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中华妇幼临床医学杂志(电子版) ›› 2026, Vol. 22 ›› Issue (01) : 24 -33. doi: 10.3877/cma.j.issn.1673-5250.2026.01.005

论著

重症肺炎支原体肺炎患儿并发塑型性支气管炎的危险因素分析及预测模型构建
刘冬霞1, 金蓉2,†(), 吴庆莉3, 林荣军2   
  1. 1济宁市第一人民医院儿科，济宁　272100
    2青岛大学附属医院综合儿科，青岛　266100
    3济宁市兖州区人民医院，济宁　272100
  • 收稿日期:2025-03-06 修回日期:2025-08-03 出版日期:2026-02-01
  • 通信作者: 金蓉

Analysis of risk factors and construction of predictive model for severe Mycoplasma pneumoniae pneumonia complicated with plastic bronchitis in children

Dongxia Liu1, Rong Jin2,†(), Qingli Wu3, Rongjun Lin2   

  1. 1Department of Pediatrics, Jining No.1 People′s Hospital, Jining 272100, Shandong Province, China
    2Department of General Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao 266100, Shandong Province, China
    3Yanzhou District People′s Hospital of Jining City, Jining 272100, Shandong Province, China
  • Received:2025-03-06 Revised:2025-08-03 Published:2026-02-01
  • Corresponding author: Rong Jin
  • Supported by:
    Shandong Province Traditional Chinese Medicine Science and Technology General Project(M-2022227)
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引用本文：

刘冬霞, 金蓉, 吴庆莉, 林荣军. 重症肺炎支原体肺炎患儿并发塑型性支气管炎的危险因素分析及预测模型构建[J/OL]. 中华妇幼临床医学杂志(电子版), 2026, 22(01): 24-33.

Dongxia Liu, Rong Jin, Qingli Wu, Rongjun Lin. Analysis of risk factors and construction of predictive model for severe Mycoplasma pneumoniae pneumonia complicated with plastic bronchitis in children[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2026, 22(01): 24-33.

目的

探讨重症肺炎支原体肺炎(SMPP)患儿并发塑型性支气管炎(PB)的危险因素，并构建PB发病风险的预测模型。

方法

选择2023年7月1日至2024年12月31日于济宁市第一人民医院住院并接受电子支气管镜检查及治疗的96例SMPP患儿为研究对象。采用回顾性分析方法，根据支气管镜检查结果是否并发PB，将其分为PB组(n＝29，并发PB)和非PB组(n＝67，未并发PB)。采用多因素非条件logistic回归分析法，确定SMPP患儿并发PB的独立危险因素，并根据这些独立危险因素构建SMPP患儿并发PB风险的列线图(Nomogram)预测模型。本研究获得济宁市第一人民医院医学伦理委员会批准(审批文号：2025-ⅡT-快076)。所有患儿监护人知情同意并签署临床研究知情同意书。

结果

①多因素非条件logistic回归分析结果显示，SMPP患儿血清LDH水平升高(OR＝1.005，95%CI：1.001~1.009，P＝0.010)，血清D-二聚体水平升高(OR＝1.000，95%CI：1.000~1.001，P＝0.039)，发生胸腔积液(OR＝3.367，95%CI：1.049~10.805，P＝0.041)，发生肺实变≥2/3单肺叶(OR＝4.872，95%CI：1.369~17.332，P＝0.014)，均为其并发PB的独立危险因素。②根据上述独立危险因素构建SMPP患儿并发PB风险预测模型的受试者工作特征(ROC)曲线的曲线下面积(AUC)为0.866(95%CI：0.785~0.947)，该预测模型预测SMPP患儿并发PB的敏感度、特异度及准确度分别为75.9%、86.6%及80.2%。Hosmer-Lemeshow拟合优度检验结果显示，该预测模型与实际情况拟合较好(χ2＝13.92，P>0.05)。列线图的校正曲线和决策曲线显示，该预测模型对SMPP患儿并发PB风险的预测效能和临床应用价值较高。③2组SMMP患儿的治疗结果比较：PB组采取支气管镜检查治疗≥2次、使用糖皮质激素治疗、多西环素或左氧氟沙星治疗患儿比例，均高于非PB组(93.1% vs 4.5%，72.4% vs 22.4%，48.3% vs 22.4%)，并且差异均有统计学意义(χ2＝74.00、P<0.001，χ2＝21.61、P<0.001，χ2＝6.43，P＝0.011)。

结论

根据SMPP患儿血清D-二聚体水平、血清LDH水平、胸腔积液、肺实变≥2/3单肺叶构建的并发PB风险预测模型，对于SMPP患儿并发PB风险预测具有较高临床价值。

关键词: 肺炎支原体, 肺炎，支原体, 支气管炎，塑型, 危险因素, 预测, 列线图, 儿童
Objective

To explore the risk factors for the development of plastic bronchitis (PB) in children with severe Mycoplasma pneumoniae pneumonia (SMPP), and to construct a predictive model for the risk of PB onset.

Methods

A total of 96 children with SMPP hospitalized at Jining No.1 People′s Hospital from July 1, 2023, to December 31, 2024, who underwent electronic bronchoscopy and treatment were enrolled. A retrospective analysis was conducted, the subjects were divided into PB group (n=29, complicated with PB) and non-PB group (n=67, not complicated with PB) based on whether PB was found through bronchoscopy. Multivariate unconditional logistic regression analysis was used to determine the independent risk factors for children with SMPP complicated with PB, and a Nomogram risk prediction model for children with SMPP complicated with PB was constructed based on these risk factors. This study was approved by the Medical Ethics Committee of Jining No.1 People′s Hospital (Approval No. 2025-IIT-quick 076). Written informed consents were obtained from all children′s guardians.

Results

① The results of multivariate unconditional logistic regression analysis showed that SMPP children′s elevated serum LDH levels (OR=1.005, 95%CI: 1.001-1.009, P=0.010), elevated serum D-dimer levels (OR=1.000, 95%CI: 1.000-1.001, P=0.039), the occurrence of pleural effusion (OR=3.367, 95%CI: 1.049-10.805, P=0.041), and occurrence of pulmonary consolidation ≥2/3 of a single lobe (OR=4.872, 95%CI: 1.369-17.332, P=0.014) were all independent risk factors for children with SMPP complicated with PB. ② The area under the curve (AUC) of receiver operating characteristic (ROC) curve of the predictive model for children with SMPP complicated with PB based on the above independent risk factors was 0.866 (95%CI: 0.785-0.947), and the sensitivity, specificity and accuracy of the predictive model for predicting children with SMPP complicated with PB were 75.9%, 86.6% and 80.2%, respectively. The Hosmer-Lemeshow goodness-of-fit test indicated that the predictive model fitted well with the actual situation (χ2=13.92, P>0.05). The calibration and decision curve analysis of the Nomogram indicated that the predictive model possessed high predictive efficacy and clinical applicability. ③ Comparison of treatment outcomes between the two groups of children with SMPP showed that the PB group exhibited significantly higher proportions of children underwent bronchoscopic examinations and treatment at least 2 times, receiving glucocorticoid therapy, and treated with doxycycline or levofloxacin compared to the non-PB group (93.1% vs 4.5%, 72.4% vs 22.4%, 48.3% vs 22.4%), and the differences were statistically significant (χ2=74.00, P<0.001; χ2=21.61, P<0.001; χ2=6.43, P=0.011).

Conclusions

The predictive model incorporating serum D-dimer levels, serum LDH levels, pleural effusion, and pulmonary consolidation ≥2/3 of a single lobe of SMPP children demonstrates high clinical value for predicting the risk of children with SMPP complicated with PB.

Key words: Mycoplasma pneumoniae, Pneumonia, Mycoplasma, Bronchitis, plastics, Risk factors, Forecasting, Nomograms, Child
图1 1例SMPP并发PB患儿(男性，6岁)电子支气管镜检查及结果图[图1A：术中见左肺下叶内前、外后基底段黏膜糜烂，胶冻样塑型黏液栓嵌塞段以下的各级支气管；图1B：支气管镜下取出的塑型(管形)黏液栓大体标本(置于10%福尔马林中性缓冲液中)呈树枝状；图1C：塑型黏液栓于显微镜下可见大量中性粒细胞浸润、坏死脱落的上皮细胞和周围纤维蛋白样结构(HE染色)]注：SMPP为重症肺炎支原体肺炎，PB为塑型性支气管炎。HE为苏木精-伊红
表1 2组SMPP患儿临床资料比较
组别 例数 年龄(岁，±s) 男性[例数(%)] 体温峰值[℃，M(Q1，Q3)] WBC[×109/L，M(Q1，Q3)] NEUT[×109/L，M(Q1，Q3)] LY[×109/L，M(Q1，Q3)]
PB组 29 7.3±1.8 15(51.7) 39.7(39.3，40.0) 8.7(7.5，10.4) 5.5(4.4，7.3) 1.9(1.2，2.7)
非PB组 67 7.6±2.4 41(61.2) 39.3(39.0，39.7) 8.8(7.2，12.2) 5.6(4.0，7.3) 2.4(1.7，3.0)
统计量   t＝－0.54 χ2＝0.75 Z＝－3.01 Z＝－0.41 Z＝－0.43 Z＝－1.95
P值   0.590 0.388 0.003 0.684 0.043 0.052
组别 例数 热程(d，±s) 既往变态反应[例数(%)] PCT[ng/mL，M(Q1，Q3)] NLR[M(Q1，Q3)] MPV[fL，M(Q1，Q3)] PLT[×109/L，M(Q1，Q3)]
PB组 29 10.2±2.4 7(14.6) 0.12(0.06，0.23) 2.9(2.1，5.6) 9.4(8.7，10.2) 280(221，350)
非PB组 67 8.4±3.4 2(3.8) 0.07(0.05，0.14) 2.5(1.6，4.0) 9.2(8.7，9.7) 287(239，376)
统计量   t＝－3.10 χ2＝4.16a Z＝－2.00 Z＝－2.02 Z＝－0.64 Z＝－1.21
P值   0.003 0.041 0.046 0.043 0.525 0.225
组别 例数 MPV/PLT(±s) D-二聚体[ng/mL，M(Q1，Q3)] LDH[U/L，M(Q1，Q3)] CRP[mg/L，M(Q1，Q3)] 白蛋白[g/L，M(Q1，Q3)]
PB组 29 0.03±0.01 1 670(1 200，3 717) 409(331，519) 12.2(6.3，26.6) 41.4(38.4，43.2)
非PB组 67 0.03±0.01 850(441，1 333) 312(264，355) 6.4(2.9，16.1) 42.4(40.5，45.0)
统计量   t＝0.61 Z＝－4.66 Z＝－4.40 Z＝－2.45 Z＝－2.16
P值   0.542 <0.001 <0.001 0.014 0.031
组别 例数 胸腔积液[例数(%)] 肺实变≥2/3单肺叶[例数(%)] PA[mg/dL，M(Q1，Q3)] ALT[U/L，M(Q1，Q3)] CK[U/L，M(Q1，Q3)] CK-MB[ng/mL，M(Q1，Q3)]
PB组 29 13(44.8) 23(79.3) 10.1(8.6，11.5) 21.3(15.7，36.1) 67.0(44.0，125.5) 1.8(1.4，3.0)
非PB组 67 10(14.9) 31(46.3) 12.9(10.8，15.0) 15.0(11.4，21.6) 58.0(43.0，90.0) 1.8(1.5，2.6)
统计量   χ2＝9.93 χ2＝8.98 Z＝－4.25 Z＝－3.04 Z＝－0.66 Z＝－0.12
P值   0.002 0.003 <0.001 0.002 0.510 0.908
表2 SMPP患儿并发PB的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
血清LDH水平(连续变量) 0.005 0.002 6.641 0.010 1.005 1.001~1.009
血清D-二聚体水平(连续变量) 3.130×10－4 1.520×10－4 4.269 0.039 1.000 1.000~1.001
胸腔积液(vs未发生胸腔积液) 1.214 0.595 4.164 0.041 3.367 1.049~10.805
肺实变≥2/3单肺叶(vs未发生肺实变≥2/3单肺叶) 1.583 0.648 5.980 0.014 4.872 1.369~17.332
常数项 －4.817 1.074 20.108 <0.001 — —
图2 4个独立影响因素预测SMPP患儿并发PB的ROC曲线比较注：4个独立影响因素分别为血清LDH水平、血清D-二聚体水平、胸腔积液、肺实变≥2/3单肺叶。SMPP为重症肺炎支原体肺炎，PB为塑型性支气管炎。ROC曲线为受试者工作特征曲线，LDH为乳酸脱氢酶
表3 4个独立影响因素预测SMPP患儿并发PB的ROC曲线分析结果
独立影响因素 ROC曲线 最佳临界值 敏感度(%) 特异度(%) 约登指数
AUC AUC 95%CI P值
血清LDH水平 0.784 0.688~0.879 <0.001 357.5 U/L 69.0 76.1 0.451
血清D-二聚体水平 0.801 0.710~0.891 <0.001 1 356 ng/mL 65.5 76.1 0.416
胸腔积液 0.650 0.523~0.776 0.020 － 44.8 85.1 0.299
肺实变≥2/3单肺叶 0.665 0.550~0.780 0.010 － 79.3 53.7 0.330
图3 根据4个独立影响因素构建SMPP患儿并发PB风险预测模型预测效能的ROC曲线注：4个独立影响因素分别为血清LDH水平、血清D-二聚体水平、胸腔积液、肺实变≥2/3单肺叶。SMPP为重症肺炎支原体肺炎，PB为塑型性支气管炎。ROC曲线为受试者工作特征曲线，LDH为乳酸脱氢酶
图4 根据4个独立影响因素应用R软件绘制的SMPP患儿并发PB风险列线图注：4个独立影响因素分别为血清LDH水平、血清D-二聚体水平、胸腔积液、肺实变≥2/3单肺叶。SMPP为重症肺炎支原体肺炎，PB为塑型性支气管炎。LDH为乳酸脱氢酶
图5 采用100次重复抽样法绘制的SMPP患儿并发PB风险的列线图预测模型校准曲线图注：SMPP为重症肺炎支原体肺炎，PB为塑型性支气管炎
图6 SMPP患儿并发PB风险列线图预测模型的决策曲线注：SMPP为重症肺炎支原体肺炎，PB为塑型性支气管炎
图7 2组SMPP患儿Kaplan-Meier肺实变吸收率曲线注：SMPP为重症肺炎支原体肺炎，PB为塑型性支气管炎
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