重症支原体肺炎患儿发生塑形性支气管炎的危险因素及TSP1、FOXP3水平对塑形性支气管炎的预测分析

赵惠; 潘余乐; 古丽巴哈·买买提; 刘玉

doi:10.16766/j.cnki.issn.1674-4152.004004

重症支原体肺炎患儿发生塑形性支气管炎的危险因素及TSP1、FOXP3水平对塑形性支气管炎的预测分析

doi: 10.16766/j.cnki.issn.1674-4152.004004

1.
新疆医科大学第一附属医院儿内一科，新疆乌鲁木齐 830000
2.
新疆维吾尔自治区伊犁哈萨克自治州伊宁市兵团第四师医院产科，新疆伊宁 835000

基金项目:

省部共建中亚高发病成因与防治国家重点实验室项目 SKL-HIDCA-2021-JH3

详细信息

通讯作者:
古丽巴哈·买买提，E-mail：156510283@qq.com

中图分类号: R563.15 R725.6
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出版历程
- 收稿日期: 2024-08-28
- 网络出版日期: 2025-08-14

Prediction analysis of risk factors and TSP1, FOXP 3 levels in children with severe Mycoplasma pneumonia

1.
Department of Pediatrics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China

摘要

摘要: 目的在重症支原体肺炎患儿发病过程中，会有一定比例的患儿出现塑形性支气管炎(PB)这种严重的并发症。探究其发病机制，分析凝血酶敏感蛋白1(TSP1)、叉状头螺旋转录因子3(FOXP3)水平对塑形性支气管炎的预测价值。方法选取2020年6月—2024年6月新疆医科大学第一附属医院儿内一科收治的320例重症支原体肺炎患儿作为研究对象，按照纤维支气管镜下是否可见塑形性支气管炎，将其分为PB组(120例)和非PB组(200例)。采用单因素及多因素分析重症支原体肺炎患儿塑形性支气管炎发生的危险因素，采用ELISA检测TSP1、FOXP3水平，采用ROC曲线评估TSP1、FOXP3对塑形性支气管炎的预测价值。结果多因素logistic回归分析显示，发热持续时间≥8 d、存在呼吸急促、存在胸腔积液、白细胞计数≥8.10×10⁹/L、中性粒细胞比例≥68.10%、淋巴细胞比例＜30%、CRP≥40 mg/L、乳酸脱氢酶(LDH)≥450 U/L均为重症支原体肺炎患儿塑形性支气管炎发生的危险因素(P < 0.05)。与非PB组TSP1[(54.68±9.00)ng/mL]、FOXP3(3.08±0.51)表达比较，PB组TSP1[(66.71±12.17)ng/mL]、FOXP3(3.92±0.69)表达升高(P < 0.05)。ROC曲线结果显示，与TSP1、FOXP3单项诊断对比，联合诊断AUC值显著高于单项(P < 0.05)。结论发热持续时间、呼吸急促、胸腔积液、WBC、PLT、淋巴细胞比例、CRP、LDH等均为导致重症支原体肺炎患儿塑形性支气管炎发生的风险因素，TSP1、FOXP3对预测塑形性支气管炎的发生有较高的价值。
- 重症支原体肺炎 /
- 塑形性支气管炎 /
- 凝血酶敏感蛋白1 /
- 叉状头螺旋转录因
Abstract: Objective In the onset process of children with severe Mycoplasma pneumonia, a certain proportion of children will have plastic bronchitis (PB). The aim is to explore the pathogenesis and analyzed the predictive value of thrombine-sensitive protein 1 (TSP1) and forked head spiral transcription factor 3 (FOXP3) levels for plastic bronchitis. Methods A total of 320 children with severe Mycoplasma pneumonia admitted to the First Affiliated Hospital of Xinjiang Medical University from June 2020 to June 2024 were selected and divided into PB group (120 cases) and non-PB group (200 cases). Univariate and multivariate factors were used to analyze the risk factors of PB in children with severe Mycoplasma pneumonia. TSP1 and FOXP3 levels were measured by ELISA. ROC evaluated the predictive value of TSP1 and FOXP3 for plastic bronchitis. Results Multivariate logistic regression analysis showed that fever duration ≥8 d, tachypnea, pleural effusion, white blood cell count ≥8.10×10⁹/L, neutrophil ratio ≥68.10%, lymphocyte ratio < 30%, CRP ≥40 mg/L, LDH ≥450 U/L were the risk factors for PB in children with severe Mycoplasma pneumonia (P < 0.05). Compared with the non-PB group, the expressions of TSP1 [(54.68±9.00) ng/mL] and FOXP3 (3.08±0.51) were increased in PB group [(66.71±12.17) ng/mL and 3.92±0.69, P < 0.05]. ROC results showed that compared with the single diagnosis of TSP1 and FOXP3, the combination of the two had higher diagnostic value (P < 0.05). Conclusion The duration of fever, tachypnea, pleural effusion, white blood cell count, neutrophil ratio, lymphocyte ratio, CRP and LDH are risk factors for plastic bronchitis in children with severe Mycoplasma pneumonia. TSP1 and FOXP3 have high value in predicting plastic bronchitis.
- Severe Mycoplasma pneumonia /
- Plastic bronchitis /
- Thrombin-sensitive protein 1 /
- Forked head spiral transcription factor 3

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图 1 TSP1、FOXP3预测患儿塑形性支气管炎发生的ROC曲线

Figure 1. ROC curves of TSP1 and FOXP3 for predicting plastic bronchitis occurrence in children

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表 1 重症支原体肺炎患儿塑形性支气管炎发生的单因素分析

Table 1. Single factor analysis of plastic bronchitis in children with severe mycoplasma pneumonia

项目	PB组(n=120)	非PB(n=200)	统计量	P值
性别(男/女，例)	68/52	112/88	0.014^a	0.907
年龄(x±s，岁)	6.81±1.52	7.02±1.91	1.025^b	0.306
发热持续时间(x±s，d)	10.20±2.02	7.12±1.15	17.383^b	< 0.001
住院时间(x±s，d)	14.31±2.11	7.01±1.03	41.417^b	< 0.001
发热[例(%)]			1.973^a	0.160
是	110(91.67)	191(95.50)
否	10(8.33)	9(4.50)
咳嗽[例(%)]			0.308^a	0.579
是	115(95.83)	194(97.00)
否	5(4.17)	6(3.00)
呼吸急促[例(%)]			49.765^a	< 0.001
是	51(42.50)	18(9.00)
否	69(57.50)	182(91.00)
气喘[例(%)]			1.138^a	0.286
是	34(28.33)	46(23.00)
否	86(71.67)	154(77.00)
胸腔积液[例(%)]			20.902^a	< 0.001
有	55(45.83)	43(21.50)
无	65(54.17)	157(78.50)
支气管镜灌洗次数(x±s, 次)	3.12±0.91	1.42±0.50	21.559^b	< 0.001
白细胞计数(x±s, ×10⁹/L)	9.94±1.32	7.11±1.20	19.666^b	< 0.001
中性粒细胞比例(x±s, %)	75.42±5.71	60.50±5.89	22.189^b	< 0.001
淋巴细胞比例(x±s, %)	25.31±5.37	41.03±5.82	24.071^b	< 0.001
CRP(x±s, mg/L)	75.11±26.72	31.85±14.25	18.868^b	< 0.001
LDH(x±s, U/L)	622.61±113.52	371.42±85.13	22.488^b	< 0.001
注：^a为χ²值，^b为t值。

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表 2 变量赋值情况

Table 2. The assignments of variables

变量	赋值方法
发热持续时间	< 8 d=0, ≥8 d=1
住院时间	< 10 d=0, ≥10 d=1
呼吸急促	否=0, 是=1
胸腔积液	否=0, 是=1
支气管镜灌洗次数	< 2次=0, ≥2次=1
白细胞计数	< 8.10×10⁹/L=0, ≥8.10×10⁹/L=1
中性粒细胞比例	< 68.10%=0, ≥68.10%=1
淋巴细胞比例	≥30%=0, ＜30%=1
CRP	< 40 mg/L=0, ≥40 mg/L=1
LDH	< 450 U/L=0, ≥450 U/L=1

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表 3 重症支原体肺炎患儿发生塑形性支气管炎影响因素的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of plastic bronchitis in children with severe mycoplasma pneumonia

变量	B	SE	Waldχ²	P值	OR值	95% CI
发热持续时间	4.021	0.517	60.490	0.001	55.757	54.723~56.791
呼吸急促	2.114	0.612	11.932	0.004	8.281	7.057~9.505
胸腔积液	2.016	0.587	11.795	0.001	7.508	6.334~8.682
白细胞计数	2.111	0.429	24.214	0.001	8.256	7.398~9.114
中性粒细胞比例	2.341	0.529	19.584	0.001	10.392	9.334~11.450
淋巴细胞比例	1.671	0.411	16.530	0.009	5.317	4.495~6.139
CRP	2.044	0.512	15.938	0.005	7.721	6.697~8.745
LDH	1.208	0.507	5.677	0.012	3.347	2.333~4.361
注：本表仅列出差异有统计学意义的结果。

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表 4 2组重症支原体肺炎患儿血清TSP1、FOXP3表达比较(x±s)

Table 4. Comparison of serum TSP1 and FOXP3 expression in children with severe mycoplasma pneumonia between the non-PB group and the PB group(x±s)

组别	例数	TSP1(ng/mL)	FOXP3
非PB组	200	54.68±9.00	3.08±0.51
PB组	120	66.71±12.17	3.92±0.69
t值		10.114	12.459
P值		0.001	0.001

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表 5 ROC曲线分析TSP1、FOXP3水平对患儿塑形性支气管炎发生的预测价值

Table 5. ROC curve analysis of the predictive value of TSP1 and FOXP3 levels for plastic bronchitis in children

项目	AUC(95% CI)	灵敏度(%)	特异度(%)	准确性(%)	P值
TSP1	0.713(0.644~0.782)	81.67(98/120)	75.00(150/200)	77.50(248/320)	0.001
FOXP3	0.668(0.598~0.738)	62.50(75/120)	71.00(142/200)	67.81(217/320)	0.001
两项联合	0.884(0.841~0.927)	93.33(112/120)	70.50(141/200)	79.06(253/320)	0.001

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