儿童传染性单核细胞增多症并发肺炎的影响因素分析及列线图模型的建立

杨幸幸; 单鸣凤; 孟慧

doi:10.16766/j.cnki.issn.1674-4152.003294

儿童传染性单核细胞增多症并发肺炎的影响因素分析及列线图模型的建立

doi: 10.16766/j.cnki.issn.1674-4152.003294

南京医科大学附属儿童医院感染科，江苏南京 210008

基金项目:

南京医科大学一般性项目 NMUB2019191

江苏省卫生健康委2020年度医学科研立项项目 Z2020075

详细信息

通讯作者:
孟慧，E-mail：menghui@163.com

中图分类号: R512.7 R725.6
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- 被引次数: 0
出版历程
- 收稿日期: 2023-02-15

Analysis of influencing factors and establishment of nomogram model for pneumonia complications in children with infectious mononucleosis

Department of Infectious Diseases, Children' s Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210008, China

摘要

摘要: 目的构建预测儿童传染性单核细胞增多症(IM)并发肺炎的列线图模型，为儿童IM患者的肺炎筛查提供工具，并评价此模型的区分度与一致性。方法选取2020年1月—2022年1月南京医科大学附属儿童医院收治的272例IM儿童为研究对象，根据是否并发肺炎分为并发肺炎组与未并发肺炎组，比较并发肺炎组与未并发肺炎组的差异；采用logistic回归模型分析儿童IM患者并发肺炎的危险因素，根据所得危险因素采用R软件构建列线图预测模型。结果 272例患儿并发肺炎40例，未发生肺炎232例，肺炎发生率为14.71%(40/272)；与未并发肺炎组相比，并发肺炎组患儿热程、住院时间增长，脾大小增大，PCT、CRP水平升高(均P＜0.05)，预防性使用抗生素比例下降(P＜0.05)；二元logistic回归分析显示，热程长、脾大小增大是儿童IM患者发生肺炎的独立危险因素，预防性使用抗生素是儿童IM患者发生肺炎的保护因素。校准曲线显示斜率接近1。Hosmer-Lemeshow值显示χ²=8.022，P=0.431，提示构建的预测儿童IM患者肺炎发生的列线图模型一致性较好。结论儿童IM患者热程长短、脾大小、是否预防性使用抗生素因素是并发肺炎的影响因素，以此构建的列线图模型可用于预测IM患儿并发肺炎的风险程度。
- 儿童传染性单核细胞增多症 /
- EB病毒 /
- 肺炎 /
- 危险因素 /
- 列线图
Abstract: Objective To develop a nomograph model for predicting pneumonia in children with infectious mononucleosis (IM), offering a valuable screening tool for identifying pneumonia in this population. Additionally, to assess the model' s ability to differentiate and maintain consistency in predicting pneumonia cases. Methods A total of 272 children with IM who were admitted to Department of Infectious Diseases, Children' s Hospital Affiliated to Nanjing Medical University hospital from January 2020 to January 2022 were enrolled in this study. The study population was divided into two groups based on the presence or absence of pneumonia. A comparative analysis was performed to identify significant differences between the pneumonia group and the non-pneumonia group. Logistic regression model was employed to analyze the risk factors contributing to pneumonia in children with IM. Subsequently, using the identified risk factors, a nomogram prediction model was constructed using R software. Results Among the 272 patients included in the study, 40 were diagnosed with pneumonia while 232 did not have pneumonia. The overall incidence of pneumonia in children with IM was found to be 14.71% (40/272). Compared with the group without pneumonia, the children with pneumonia exhibited prolonged fever duration, increased hospitalization time, enlarged spleen size, elevated PCT and CRP levels (all P < 0.05). Moreover, a lower proportion of children with pneumonia had received preventive antibiotic treatment (P < 0.05). Binary logistic regression analysis showed that prolonged fever duration and enlarged spleen size were independent risk factors for pneumonia, whereas preventive use of antibiotics was found to be a protective factor against pneumonia in children with IM. The calibration curve of the nomogram model showed a slope close to 1. Furthermore, the Hosmer-Lemeshow test yielded a non-significant result (χ²=8.022, P=0.431), indicating excellent consistency of the nomograph model for predicting pneumonia in children with IM. Conclusion The duration of fever, spleen size, and prophylactic use of antibiotics were identified as independent risk factors for pneumonia in children with IM. A nomogram model constructed based on these factors can be used to predict the risk level of pneumonia in children with IM.
- Infectious mononucleosis in children /
- Epstein-Barr virus /
- Pneumonia /
- Risk factors /
- Nomogram model
利益冲突 无

HTML全文

图 1 基于热程、脾大小、是否预防性使用抗生素因素构建的预测儿童IM患者肺炎发生列线图

Figure 1. The nomogram predicting pneumonia occurrence in children with IM based on heat duration, spleen size, and prophylactic antibiotic use

下载: 全尺寸图片幻灯片

图 2 ROC曲线评估儿童IM患者并发肺炎模型的区分度

Figure 2. ROC curve for the pneumonia differentiation model in children with IM

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图 3 儿童IM患者并发肺炎模型的校准曲线

Figure 3. Calibration curve for the pneumonia model in children with IM complications

下载: 全尺寸图片幻灯片

表 1 未并发肺炎组与并发肺炎组儿童IM患者一般资料比较

Table 1. Comparing general data between the pneumonia-free group and the pneumonia group

项目	未并发肺炎组(n=232)	并发肺炎组(n=40)	统计量	P值
性别(例)			0.098^a	0.754
男	128	21
女	104	19
年龄(x±s，岁)	5.72±0.72	5.83±0.79	0.880^b	0.380
住院时间(x±s，d)	6.12±0.68	7.81±0.82	14.063^b	＜0.001
颈部淋巴结肿大(例)			1.117^a	0.291
有	167	32
无	65	8
眼睑水肿(例)			2.289^a	0.130
有	139	29
无	93	11
咽峡炎(例)			0.781^a	0.377
有	188	30
无	44	10
最高体温(例)			0.241^c	0.810
＜37.3 ℃	18	4
37.3~38.5 ℃	136	21
＞38.5 ℃	78	15
热程[M(P₂₅, P₇₅)，d]	6.0(4.0，8.0)	8.0(5.0，11.5)	5.261^c	＜0.001
肝大小[M(P₂₅, P₇₅)，cm]	2.2(1.3，3.4)	2.7(1.9，3.6)	1.136^c	0.064
脾大小[M(P₂₅, P₇₅)，cm]	1.5(0.2，2.6)	2.2(1.5，3.5)	4.271^c	＜0.001
WBC[M(P₂₅, P₇₅)，×10⁹/L]	13.2(9.5，16.8)	18.3(9.3，20.5)	2.252^c	0.052
PBL[M(P₂₅, P₇₅)，×10⁹/L]	7.6(4.5，12.7)	8.2(5.8，12.5)	1.338^c	0.172
变异淋巴细胞比例[M(P₂₅, P₇₅), %]	0.1(0.0, 0.2)	0.1(0.0, 0.2)	1.734^c	0.084
PCT[M(P₂₅, P₇₅)，μg/L]	0.05(0.01，0.10)	0.06(0.02，0.10)	2.224^c	0.038
CRP(x±s，mg/L)	3.46±0.35	4.26±0.44	12.824^b	＜0.001
LDH[M(P₂₅, P₇₅)，U/L]	447.6(381.5，567.2)	495.1(372.8，572.4)	1.432^c	0.125
是否预防性使用抗生素(例)			23.466^b	＜0.001
是	131	6
否	101	34
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 儿童IM患者并发肺炎的危险因素logistic回归分析

Table 2. Logistic regression analysis of risk factors for pneumonia in children with IM

变量	B	SE	Wald χ²	P值	OR值	95% CI
住院时间	0.117	0.346	0.115	0.733	1.125	0.570~2.216
热程	1.419	0.281	25.550	＜0.001	4.134	2.384~7.167
脾大小	1.320	0.491	7.239	0.007	3.744	1.431~9.793
PCT	0.035	0.126	0.078	0.778	1.036	0.809~1.326
CRP	0.332	0.221	2.259	0.132	1.394	0.903~2.149
是否预防性使用抗生素	-1.728	0.580	89.892	0.003	0.178	0.057~0.553

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