摘要
目的探究外周血白细胞介素(IL)-6、IL-18、IL-1β、肿瘤坏死因子(TNF)-α、降钙素原(PCT)、C-反应蛋白(CRP)、血管细胞黏附分子-1(VCAM-1)水平与支原体肺炎(MPP)患儿病情及预后的关系,并构建预测模型。方法选取2022年1月-2024年1月四川省达州市中心医院收治的MPP患儿196例设为MPP组,根据临床肺部感染评分(CPIS)分为轻症组(n=124)及重症组(n=72),另外纳入同期于医院参加健康体检的健康儿童200名设为健康组。196例MPP患儿均接受相关治疗,根据其预后情况划分为预后不良组(n=40)及预后良好组(n=156)。检测全部研究对象的外周血IL-6、IL-18、IL-1β、TNF-α、PCT、CRP、VCAM-1水平,分析影响MPP患儿病情及预后的危险因素,并构建预测模型,绘制受试者工作特征(ROC)曲线以及计算曲线下面积(AUC)评估所构建预测模型的预测效果。结果MPP组外周血IL-6、IL-18、IL-1β、TNF-α、PCT、CRP、VCAM-1水平高于健康组(P<0.05);重症组外周血IL-6、IL-18、IL-1β、TNF-α、PCT、CRP、VCAM-1水平高于轻症组(P<0.05);IL-6(OR=1.203)、IL-18(OR=1.072)、IL-1β(OR=4.060)、TNF-α(OR=1.264)、PCT(OR=3.132)、CRP(OR=1.546)、VCAM-1(OR=1.009)是MPP患儿出现重症的危险因素(P<0.05);构建的MPP患儿出现重症的预测模型为,Logit(P)=-67.522+0.185×IL-6+0.069×IL-18+1.401×IL-1β+0.234×TNF-α+1.142×PCT+0.436×CRP+0.009×VCAM-1。预测模型预测MPP患儿出现重症的AUC为0.985;预后不良组外周血IL-6、IL-18、IL-1β、TNF-α、PCT、CRP、VCAM-1水平高于预后良好组(P<0.05);IL-6(OR=1.083,95%CI:1.024~1.145,P=0.005)、TNF-α(OR=1.083,95%CI:1.002~1.172,P=0.046)、VCAM-1(OR=1.029,95%CI:1.015~1.044,P<0.001)是MPP患儿预后不良的危险因素;构建的MPP患儿出现预后不良的预测模型为,Logit(P)=-31.557+0.080×IL-6+0.080×TNF-α+0.029×VCAM-1;预测模型预测MPP患儿出现预后不良的AUC为0.979。结论外周血IL-6、IL-18、IL-1β、TNF-α、PCT、CRP、VCAM-1水平与MPP患儿病情程度密切相关;基于以上指标构建的预测模型能预测MPP患儿出现重症的风险,基于IL-6、TNF-α、VCAM-1构建的预测模型能预测MPP患儿出现预后不良的风险。
OBJECTIVE To explore the relationship between levels of peripheral blood interleukin(IL)-6,IL-18,IL-1β,tumor necrosis factor(TNF-α),procalcitonin(PCT),C-reactive protein(CRP)and vascular cell adhesion molecule-1(VCAM-1)and disease condition and prognosis in children with Mycoplasma pneumoniae pneumonia(MPP),and to construct a prediction model.METHODS A total of 196 children with MPP admitted to Dazhou Central Hospital in Sichuan Province from Jan.2022 to Jan.2024 were selected as the MPP group and were divided into the mild group(n=124)and the severe group(n=72)according to the clinical pulmonary infection score(CPIS),and 200 healthy children who participated in physical examination in the hospital during the same period were selected as the healthy group.All 196 children with MPP received relevant treatments and were divided into a poor prognosis group(n=40)and a good prognosis group(n=156)according to their prognosis.The levels of peripheral blood IL-6,IL-18,IL-1β,TNF-α,PCT,CRP and VCAM-1 were measured in all the subjects,the risk factors affecting the disease condition and prognosis of children with MPP were analyzed,the prediction model was constructed,and the receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate the predictive effect of the constructed prediction model.RESULTS Peripheral blood IL-6,IL-18,IL-1β,TNF-α,PCT,CRP and VCAM-1 levels in the MPP group were higher than those in the healthy group(P<0.05).The levels of IL-6,IL-18,IL-1β,TNF-α,PCT,CRP and VCAM-1 in peripheral blood were significantly higher in the severe group than those in the mild group(P<0.05).IL-6(OR=1.203),IL-18(OR=1.072),IL-1β(OR=4.060),TNF-α(OR=1.264),PCT(OR=3.132),CRP(OR=1.546)and VCAM-1(OR=1.009)were risk factors for severe condition in MPP children(P<0.05).The prediction model constructed for the devel-opment of severe illness in MPP children was as follows:Logit(P)=-67.522+0.185×IL-6+0.069×IL-18+1.401×IL-1β+0.234×TNF-α+1.142×PCT+0.436×CRP+0.009×VCAM-1.The AUC of the prediction model for predicting severe conditions in MPP children was 0.985.The levels of IL-6,IL-18,IL-1β,TNF-α,PCT,CRP and VCAM-1 in peripheral blood in the poor prognosis group were higher than those in the good prognosis group(P<0.05).IL-6(OR=1.083,95%CI:1.024-1.145,P=0.005),TNF-α(OR=1.083,95%CI:1.002-1.172,P=0.046)and VCAM-1(OR=1.029,95%CI:1.015-1.044,P<0.001)were risk factors for poor prognosis in MPP children.The prediction model established for poor prognosis in children with MPP was as follows:logit(P)=-31.557+0.080×IL-6+0.080×TNF-α+0.029×VCAM-1.The AUC of the prediction model for predicting poor prognosis in MPP children was 0.979.CONCLUSIONS The levels of IL-6,IL-18,IL-1β,TNF-α,PCT,CRP and VCAM-1 in pe-ripheral blood are closely related to the severity of illness in children with MPP.The prediction model constructed on the basis of the above indicators predicts the risk of severe disease in children with MPP,and the prediction model constructed on the basis of IL-6,TNF-αand VCAM-1 predicts the risk of poor prognosis in children with MPP.
作者
彭娜
马洪梅
邓春晖
谭静
邹红
PENG Na;MA Hongmei;DENG Chunhui;TAN Jing;ZOU Hong(Dazhou Central Hospital,Dazhou,Sichuan 635000,China)
出处
《中华医院感染学杂志》
北大核心
2025年第11期1674-1678,共5页
Chinese Journal of Nosocomiology
基金
重庆市科卫联合医学基金资助项目(2022MSXM020)。
关键词
支原体肺炎
儿童
危险因素
病情
预后
预测模型
Mycoplasma pneumoniae pneumonia
Children
Risk factor
Disease condition
Prognosis
Prediction model
