摘要
目的 探讨含凝血功能五项[活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶原时间(PT)、D-二聚体(D-D)、凝血酶时间(TT)]的Nomogram预测模型预测重症肺炎支原体肺炎(MPP)患儿预后的效果。方法 选取2015年1月—2019年12月100例重症MPP患儿,统计其预后,比较不同预后患儿相关资料,分析重症MPP患儿预后不良的影响因素,构建Nomogram预测模型,评价该模型的预测效能,绘制决策曲线分析含凝血功能五项预测模型的临床净获益,同时另选取同期85例重症MPP患儿进行外部验证。结果 治疗1个月内,100例重症MPP患儿中有32例预后不良归为预后不良组,68例预后良好归为预后良好组。氧疗时间、住院时间、肺炎严重程度评分、急性生理学与慢性健康状况评分系统Ⅱ评分、FIB、TT、D-D、白细胞介素-6及免疫球蛋白M均为重症MPP患儿预后不良的危险因素,PT、APTT均为其保护因素(P<0.01)。Nomogram预测模型预测重症MPP患儿预后不良发生因素的一致性指数为0.922(95%CI:0.844,0.978),决策曲线显示:当含凝血功能五项的预测模型预测重症MPP患儿预后不良的阈概率值在0.1~0.6区间时,可提供附加临床净获益。外部验证显示该模型预测敏感度为92.31%,特异度为91.30%。结论 含凝血功能五项的Nomogram预测模型可提高预测重症MPP患儿预后不良的准确性。
Objective To investigate the prognosis effect of Nomogram prediction model with five coagulation function indicators[activated partial thrombin time(APTT),fibrinogen(FIB),prothrombin time(PT),D-dimer(D-D),thrombin time(TT)]in predicting the prognosis of children with severe mycoplasma pneumonia(MMP).Methods A total of 100 children with severe MPP treated from January 2015 to December 2019 were selected,and their prognoses were analyzed.Relevant data of children with different prognoses were compared,and the influencing factors of poor prognosis in children with severe MPP were analyzed.A Nomogram prediction model was established to evaluate the prediction efficiency of the model.The decision curve was drawn to analyze net clinical benefits with prediction model with five coagulation function indicators.Meanwhile,85 children with severe MPP were selected for external verification.Results After 1 month of treatment,32 of 100 patients with severe MPP were classified as poor prognosis group and 68 patients with good prognosis were classified as good prognosis group.Duration of oxygen therapy,length of hospital stay,pneumonia severity score,acute physiology and Chronic health status scoreⅡ(APACHEⅡ),FIB,TT,D-D,interleukin-6(IL-6)and immunoglobulin M were all risk factors for poor prognosis in children with severe MPP,while PT and APTT were all protective factors(P<0.01).The consistency index of Nomogram prediction model in predicting adverse prognostic factors in children with severe MPP was 0.922(95%CI:0.844,0.978).The decision curve showed that additional net clinical benefit was provided when the threshold probability of poor prognosis in children with severe MPP was predicted in the range of 0.1 to 0.6 by the prediction model with five items of coagulation function.External verification showed that the prediction sensitivity and specificity of this model were 92.31%and 91.30%respectively.Conclusion Nomogram prediction model with five items of coagulation function can improve the accuracy of predicting poor prognosis in children with severe MPP.
作者
袁静
陈庆仪
杨好贤
钟柏茂
YUAN Jing;CHEN Qingyi;YANG Haoxian;ZHONG Baimao(Department of Paediatrics,Dongguan Children's Hospital Affiliated to Guangdong Medical University,Dongguan,Guangdong 523000,China)
出处
《临床误诊误治》
CAS
2023年第3期90-94,共5页
Clinical Misdiagnosis & Mistherapy
基金
东莞市社会科技发展(重点)项目(2019507150100185)。
作者简介
袁静,本科,主治医师。主要从事小儿呼吸方向研究;通讯作者:钟柏茂,E-mail:zbm@dgp-institute.com。
