基于影像学和临床严重度分类的2054例儿童肺炎支原体肺炎的临床特征及危险因素研究OA

Objective To investigate the clinical characteristics and risk factors of Mycoplasma pneumoniae pneu-monia(MPP)in children based on a dual classification integrating imaging features and clinical severity.Meth-ods Medical records of 2 054 pediatric patients with MPP were retrospectively analyzed.The cohort was stratified into severe consolidation(n=253),severe non-consolidation(n=118),non-severe consolidation(n=393),and non-severe non-consolidation groups(n=1 290)based on clinical and radiological findings.Inter group data and characteristics were compared and multiple regression analysis was conducted to construct a prediction model for se-vere consolidation group.Results Significant differences were observed among the groups in terms of age,dura-tion of fever,length of hospital stay,presence of pulmonary rales,inflammatory markers[C-reactive protein(CRP)and lactate dehydrogenase(LDH)],the use of hormones,and bronchoscopic treatment(all P<0.05).Compared with the severe non-consolidation group,non-severe consolidation group,and non-severe non-consolidation group,children in severe consolidation group exhibited the longest duration of fever[8(6,11)days vs 6(2,9),7(6,9)and 6(3,8)days,respectively]and the longest length of hospital stay[7(5,8)days vs 6(5,8),6(5,8)and 6(4,7)days,respectively].They also had the highest incidence of reduced breath sounds[34 cases(13.4%)vs 2 cases(1.7%),29 cases(7.4%)and 13 cases(1.0%),respectively]and a substan-tially higher rate of coinfections,particularly viral infections[63 cases(24.9%)vs 23 cases(19.5%),60 cases(15.3%)and 190 cases(14.7%),respectively].Multivariate analysis indicated that the independent risk factors for severe MPP(SMPP)were age>4.5 years,length of hospital stay>6.5 days,reduced breath sounds,neutrophil-to-lymphocyte ratio(NLR)>1.66,LDH>370.5 U/L,CRP>9.5 mg/L,and coinfection with vi-ruses.Reduced breath sounds(OR=5.58,95%CI:2.45-12.69)and coinfection with bacteria(OR=3.11,95%CI:1.43-6.75)were identified as the most significant risk factors for pulmonary consolidation in non-severe MPP children.Additionally,reduced breath sounds,coinfection with viruses,LDH>365.5 U/L,and CRP>32.1 mg/L were risk factors for severe pneumonia in children with pulmonary consolidation.For non-consolidation MPP children,the presence of pulmonary dry rales(OR=2.28,95%CI:1.46-3.56)was the primary indepen-dent risk factor for the development of severe pneumonia.Conclusion The chest imaging findings of MPP are asso-ciated with clinical severity,and the risk factor model constructed based on this imaging-clinical classification can assist in achieving precise hierarchical diagnosis and treatment in clinical practice.