基于中医证型及临床指标构建儿童肺炎支原体肺炎发展为重症的预测模型OA
Construction of a Predictive Model for Mycoplasma pneumoniae Pneumonia in Children Developing into Severe MPP Based on TCM Syndromes and Clinical Indicators
目的 分析儿童肺炎支原体肺炎(MPP)发展为重症的危险因素,并构建列线图预测模型.方法 采用回顾性队列研究,纳入2024年1月1日-12月31日北京市顺义区妇幼保健院中医儿科门诊首次诊断为MPP患儿的中医证型及临床资料,根据最终是否发展为重症肺炎支原体肺炎(SMPP)分为轻症组和重症组,比较2组患儿性别、年龄、中医证型、咳嗽天数、发热天数、高热天数、中性粒细胞计数、C反应蛋白(CRP)、血清淀粉样蛋白A、胸片评分等13个指标,将单因素分析有意义的指标纳入二元Logistic回归进行多因素分析,以明确独立危险因素并构建列线图预测模型,采用受试者工作特征曲线、校准曲线、Hosmer-Lemeshow拟合优度检验、决策曲线分析评价列线图.结果 最终纳入患儿307例,其中轻症组222例、重症组85例,中医证型为痰热闭肺证(aOR=3.246,95%CI:1.018～10.355,P=0.047)、高热天数(aOR=2.362,95%CI:1.641～3.402,P<0.001)、胸片评分(aOR=1.657,95%CI:1.288～2.132,P<0.001)及CRP(aOR=1.064,95%CI:1.012～1.118,P=0.015)是MPP发展为SMPP的独立危险因素,而咳嗽天数(aOR=0.618,95%CI:0.461～0.828,P=0.001)表现出保护效应,根据以上5个指标构建的列线图预测模型,经内部验证,具有良好的判别能力、校准度及临床实用性.结论 中医证型(痰热闭肺证)、高热天数、胸片评分及CRP是MPP发展为SMPP的独立危险因素,咳嗽天数为保护因素,在此基础上构建的列线图预测模型有助于临床医生早期识别高危患儿,从而实现精准治疗.
Objective To analyze the risk factors for Mycoplasma pneumoniae pneumonia(MPP)in children developing into severe MPP(SMPP);To construct a nomogram prediction model.Methods A retrospective cohort study was conducted.The TCM syndromes and clinical data of children with MPP diagnosed for the first time in the pediatric outpatient department of Traditional Chinese Medicine of Shunyi Maternal and Children's Hospital of Beijing Children's Hospital from January 1st 2024 to December 31st 2024 were included.According to whether they eventually developed into SMPP,they were divided into general group and severe group.Totally 13 indicators including gender,age,TCM syndrome type,cough days,fever days,high fever days,neutral cell count,CRP,SAA,chest X-ray score were compared between the two groups.The meaningful indicators of univariate analysis were included in binary Logistic regression for multivariate analysis to identify independent risk factors and construct a nomogram prediction model.Receiver operating characteristic curve,calibration curve,Hosmer-Lemeshow goodness of fit test,and decision curve analysis were used to evaluate the nomogram.Results A total of 307 cases were included,including 222 cases in the general group and 85 cases in the severe group.TCM syndrome type of phlegm-heat obstructing lung syndrome(aOR=3.246,95%CI:1.018-10.355,P=0.047),high fever days(aOR=2.362,95%CI:1.641-3.402,P<0.001),chest X-ray score(aOR=1.657,95%CI:1.288-2.132,P<0.001)and CRP(aOR=1.064,95%CI:1.012-1.118,P=0.015)were independent risk factors for MPP to develop into SMPP,while cough days(aOR=0.618,95%CI:0.461-0.828,P<0.001)showed a protective effect.The nomogram prediction model constructed based on the above five indicators had a good discriminant ability,calibration and clinical practicability after internal verification.Conclusion TCM syndrome type(phlegm-heat obstructing lung syndrome),high fever days,chest X-ray score and CRP are independent risk factors for the development of MPP into SMPP,and the number of cough days is a protective factor.The nomogram prediction model constructed on this basis is helpful for clinicians to identify high-risk children early,so as to achieve accurate treatment.
申慧贞;王俊宏;郝静;赵骞;李旭峰;赵磊
北京中医药大学东直门医院,北京 100700北京中医药大学东直门医院,北京 100700国家儿童医学中心/首都医科大学附属北京儿童医院,北京 100045国家儿童医学中心/首都医科大学附属北京儿童医院,北京 100045北京市顺义区妇幼保健院/北京儿童医院顺义妇儿医院,北京 101300北京市顺义区妇幼保健院/北京儿童医院顺义妇儿医院,北京 101300
医药卫生
中医证型临床指标肺炎支原体肺炎重症肺炎支原体肺炎预测模型
TCM syndrome typeclinical indexMycoplasma pneumoniae pneumoniasevere MPPprediction model
《中国中医药信息杂志》 2026 (5)
117-122,6
首都卫生发展科研专项(首发2024-2-2096)
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