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    肺炎支原体肺炎患儿肝损害发生情况及相关影响因素调查

    Investigation on the occurrence of liver damage and related influencing factors in children with mycoplasma pneumoniae pneumonia

      摘要
    • 摘要:
      目的： 分析肺炎支原体肺炎（MPP）患儿肝损害发生情况，并探索其相关影响因素，建立预测模型，探索其预测价值，为指导临床合理制定护理对策提供参考。
      方法： 回顾性收集MPP患儿293例，依据患儿肝损害发生情况分为发生组、未发生组。采用单因素和logistic回归分析MPP患儿肝损害发生的影响因素，并建立预测模型，探索其预测价值。
      结果： 293例中发生肝损害51例，发生率为17.41%。logistic回归分析结果显示，热程≥7 d（OR = 3.367，95%CI = 1.338 ~ 8.475）、热峰≥39 ℃（OR = 2.968，95%CI = 1.385 ~ 6.363）、发病5 d后应用大环内酯类抗菌药物（MA）（OR = 2.869，95%CI = 1.420 ~ 5.799）、累及心肌（OR = 2.210，95%CI = 1.201 ~ 4.066）、外周血白细胞计数（WBC）水平＞10 × 109/L（OR = 2.514，95%CI = 1.249 ~ 5.062）、血清C反应蛋白（CRP）水平＞10 mg/L（OR = 2.012，95%CI = 1.325 ~ 3.054）、血清白蛋白（ALB）水平＜35 g/L（OR = 1.817，95%CI = 1.185 ~ 2.785）均是MPP患儿肝损害的独立危险因素（P ＜ 0.05）。建立预测模型：logit（P） = –7.023 + 热程≥7 d × 1.214 + 热峰≥39 ℃ × 1.088 + 发病5 d后应用MA × 1.054 + 累及心肌 × 0.793 + WBC ＞ 10 × 109/L × 0.922 + CRP ＞ 10 mg/L × 0.699 + ALB ＜ 35 g/L × 0.597。Hosmer–Lemeshow拟合优度检验显示P ＞ 0.05，提示预测模的拟合效果较好。ROC曲线分析结果显示，当logit（P） ＞ 0.89时，曲线下面积（AUC）值为0.903，灵敏度和特异度分别为86.27%、79.75%。
      结论： MPP患儿存在一定的肝损害现象，其危险因素涉及热程≥7 d、热峰≥39 ℃、发病5 d后应用MA、累及心肌、外周血WBC水平＞10 × 109/L、血清CRP水平＞10 mg/L及ALB水平＜35 g/L等，据此建立的预测模型具有较好的预测价值，临床可据此及时制定合理护理对策，以降低MPP患儿肝损害风险。

       

      Abstract:
      Objective To analyze the occurrence of liver damage in children with mycoplasma pneumoniae pneumoniae (MPP), and explore its related influencing factors, establish a predictive model to explore its predictive value for providing the reference in guiding the clinical rational development of nursing countermeasures.
      Methods A total of 293 children with MPP were retrospectively collected, and divided into the occurrence group and non-occurrence group according to the occurrence of liver damage. Univariate and logistic regression analysis were used to analyze the influencing factors of liver damage in children with MPP, and a predictive model was established to explore its predictive value.
      Results There were 51 cases of liver damage in 293 cases, with an incidence of 17.41%. The results of logistic regression analysis showed that the fever duration ≥7 d (OR = 3.367, 95%CI = 1.338 ~ 8.475), fever peak ≥39 ℃ (OR = 2.968, 95%CI = 1.385 ~ 6.363), application of macrolide antimicrobials (MA) after 5d of onset (OR = 2.869, 95%CI = 1.420 ~ 5.799), involvement of myocardium (OR = 2.210, 95%CI = 1.201 ~ 4.066), level of peripheral blood white blood cell count (WBC) ＞10 × 109/L (OR = 2.514, 95%CI = 1.249 ~ 5.062), level of serum C-reactive protein (CRP) ＞10 mg/L (OR = 2.012, 95%CI = 1.325 ~ 3.054), and level of serum albumin (ALB) ＜35 g/L (OR = 1.817, 95%CI = 1.185 ~ 2.785) were the independent risk factors of liver damage in children with MPP (P ＜ 0.05). A prediction model was established: logit (P) = -7.023 + fever duration≥7 d × 1.214 + fever peak ≥39 ℃ × 1.088 + application of MA after 5 d of onset × 1.054 + involvement of myocardium × 0.793 + WBC ＞ 10 × 109/L × 0.922 + CRP ＞ 10 mg/L × 0.699 + ALB ＜ 35 g/L × 0.597. The Hosmer-Lemeshow goodness-of-fit test showed P＞0.05, suggesting that the fitting effect of the predictive model was good. The results of ROC curve analysis showed that when logit(P) ＞ 0.89, the area under the curve (AUC) value was 0.903, and the sensitivity and specificity were 86.27% and 79.75%, respectively.
      Conclusions Children with MPP have certain liver damage phenomena. The risk factors involve fever duration ≥7 days, fever peak ≥39 ℃, application of MA 5 days after onset, involvement of myocardium, peripheral blood WBC level ＞10 × 109/L, serum CRP level ＞10 mg/L and ALB level ＜35 g/L, etc. The predictive model established based on this has good predictive value. Clinically, reasonable nursing countermeasures can be formulated in a timely manner based on it to reduce the risk of liver damage in children with MPP.

       

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