关键词: 儿童, 肺炎支原体肺炎, 重症化, 列线图

Abstract:

Objective　To analyze the influencing factors of severe Mycoplasma pneumoniae pneumonia (MPP) in children and to construct a nomogram model based on these factors. Method　A retrospective analysis was conducted on the clinical data of 246 children with MPP admitted to Xi'an Children's Hospital from February 2022 to May 2024. Based on the progression of the disease, the children were divided into a severe group (54 cases) and a non-severe group (192 cases). The severe group included 34 males and 20 females, with an average age of (7.56±2.32) years and a disease duration of (8.11±1.42) days; the non-severe group included 110 males and 82 females, with an average age of (8.11±2.74) years and a disease duration of (7.85±1.35) days. General data were compared between the two groups, and multivariate logistic regression analysis was used to identify the influencing factors for the severe progression of MPP. Additionally, the R 3.4.3 software was used to create a nomogram model for predicting severe MPP. The internal validation of the model was primarily conducted using the Bootstrap method, while the calibration and predictive performance were assessed using calibration curves and the receiver operating characteristic (ROC) curve. Statistical analysis was performed using χ² tests and t tests. Results　The levels of C-reactive protein (CRP), interleukin-2 (IL-2), procalcitonin (PCT), lactate dehydrogenase (LDH), D-dimer (D-D), and erythrocyte sedimentation rate (ESR) in the severe group were higher than those in the non-severe group [ (10.81±3.22) mg/L vs. (7.73±2.54) mg/L, (3.98±0.83) ng/L vs. (3.55±0.72) ng/L, (0.58±0.11) µg/L vs. (0.26±0.06) µg/L, (365.65±115.52) U/L vs. (252.36±75.36) U/L, (3.25±1.02) mg/L vs. (2.62±0.87) mg/L, (46.32±13.65) mm/h vs. (33.25±11.01) mm/h], with statistically significant differences (t=7.399, 3.746, 28.150, 8.582, 4.521, 7.293, all P<0.001). Multivariate logistic regression analysis indicated that elevated levels of CRP, IL-2, PCT, LDH, D-D, and ESR were all risk factors for severe MPP in children (all P<0.05). The consistency index (C-index) of the nomogram prediction model constructed based on these factors, validated by the Bootstrap method, was 0.934, and the calibration curve showed good fit with the ideal curve. The ROC analysis indicated that the area under the curve (AUC), sensitivity, and specificity of the nomogram model for predicting severe MPP were 0.911, 93.75%, and 85.94%, respectively. Conclusion　The elevated levels of CRP, IL-2, PCT, LDH, D-D and ESR are all risk factors of severity of MPP in children, and the nomogram model constructed based on the above influence factors has good predictive efficacy, and it can provide reference for clinical prevention and treatment to improve the prognosis of children.

Key words: Children,  , Mycoplasmal pneumoniae pneumonia,  , Severe,  , Nomogram