摘要
目的探讨甘油三酯-葡萄糖(TyG)指数与肺炎支原体肺炎(MPP)患儿并发症及不良结局的关联。方法回顾性纳入浙江大学医学院附属儿童医院2023年5月至2024年11月收治的131例入院时急性期MPP住院患儿,按TyG指数中位数分为低TyG指数组(7.27~8.67)和高TyG指数组(8.68~10.09)。通过Logistic回归分析TyG指数与并发症(坏死性肺炎、血栓、低氧血症)及不良结局(支气管镜≥2次、入住PICU、住院时间)的关联,并采用ROC曲线评估预测效能。结果高TyG指数组患儿入院后发热时间为3.00(1.00,4.25)d,总发热时间为10.50(8.00,14.00)d,均显著高于低TyG指数组患儿(H=2.43和2.65,P=0.016和0.009)。高TyG指数组患儿炎症标志物(中性粒细胞百分比、IL-6)水平及并发症(低氧血症、血栓)发生率分别为78.62(62.72,86.48)%、39.10(21.95,71.30)pg/mL、43.75%(21/48)、16.67%(8/48),显著高于低TyG指数组患儿(H=1.89,P=0.005;H=2.11,P=0.039;χ^(2)=18.65,P<0.001;确切概率法,P=0.024)。多因素Logistic回归分析显示,调整了性别、年龄、C反应蛋白、乳酸脱氢酶、D-二聚体后,TyG指数是低氧血症(OR=4.63,95%CI:1.60~13.37)、血栓(OR=5.14,95%CI:1.23~21.42)和入住PICU(OR=6.23,95%CI:1.02~38.20)的独立风险因素。ROC分析提示,TyG指数预测血栓的曲线下面积(AUC)为0.74(95%CI:0.62~0.87),灵敏度77.31%,特异性66.67%。结论TyG指数升高与MPP患儿并发症及不良结局风险显著相关,对血栓和低氧血症具有独立预测价值,或可作为早期不良结局的分层指标。
Objective To investigate the association between the triglyceride-glucose(TyG)index and complications and adverse outcomes in children with Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 131 hospitalized children with acute-phase MPP at the Zhejiang University Children’s Hospital from May 2023 to November 2024 were retrospectively enrolled.Based on the median level of TyG index,they were stratified into low TyG index groups(7.27-8.67)and high TyG index groups(8.68-10.09).Multivariate Logistic regression were used to analyze the associations between the TyG index and complications(necrotizing pneumonia,thrombosis,hypoxemia)or adverse outcomes(≥2 bronchoscopies,PICU admission,prolonged hospitalization).ROC curves were used to evaluate the predictive performance.Results In the high TyG index group,the fever duration after admission and the total fever duration were 3.00(1.00,4.25)days and 10.50(8.00,14.00)days,respectively,which were both significantly higher than those in the low TyG index group(H=2.43 and 2.65,P=0.016 and 0.009).The levels of inflammatory markers(neutrophil percentage,IL-6)and the incidence of complications(hypoxemia,thrombosis)in the high TyG index group were 78.62(62.72,86.48)%,39.10(21.95,71.30)pg/mL,43.75%(21/48),and 16.67%(8/48),respectively,which were significantly higher than those in the low TyG index group(H=1.89,P=0.005;H=2.11,P=0.039;χ^(2)=18.65,P<0.001;Fisher's exact test,P=0.024).Multivariate Logistic regression demonstrated that after adjusting for gender,age,C-reactive protein,lactate dehydrogenase,and D-dimer,TyG index was independent risk factor for hypoxemia(OR=4.63,95%CI:1.60-13.37),thrombosis(OR=5.14,95%CI:1.23-21.42),and PICU admission(OR=6.23,95%CI:1.02-38.20).ROC analysis showed that the area under the curve(AUC)of TyG index for predicting thrombosis was 0.74(95%CI:0.62-0.87),with a sensitivity of 77.31%and a specificity of 66.67%.Conclusions Elevated TyG index is significantly associated with complications and adverse outcomes in MPP children,demonstrating independent predictive value for thrombosis and hypoxemia,suggesting its potential as an early stratification marker for adverse clinical progression.
作者
王群
张熙
章虎
张贤丽
杨鑫月
王李佳
黄丽素
Wang Qun;Zhang Xi;Zhang Hu;Zhang Xianli;Yang Xinyue;Wang Lijia;Huang Lisu(Department of Infectious Disease,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Pediatric Infectious Disease,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Infectious Disease,Children's Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Pediatrics,the Second Hospital of Yinzhou District,Ningbo 315010,China;Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China)
出处
《国际流行病学传染病学杂志》
2025年第3期172-180,共9页
International Journal of Epidemiology and Infectious Disease
基金
浙江省科技计划(2024C03178)。
关键词
肺炎支原体肺炎
甘油三酯-葡萄糖指数
不良结局
儿童
Mycoplasma pneumoniae pneumonia
Triglyceride-glucose index
Adverse outcomes
Children
