目的 分析儿童大环内酯类耐药重症肺炎支原体肺炎（SMPP）的危险因素,构建列线图预测模型。 方法 回顾性收集2023年1月—2024年9月在广州医科大学附属番禺中心医院儿科住院治疗的1 121例大环内酯类耐药肺炎支原体肺炎患儿入院初期的临床资料。按7∶3比例将患儿资料随机分为训练集（784例）和验证集（337例）。采用R4.4.1软件使用10重交叉验证最小绝对收缩与选择算法（LASSO）回归分析进行单因素变量筛选,采用Logistics回归分析建立预测模型, 绘制可视化列线图。使用受试者操作特征曲线（ROC）, 校准曲线、Hosmer-Lemeshow（HL）检验及临床决策曲线（DCA）分别评估模型的区分度、校准度和临床使用价值。 结果 在训练集中, LASSO回归结合Logistics回归分析结果显示,院前发热时间>5.5 d、谷丙转氨酶>14.5 U/L、乳酸脱氢酶>287.5 U/L、C反应蛋白>18.65 mg/L、肺实变、合并病毒感染是大环内酯类耐药SMPP发生的危险因素（P<0.05）, 根据上述危险因素构建列线图预测模型。训练集和验证集ROC曲线下面积分别为0.847和0.822; 校准曲线和HL检验显示模型具有良好的校准度; DCA显示预测模型在风险阈值为0.05~0.95时预测性能最优。 结论 院前发热时间、谷丙转氨酶、乳酸脱氢酶、C反应蛋白、肺实变、合并病毒感染是大环内酯类耐药SMPP发生的影响因素, 基于以上因素构建的列线图模型具有较好的预测效能, 有利于早期识别耐药重症病例, 及早采取有效干预,改善患者预后。

      Objective To explore the risk factors and to construct a nomogram prediction model for severe macrolide-resistant Mycoplasma pneumoniae pneumonia（MPP）in children．Methods The clinical data during the initial admission period of 1 121 children with macrolide-resistant MPP who were hospitalized in the Department of Pediatrics of the Affiliated Panyu Central Hospital of Guangzhou Medical University from January 2023 to September 2024 were retrospectively collected．The children data were randomly divided into a training set（n=784）and a validation set（n=337）at a ratio of 7∶3．With R language software（version 4.4.1）, least absolute shrinkage and selection operator（LASSO）regression analysis with tenfold cross-validation was used to screen risk factors, Logistics regression analysis was used to establish prediction model, and a visualization of the risk variables was created using a nomogram．The receiver operating characteristic（ROC）curves, calibration curves, Hosmer-Lemeshow（HL）test and clinical decision curve analysis（DCA）were used to evaluate the discrimination, calibration and clinical application value of the model．Results In the training set, LASSO regression analysis combined with Logistics regression analysis showed that prehospital fever duration > 5.5 days, alanine aminotransferase level> 14.5 U/L, lactate dehydrogenase level> 287.5 U/L, C-reactive protein > 18.65 mg/L, lung consolidation, and co-infection with virus were risk factors for severe macrolide-resistant MPP（P<0.05）．A nomogram prediction model was constructed based on the above risk factors．The area under the ROC curves of the training set and the validation set were 0.847 and 0.822, respectively．The calibration curves and HL test showed that the model had good calibration． The DCA curves showed that the prediction model had the best prediction performance when the risk threshold was between 0.05-0.95．Conclusions Prehospital fever duration, alanine aminotransferase level, lactate dehydrogenase level, C-reactive protein level, lung consolidation and co-infection with virus were risk factors for prediction of severe macrolide-resistant MPP．The nomogram model based on the above factors had a good prediction efficiency, which was conducive to early identification of severe cases with macrolide-resistant, and taking early effective interventions to improve the prognosis．

目的 分析儿童肺炎支原体肺炎（MPP）合并EB病毒（EBV）感染的临床表现及危险因素,以期进一步提升疾病预防及治疗有效率。方法 分析2020年4月—2022年4月间于我院进行入院治疗的MPP合并EBV感染患儿基本资料,选择84例进行研究,另选择单一EBV感染患儿作为对照组,对比两组患儿临床表现差异及各项指标,分析合并感染的危险因素。结果 一般资料上,研究组患儿低体质量、免疫力低下、流行病接触史占比均高于对照组,数据差异存在统计学意义（P<0.05）;临床表现上,研究组患儿高热、发热时间≥10 d、呼吸困难、胸腔积液、侵犯多肺叶占比及白细胞、淋巴细胞指标均高于对照组,血小板、Hb低于对照组,数据差异存在统计学意义（P<0.05）;经多因素分析发现,低体质量、免疫力低下、流行病接触史、高热、发热时间≥10 d、呼吸困难、胸腔积液、侵犯多肺叶、白细胞、血小板、Hb、淋巴细胞是MPP合并EBV感染的重要危险因素（P<0.05）。结论 儿童MPP合并EBV感染临床病症表现明显,且相较于单一EBV感染症状更为严重,医务人员需要根据患儿表现及相关危险因素及时予以准确诊断,对患儿实施针对性有效治疗,提升疾病治疗有效率。

        目的   探究支气管镜联合雾化吸入药物对肺炎支原体肺炎患儿症状持续时间及肺部影像学好转情况。方法   选取94例肺炎支原体肺炎患儿为研究对象，以随机数字表法分为A组、B组，各47例，分别实施布地奈德雾化吸入治疗、支气管镜肺泡灌洗联合布地奈德雾化吸入治疗，比较两组症状持续时间、治疗后肺部影像改善情况、炎症指标水平及不良反应发生率。结果  B组体温恢复时间（2.73±0.51）d、咳嗽消失时间（5.98±1.24）d、住院时间（10.96±3.36）d，A组分别为（3.14±0.83）（7.06±2.33）（13.27±3.18）d，B组较A组短（t=2.885、2.809、3.423，均P＜0.05）；治疗后B组40.43%阴影完全消失、34.04%阴影显著缩小、23.40%阴影有所缩小、2.13%阴影改善不明显，A组分别为21.28%、36.17%、25.53%、17.02%，B组肺部阴影改善情况优于A组（Z=8.311，P＜0.05）；治疗前B组白细胞计数（WBC）、超敏C-反应蛋白（hs-CRP）、降钙素原（PCT）水平与A组相近（P＞0.05）；治疗后B组WBC（7.71±1.94）×109 /L、hs-CRP（4.96±1.44）mg/L、PCT（84.32±21.40）pg/mL，A组分别为（9.05±2.48）×109 /L、（6.17±1.85）mg/L、（105.46±34.02）pg/mL，B组水平较A组低（t=2.918、3.538、3.606，均P＜0.05）；B组不良反应发生率为8.52%，A组为4.26%，B与A组相近（χ ² =0.178，P＞0.05）。结论   对肺炎支原体肺炎患儿实施支气管镜联合雾化吸入药物治疗，可缩短康复时间，促进肺部阴影消退，降低其炎症指标水平，且未增加不良反应发生率。

     Objective  To investigate the effect of bronchoscopy combined with nebulized inhalation of medication on the duration of symptoms and pulmonary imaging conversion in children with Mycoplasma pneumoniae pneumonia（MPP）．Methods  A total of 94 children with MPP were selected as the research subjects and randomly divided into Group A and Group B using a random number table，with 47 cases in each group．They were treated with budesonide nebulization inhalation therapy and bronchoalveolar lavage combined with budesonide nebulization inhalation therapy，respectively．The duration of symptoms，improvement of lung imaging before and after treatment，levels of inflammatory indicators，and incidence of adverse  reactions were compared between the two groups．The results showed that the temperature recovery time was（2.73±0.51）days，cough disappearance time was（5.98±1.24）days，and hospitalization time was（10.96±3.36）days in Group B，（3.14±0.83）days，（7.06±2.33）days，and（13.27±3.18）days in Group A，respectively．Durpation in Group B was shorter than Group A（t=2.885，2.809，3.423，all P＜0.05）． After treatment，40.43% of the shadows in Group B completely disappeared，34.04% of the shadows significantly reduced，23.40% of the shadows reduced，and 2.13% of the shadows showed no significant improvement，better than 21.28%，36.17%，25.53%，and 17.02% in Group A（Z=8.311，P＜0.05）． Before treatment，the white blood cell count（WBC），high-sensitivity C-reactive protein（hs CRP），and procalcitonin（PCT）levels in group B were similar to those in Group A（P＞0.05）．After treatment，the WBC（7.71±1.94）×109 /L，hs CRP（4.96±1.44）mg/L，and PCT（84.32±21.40）pg/mL in Group B were lower than those in Group A（9.05±2.48）×109 /L，（6.17±1.85）mg/L，and（105.46±34.02）pg/mL，respectively（t=2.918，3.538，3.606，all P＜0.05）．The incidence of adverse reactions in Group B was 8.52%，while in Group A it was 4.26%．The incidence of adverse reactions in group B was similar to that in group A（χ ² =0.178，P＞0.05）．Conclusions  Bronchoscopy combined with nebulized inhalation therapy for children with MPP can shorten the recovery time，promote the disappearance of lung shadows，reduce their inflammatory index levels，and without increasing the incidence of adverse reactions．