摘要
目的探究儿童流感后出现细菌性肺炎的独立危险因素,建立临床预测模型,以便早期识别出高危儿童。方法回顾性选择2023年1月-2024年5月重庆市高新区人民医院儿科收治的315例流感住院患儿,根据是否继发细菌性肺炎分为肺炎组(105例)和非肺炎组(210例)。收集患儿临床资料,用单因素、多因素Logistic回归分析筛选独立危险因素,并建立列线图预测模型。用Bootstrap法做内部验证,用ROC曲线来评价模型的区分度。结果年龄小于3岁、抗病毒治疗时间超过48小时、有基础疾病、高热(39℃以上)和炎症指标(中性粒细胞比例、CRP、PCT)升高与继发肺炎有关(P<0.05)。经过多因素分析得到年龄≤3岁(OR=2.85,95%CI:1.62-5.01)、延迟抗病毒治疗(OR=3.42,95%CI:1.98-5.91)、有基础病(OR=2.51,95%CI:1.38-4.55)、CRP≥40mg/L(OR=4.18,95%CI:2.38-7.33)是独立危险因素。由此建立的预测模型AUC值为0.846,95%可信区间为0.802-0.890,内部验证证明模型有良好的校准度。结论年龄小、延迟抗病毒治疗、有基础疾病和高CRP水平为流感患儿继发细菌性肺炎的独立危险因素。建立的临床预测模型有较好的预测效能,可早期发现高危患儿,指导临床干预。
Objective To explore the independent risk factors for bacterial pneumonia in children after influenza and establish a clinical prediction model in order to identify high-risk children at an early stage.Methods A retrospective selection was made of 315 hospitalized children with influenza admitted to the Pediatrics Department of Chongqing High-tech Zone People’s Hospital from January 2023 to May 2024.They were divided into the pneumonia group(105 cases)and the non-pneumonia group(210 cases)based on whether secondary bacterial pneumonia occurred.Clinical data of the children patients were collected.Independent risk factors were screened by univariate and multivariate Logistic regression analyses,and a nomogram prediction model was established.Internal validation was conducted using the Bootstrap method,and the ROC curve was used to evaluate the discrimination of the model.Results Age less than 3 years old,antiviral treatment duration exceeding 48 hours,underlying diseases,high fever(above 39℃),and elevated inflammatory indicators(neutrophil ratio,CRP,PCT)were associated with secondary pneumonia(P<0.05).Through multivariate analysis,it was found that the age was≤3 years old(OR=2.85,95%CI:1.62-5.01),delayed antiviral treatment(OR=3.42,95%CI:1.98-5.91),and had underlying diseases(OR=2.51,95%CI:1.38-4.55),CRP≥40mg/L(OR=4.18,95%CI:2.38-7.33)was an independent risk factor.The AUC value of the prediction model established thereby is 0.846,and the 95%confidence interval is from 0.802 to 0.890.Internal validation proves that the model has good calibration.Conclusion Young age,delayed antiviral treatment,underlying diseases and high CRP levels are independent risk factors for secondary bacterial pneumonia in children with influenza.The established clinical prediction model has good predictive efficacy,can detect high-risk children at an early stage,and guide clinical intervention.
作者
费勇
夏爽
Fei Yong;Xia Shuang(Chongqing High-tech Zone People’s Hospital,Chongqing 400050,China;Jiulongpo District Erlang Sub-district Community Health Service Center,Chongqing 400038,China)
出处
《首都食品与医药》
2026年第4期52-54,共3页
Capital Food Medicine
