摘要
目的探讨儿童难治性肺炎支原体肺炎(RMPP)的临床特征以及维生素D(VD)水平的预测价值。方法选择2019年5月至2022年2月于昆明市儿童医院就诊的肺炎支原体肺炎(MPP)患儿(282例)为研究对象;通过随机化方法分为训练集(188例)和验证集(94例)。采用多因素Logistic回归分析影响RMPP发生的危险因素,建立预测评分模型并评价。采用Logistic回归、限制性立方样条模型和临床决策(DCA)曲线分析VD水平的临床预测价值。结果发热持续时间>7 d、住院时间>7 d、C-反应蛋白(CRP)≥14 mg/L、乳酸脱氢酶(LDH)≥365.2 U/L、VD≤30 ng/mL、白细胞介素-6(IL-6)≥20.4 pg/mL、干扰素-γ(IFN-γ)≥12.2 pg/mL、肺实变,均为RMPP发生的独立危险因素(P<0.05)。模型评价结果显示,该预测评分模型具有较高的精准度,且有效性较好、安全可靠、实用性强。VD连续性变化与RMPP发生概率的关联强度呈非线性剂量反应关系(P<0.01)。VD水平与RMPP发生概率呈显著负相关。DCA曲线分析结果显示,VD水平对预测RMPP发生概率具有重要临床价值。结论VD≤30 ng/mL是儿童RMPP发生的独立危险因素,且二者关联强度呈非线性剂量反应关系。
Objective To explore the clinical characteristics of children’s refractory mycoplasma pneumoniae pneumonia(RMPP)and the predictive value of vitamin D(VD)level.Methods Children with mycoplasma pneumoniae pneumonia(MPP)(282 cases)who visited Kunming Children’s Hospital from May 2019 to February 2022 were selected as the study subjects.It is divided into training set(188 cases)and verification set(94 cases)through randomization.Multifactor Logistic regression was used to analyze the risk factors affecting the occurrence of RMPP,and a predictive scoring model was established and evaluated.Logistic regression,restricted cubic spline model and decision curve analysis(DCA)were used to ana lyze the clinical predictive value of VD level.Results Fever duration>7 d,hospital stay>7 d,C-reactive protein(CRP)≥14 mg/L,lactate dehydrogenase(LDH)≥365.2 U/L,VD≤30 ng/mL,interleukin-6(IL-6)≥20.4 pg/mL,interferon-γ(IFN-γ)≥12.2 pg/mL and pulmonary consolidation were independent risk factor for RMPP(P<0.05).The model evaluation results show that the prediction scoring model has high accuracy,good effectiveness,safety,reliability and practicability.There was a nonlinear dose-response relationship between the continuous change of VD and the incidence probability of RMPP(P<0.01).There was a significant negative correlation between VD level and the occurrence probability of RMPP.DCA curve analysis showed that VD level had important clinical value in predicting the probability of RMPP.Conclusion VD≤30 ng/mL is an independent risk factor for RMPP in children,and the correlation intensity between them is nonlinear dose response relationship.
作者
杨燕飞
范娜
刘兴祝
吴玉芹
YANG Yanfei;FAN Na;LIU Xingzhu;WU Yuqin(Special Need Ward of Kunming Children’s Hospital,Kunming,Yunnan 650000,China)
出处
《中国优生与遗传杂志》
2023年第7期1414-1419,共6页
Chinese Journal of Birth Health & Heredity
基金
昆明市卫生健康委员会卫生科研课题项目(2022-06-01-005)。
关键词
维生素D
难治性肺炎支原体肺炎
儿童
决策曲线分析
剂量反应分析
vitamin D
refractory Mycoplasma pneumoniae pneumonia
child
decision curve analysis
dose-response analysis
