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| 难治性哮喘合并肺炎支原体感染危险因素分析与疾病预测模型的建立 |
| Analysis of risk factors of Mycoplasma pneumoniae infection in refractory asthma and establishment of disease prediction model |
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| DOI：10.3969/j.issn.1007-8134.2022.06.007 |
| 中文关键词: 新型冠状病毒肺炎 血清白蛋白 病毒转阴 病毒阳性 限制立方样条回归 Cox比例风险回归模型 累积转阴率 因果关系 |
| 英文关键词: Mycoplasma pneumonia refractory asthma Gram-positive bacilli Gram-negative bacilli risk factor inflammatory factor prediction model |
| 基金项目:河北省张家口市2019年市级科技计划自筹经费项目（1921088D） |
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| 中文摘要: |
| [摘要]?目的? 探究难治性哮喘（refractory asthma, RA）合并肺炎支原体（Mycoplasmal pneumonia, MP）感染患者的临床特点以及相关危险因素，并构建相关预测模型。方法?选取2018年1月10日—2021年2月26日我院收治的82例RA合并MP感染患者作为研究组，随机选取同期82例RA而无MP感染患者作为对照组。收集并分析2组患者的临床特征，使用多因素Logistic回归分析影响RA合并MP感染发生的相关危险因素，建立预测模型，并进行模型评价。结果?研究组患者支气管肺泡灌洗液中的革兰阳性菌（36株，33.03%）显著多于对照组（8株，7.69%），而革兰阴性菌（70株，64.22%）显著少于对照组（92株，88.46%）（P均＜0.05）。研究组身体质量指数（body mass index, BMI）≥24 kg/m2、有吸烟史、有呼吸道反复感染史以及有鼻炎或者鼻窦炎的患者比例均显著高于对照组，而长期规律性用药患者的比例显著低于对照组（P均＜0.05）。研究组患者的支气管腔内径显著小于对照组，而支气管壁厚度、支气管壁厚度/支气管外径以及支气管壁面积均显著大于对照组（P均＜0.05）。研究组患者的1 s用力呼气容积、呼气峰流速、用力呼出25%肺活量呼气流速、用力呼出50%肺活量呼气流速、用力呼气中期流速均显著低于对照组（P均＜0.05）。研究组患者的IL-6、IL-8以及TNF-α水平均显著高于对照组（P均＜0.05）。多因素Logistic回归分析以及森林图预测模型结果显示，有吸烟史、未长期规律性用药、有呼吸道反复感染史以及有鼻炎或者鼻窦炎均为RA合并MP发生的危险因素（P均＜0.05）。模型评价结果显示，该预测模型的区分度较好、准确度较高、有效性较好，安全可靠，实用性强。结论?RA合并MP感染患者支气管肺泡灌洗液革兰阳性菌检出率上升，革兰阴性菌检出率降低。肺功能显著降低，血清中炎症因子水平显著升高。有吸烟史、未长期规律性用药、有呼吸道反复感染史以及有鼻炎或者鼻窦炎均为RA合并MP发生的危险因素，据此构建的模型能较好地预测RA患者MP感染的发生风险，可以指导临床医生及早干预。 |
| 英文摘要: |
| [Abstract] Objective To explore the clinical characteristics and related risk factors of patients with refractory asthma (RA) complicated with Mycoplasma pneumoniae (MP) infection. Methods?From January 10, 2018 to February 26, 2021, patients with RA complicated with MP infection (82 cases) admitted to our hospital were selected as the research group, and patients with RA without MP (82 cases) during the same period were selected as the control group. The clinical characteristics of patients with RA combined with MP were compared and analyzed. Multivariate Logistic regression analysis was used to analyze the related risk factors affecting the occurrence of RA combined with MP, and a prediction model was established, and the model was evaluated. Results?Gram-positive bacteria (36 strains, 33.03%) in the bronchoalveolar lavage fluid of the study group were significantly more than those in the control group (8 strains, 7.69%) (P＜0.05), while Gram-negative bacteria (70 strains, 64.22%) were significantly less than those in the control group (92 strains, 88.46%) (P＜0.05). The proportion of patients with body mass index (BMI)≥24 kg/m2, smoking history, history of repeated respiratory tract infection, and rhinitis or sinusitis in the study group were significantly higher than those in the control group (P＜0.05), while the proportion of patients with long-term regular medication was significantly lower than that in the control group (P＜0.05). The bronchial lumen diameter of the study group was significantly smaller than that of the control group (P＜0.05), while the bronchial wall thickness, wall thickness/tube outer diameter and wall area were significantly larger than those of the control group (P＜0.05). The forced expiratory volume in one second, peak expiratory flow, forced expiratory flow at 25% of FVC, forced expiratory flow at 50% of FVC, maximal mid-expiratory flow at 25%-75% of FVC of the patients in the study group were significantly lower than those in the control group (P＜0.05). The levels of IL-6, IL-8 and TNF-α in the study group were significantly higher than those in the control group (P＜0.05). Multivariate Logistic regression analysis and forest plot prediction model showed that smoking history, lack of long-term regular medication, history of repeated respiratory tract infection, and rhinitis or sinusitis were all risk factors for RA complicated with MP (P＜0.05). The prediction model evaluation results show that the prediction model has good discrimination, high accuracy, good effectiveness, safety and reliability, and strong practicability. Conclusions?In patients with RA combined with MP, the detection rate of Gram-positive bacteria in bronchoalveolar lavage fluid increased, while the detection rate of Gram-negative bacteria decreased, the lung function will be significantly reduced, and the levels of inflammatory factors in serum will be significantly increased. A history of smoking, lack of long-term regular medication, a history of repeated respiratory tract infections, and rhinitis or sinusitis were all risk factors for RA complicated with MP, the model constructed on this basis can better predict the risk of MP infection in RA patients, and can guide clinicians to intervene as early as possible. |
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