摘要
目的 探讨肺炎支原体肺炎（MPP）患儿复发喘息的影响因素，并构建风险预测模型。方法 选取349例MPP患儿，根据MPP患儿复发喘息情况将其分为复发喘息组121例和非复发喘息组228例。比较两组的临床资料，包括性别、年龄、个人过敏史、家族过敏史、白细胞计数（WBC）、嗜酸性粒细胞（EOS）、中性粒细胞（NEUT）、淋巴细胞（LYMPH）、单核细胞（MONO）、免疫球蛋白E（IgE）。采用多因素Logistic回归分析复发喘息的影响因素，并构建风险预测模型，Homser-Lemeshow检验拟合优度，绘制受试者工作特征（ROC）曲线评估模型预测效能。结果 与非复发喘息组比较，复发喘息组性别、年龄、个人过敏史、家族过敏史、WBC、EOS、LYMPH、MONO、IgE比例高（P<0.05）。多因素Logistic回归分析显示个人过敏史、家族过敏史、WBC、EOS、LYMPH是MPP患儿复发喘息的独立危险因素（P<0.05）。预测模型Homser-Lemeshow检验有较好的拟合优度（χ2=4.801，P=0.779），模型预测患儿复发喘息的曲线下面积为0.89，敏感度为0.79，特异度为0.85。结论 依据个人过敏史、家族过敏史、WBC、EOS、LYMPH影响因素构建的风险预测模型对患儿复发喘息具有优良的预测效能。
关键词： 肺炎支原体肺炎；风险预测模型；复发喘息
Abstract
Objective To investigate the influencing factors of recurrent wheezing in children with Mycoplasma pneumoniae pneumonia (MPP) and construct a risk prediction model. Methods A total of 349 children with MPP were enrolled and divided into a recurrent wheezing group (121 cases) and a non-recurrent wheezing group (228 cases) based on wheezing recurrence. Clinical data including gender, age, personal allergy history, family allergy history, white blood cell count (WBC), eosinophils (EOS), neutrophils (NEUT), lymphocytes (LYMPH), monocytes (MONO), and immunoglobulin E (IgE) were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent influencing factors, followed by the construction of a risk prediction model. The Hosmer-Lemeshow test was used to evaluate goodness-of-fit, and the receiver operating characteristic (ROC) curve was plotted to assess the predictive efficacy. Results Compared with the non-recurrent wheezing group, the recurrent wheezing group showed higher proportions of male gender, younger age, personal allergy history, family allergy history, WBC, EOS, LYMPH, MONO, and IgE (P<0.05). Multivariate analysis identified personal allergy history, family allergy history, WBC, EOS, and LYMPH as independent risk factors for recurrent wheezing (P<0.05). The Hosmer-Lemeshow test demonstrated good model fit (χ²=4.801, P=0.779). The area under the ROC curve was 0.89, with sensitivity of 0.79 and specificity of 0.85. Conclusion The risk prediction model incorporating personal allergy history, family allergy history, WBC, EOS, and LYMPH exhibits excellent predictive efficacy for recurrent wheezing in MPP children.
Key words： Mycoplasma pneumoniae pneumonia; Risk prediction model; Recurrent wheezing
参考文献 References
[1] 黎芮彤,岳玉川,谷续洁,等. 儿童难治性肺炎支原体肺炎风险预测模型的系统评价[J]. 中国全科医学,2025, 28(9): 1105-1114.
[2] 李娜,徐香琴,丘国清,等.肺炎支原体肺炎所致难治性哮喘临床特点及危险因素分析[J].中国实用医药,2022, 17(26): 32-35.
[3] Sun H, Li S, Wang T, et al. Mycoplasma Pneumoniae Infection and Persistent Wheezing in Young Children: A Retrospective Case-Control Study[J]. Front Pediatr, 2022, 10:811086.
[4] Ha EK, Jin JO, Kim JH, et al. Age-related effects of Mycoplasma pneumoniae infectionand subsequent asthma exacerbation in children[J]. Pediatr Pulmonol, 2024,59(6): 1569-1577.
[5] 李霞.小儿喘息性肺炎发作与肺炎支原体感染及过敏的关系探索[J].按摩与康复医学,2021,12(10):77-78.
[6] 饶树考,林传良.特应性体质儿童肺炎支原体肺炎临床特征及治疗分析[J].福建医药杂志,2021,43(01):95-99.
[7] Cottin V. Eosinophilic Lung Diseases[J].Immunol Allergy Clin North Am, 2023,43(2):289-322.
[8] Jackson DJ, Akuthota P, Roufosse F. Eosinophils and eosinophilic immune dysfunction in health and disease[J]. Eur Respir Rev, 2022,31(163):210150.
[9] 杨晓琳,杨妍.肺炎支原体感染合并喘息性支气管肺炎患儿临床特征[J].临床荟萃,2024,39(09):808-811.
[10] Tsai TA, Tsai CK, Kuo KC, et al. Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children[J]. J Microbiol Immunol Infect, 2021,54(4):557-565.
[11] 郑丹丹,马金海.肺炎支原体感染后喘息患儿淋巴细胞亚群及细胞因子变化的研究[J].生命科学仪器,2024, 22(05): 67-69.
[12] Sun L, Su Y, Jiao A, et al. T cells in health and disease[J]. Signal Transduct Target Ther, 2023,8(1):235.
[13] Wik JA, Skålhegg BS. T Cell Metabolism in Infection[J]. Front Immunol, 2022,13:840610.
[14] 曾敏.小儿肺炎支原体肺炎诊治的研究进展[J].中国社区医师,2023,39(14):4-6.
[15] 刘瀚旻,马融.儿童肺炎支原体肺炎中西医结合诊治专家共识（2023年）[J].中国实用儿科杂志,2024,39(03):161-167+222.
[16] 王凯丽.CRP、PCT和肺炎支原体抗体IgM在支原体肺炎患儿诊治中的应用[J].黑龙江医药科学,2023, 46(02): 131-132+134.