛选出与RMPP有关的危险因素,再建立多因素Logistic回归模型并经逐步回归筛选出独立危险因素,绘制联合因子的受试者工作特征曲线(ROC)进行预测效能分析。结果 本研究纳入141例,其中MPP85例,RMPP56例。单因素分析结果显示,年龄、胸腔积液、咳嗽持续时间、C反应蛋白(CRP)、红细胞沉降率(ESR)、淋巴细胞计数(LY)、淋巴细胞百分比(LY%)在MPP组与RMPP组间差异有统计学意义(P<0.05)。最终将胸腔积液、发热持续时间、咳嗽持续时间、CRP和LY%作为联合因子建立RMPP预测模型,AUC为0.834(95%CI:0.768～0.900),Youden指数最大为0.522,敏感性为80.4%,特异性为71.8%。结论 本研究为RMPP患儿构建了合并胸腔积液、发热持续时间、咳嗽持续时间、CRP和LY%指标的联合预测模型,对于RMPP的预测诊断和糖皮质激素的使用具有临床指导意义。

Objective To study the risk factors that can be used to distinguish children's refractory mycoplasma pneumonia (RMPP) from mycoplasma pneumonia (MPP),thus to determine the combined predictors for predicting RMPP,so as to provide basis for customizing accurate treatment and medication plan for RMPP children. Methods A total of 141 children with MPP admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 1st,2016 to December 31st,2018 were included,and clinical data and laboratory examination data were collected. The patients were divided into MPP group and RMPP group according to the therapeutic efficacy of the first 3 days. The risk factors related to RMPP were preliminarily screened out by univariate analysis,and a multivariate Logistic regression model was established and independent risk factors were selected through stepwise regression. Finally,the receiver operating characteristic curve (ROC) of combined factors was drawn for prediction efficiency analysis. Results There were 85 cases of MPP and 56 cases of RMPP among 141 children.Age,pleural effusion,cough duration,C-creactive protein (CRP),erythrocyte sedimentation rate (ESR),lymphocyte count (LY)and percentage of lymphocytes (LY%) were significantly different between MPP group and RMPP group (P<0.05). Pleural effusion,fever duration,cough duration,CRP and LY% finally entered the prediction model of RMPP,with AUC of 0.834(95%CI:0.768—0.900),Youden index of 0.522 at the maximum. And the sensitivity and specificity were 80.4% and 71.8%,respectively. Conclusion This study constructs a combined model for predicting RMPP with pleural effusion,fever duration,cough duration,CRP,LY%,which has clinical guiding significance for the predictive diagnosis of RMPP and the use of glucocorticoids.