摘要
目的 探究小儿支原体肺炎合并腹泻对白细胞介素(IL)-4/IL-6等细胞因子的影响,构建并发腹泻的列线图预测模型,并进行验证。方法 纳入于2021年9月至2023年9月诊治的支原体肺炎患儿为研究对象,采用随机数字表法随机抽取临床资料完整的患儿300例,分为建模集200例及验证集100例;根据是否并发腹泻分为两组,建模集中不腹泻组150例,腹泻组50例;验证集中不腹泻组76例,腹泻组24例,收集临床数据,采用受试者工作特征(ROC)曲线分析连续性变量的预测价值;采用logistic回归分析相关因素;采用R语言构建Nomogram预测模型;采用ROC、校准曲线和决策曲线评价模型;并分析相关细胞因子的变化。结果 与不腹泻组相比,发热峰值≥40℃、低补体状态腹泻组占比更多(P<0.05),病程、发热持续时间、抗生素应用时间、IL-4、IL-6、肿瘤坏死因子-α(TNF-α)水平腹泻组均更大(P<0.05),为危险性因素。由此类因素构建的列线图预测模型区分能力较强且预测小儿支原体肺炎合腹泻风险效果良好,其C指数为0.997(0.992~1.003);且DCA结果显示,当其风险阅值>0.12时,该模型可以较好地提供标准化净收益,模型表现良好。结论 发热峰值是否≥40℃、是否为低补体状态腹泻组更少,病程、发热持续时间、抗生素应用时间、IL-4、IL-6、TNF-α水平为危险性因素,且模型拥有较好的预测能力。
Objective To investigate the effects of mycoplasma pneumonia combined with diarrhea on cytokines such as IL-4 and IL-6 in children,and to construct and validate a nomogram prediction model for the risk of diarrhea in these patients.Methods From September 2021 to September 2023,300 children with mycoplasma pneumonia with complete clinical data were randomly selected using a random number table.They were divided into a modeling cohort(200 cases)and a validation cohort(100 cases).In the modeling cohort,patients were further categorized into a non-diarrhea group(150 cases)and a diarrhea group(50 cases);in the validation cohort,there were 76 non-diarrhea cases and 24 diarrhea cases.Clinical data were collected,and the predictive value of continuous variables was analyzed using receiver operating characteristic(ROC)curve analysis.Logistic regression was applied to identify risk factors,and a nomogram prediction model was constructed using R language.The model's performance was evaluated by ROC curves,calibration curves,and decision curve analysis(DCA).Additionally,changes in relevant cytokine levels were analyzed.Results Compared with the non-diarrhea group,the diarrhea group had a significantly higher proportion of patients with peak fever≥40℃and a lower proportion with low complement status(P<0.05).Moreover,the diarrhea group exhibited a longer disease course,prolonged fever duration,extended antibiotic application time,and higher levels of interleukin(IL)-4,IL-6,and tumor necrosis factor-α(TNF-α)(P<0.05),all of which were identified as risk factors.The constructed nomogram demonstrated excellent discrimination,with a C-index of 0.997(95%CI:0.992-1.003).Decision curve analysis indicated that when the risk threshold was>0.12,the model provided substantial net clinical benefit.Conclusion In children with mycoplasma pneumonia,the presence of peak fever≥40℃,absence of low complement status,longer disease duration,extended fever and antibiotic treatment,and elevated levels of IL-4,IL-6,and TNFαare associated with an increased risk of diarrhea.The nomogram prediction model shows excellent predictive capability and may serve as a valuable tool for early identification and risk stratification in clinical practice.
作者
赵婵
高原
ZHAO Chan;GAO Yuan(Medlicul Department,Jinhua CentralHospital,Jinhua 321000,Zhejiang,China;不详)
出处
《广东医学》
2025年第5期653-658,共6页
Guangdong Medical Journal
基金
金华市重点科学技术研究项目(2022-3-081,2021-3-128)。
