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 研究甲泼尼龙琥珀酸钠对重症支原体肺炎（SMPP）患儿的治疗效果及安全性。方法 采用随机数表法将南华大学附属长沙中心医院2021年1月—2022年12月收治的108例SMPP患儿分为两组,对照组（54例）采用常规治疗,研究组（54例）采用常规治疗联合甲泼尼龙琥珀酸钠治疗,比较2组临床疗效。结果 治疗后研究组炎症因子水平低于对照组,肺功能指标、健康状况评分均高于对照组,发热、咳嗽、肺啰音及肺阴影消失时间均短于对照组（P<0.05）;两组不良反应发生率比较差异无统计学意义（P>0.05）。结论 应用甲泼尼龙琥珀酸钠治疗可加快患儿症状缓解,改善机体炎症反应及肺功能,且安全性较高。

Objective To study the therapeutic effect and safety of methylprednisolone sodium succinate on children with severe Mycoplasma pneumoniae pneumonia（SMPP）．Methods A total of 108 children with SMPP admitted to Changsha Central Hospital from January 2021 to December 2022 were divided into two groups by random number table method．The control group（54 cases）was treated with conventional therapy,and the study group（54 cases）was treated with conventional therapy combined with methylprednisolone sodium succinate．The clinical effects of the two groups were compared．Results After treatment,the levels of inflammatory factors in the study group were lower than those in the control group,and lung function indicators and health status scores were higher than those in the control group．The disappearance time of fever,cough,lung rales and lung shadows was shorter than that in the control group（P<0.05）．There was no statistically significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions The application of methylprednisolone sodium succinate treatment can accelerate the relief of symptoms in children,improve the body's inflammatory response and lung function,and has high safety．

目的 分析肺炎支原体RNA实时荧光恒温扩增技术(MP-SAT)作为肺炎支原体肺炎(MPP)患儿疗效监测指标的可行性。方法 选择2017年10月—2018年10月我院儿科收治的因CAP住院的患儿178例为研究对象,其中MPP组80例,非MPP组98例,分别检测血清MP抗体(MP-Ab)和咽拭子MP-RNA,对两种方法检测结果进行统计学分析,以MP-Ab检测为诊断MPP的参照试验,分析MP-SAT诊断MPP的准确性,对MP-SAT和MP-Ab均阳性的MPP病例行动态观察,比较MP-SAT和MP-Ab在患儿不同治疗时间点的检出率,分析MP-SAT转阴时间与临床痊愈时间的相关性,分析MP-SAT转阴时间与MPP患儿临床症状、实验室指标及X线胸片的相关性。结果 MP-SAT和MP-Ab结果不一致的比例在MPP组和非MPP组分别为60.00% (48/80)和19.39%(19/98);MP-SAT、MP-Ab在特异性和阳性预测值方面,差异有统计学意义(P＜0.05);MP-SAT、MP-Ab在敏感度和阴性预测值方面,差异无统计学意义(P＞0.05);MP-SAT、MP-Ab均为阳性28例(35.00%),MP-SAT阳性检出率随治疗时间的延长降低(P＜0.05),MP-Ab阳性检出率随治疗时间的延长升高(P＜0.05);28例临床痊愈时间为(3.11±0.88)周,MP-SAT转阴时间为(3.25±0.74)周,差异无统计学意义(P＞0.05);MP-SAT转阴时间越长的病例表现为发热持续时间越长,X线胸片肺大片实变比例越高,CRP水平越高,LDH水平越高,中性粒细胞百分比越高,淋巴细胞百分比越低(P＜0.05)。结论 MP-SAT作为新一代RNA活菌检测技术在支原体肺炎患儿疗效监测中有较高的价值,值得推广。

Objective To investigate the feasibility of Mycoplasma pneumoniae-simultaneous amplification and testing (MP-SAT)as a monitoring index for children with Mycoplasma pneumoniae pneumonia (MPP). Methods 178 hospitalized children with community-acquired pneumonia (CAP)in our hospital from October 2017 to October 2018 were selected and divided into two groups, namely MPP group (n=80)and non-MPP group (n=98). Serum MP antibody (MP-Ab)and throat swab MP-RNA were detected separately. The MP-Ab test was used as a reference for the analysis of accuracy of MP-SAT for MPP diagnosis. The MPP patients with positive MP-SAT and positive MP-Ab were observed dynamically. The detection rates of MP-SAT and MP-Ab in different treatment time points were compared. The correlation of MP-SAT negative time with clinical recovery time, clinical symptoms, laboratory parameters and chest X-ray was analyzed. Results The ratio of inconsistent MP-SAT and MP-Ab results was 60.00% (48/80)and 19.39% (19/98)in the MPP group and the non-MPP group, respectively. The MP-SAT and MP-Ab were statistically different in terms of specificity and positive predictive value (P<0.05), while no difference was found in the sensitivity and negative predictive value (P>0.05). Both MP-SAT and MP-Ab were positive in 28 cases (35.00%). The positive rate of MP-SAT was decreased with the prolongation of treatment time (P<0.05), meanwhile the positive rate of MP-Ab was increased with the treatment time (P<0.05); the clinical recovery time of 28 cases was (3.11±0.88)weeks, and the MP-SAT negative time was (3.25±0.74)weeks, with no statistical difference (P>0.05). The long-term duration of MP-SAT was characterized by long duration of fever, high consolidation rate of X-ray chest radiograph, high CRP level, high LDH level, high percentage of neutrophils, and low percentage of lymphocytes (P<0.05). Conclusion MP-SAT, as a new generation of RNA live bacteria detection technology, has high value in monitoring the efficacy of Mycoplasma pneumonia in children, and it is worth promoting.

目的 比较肺炎支原体肺炎(MPP)、非MPP患儿和健康儿童的免疫球蛋白、补体水平,以探讨儿童MPP体液免疫指标的变化规律。方法 分别检测52例MPP、55例非MPP患儿和33例健康儿童的血清免疫球蛋白(IgG、IgA、IgM)、补体(C3、C4),并比较儿童MPP急性期和恢复早期体液免疫指标。结果 MPP组急性期血清IgM、C3、C4水平高于非MPP组急性期和健康儿童(P<0.05)。儿童MPP恢复早期IgM水平高于急性期,C4水平低于急性期(P<0.05)。结论 与非MPP和健康儿童比较,MPP患儿存在明显体液免疫功能紊乱,从急性期到恢复早期,血清IgM逐渐升高,补体C4先升高后降低,自身免疫反应可能参与了儿童MPP的发病过程。

Objective To investigate the changes of serum immunoglobulins and complement in children with mycoplasma pneumoniae pneumonia (MPP). Methods 52 children with MPP, 55 children with non-MPP and 33 healthy children were enrolled. The levels of serum immunoglobulins (IgG, IgA and IgM) and complements (C3, C4) were detected. Results Compared with the non-MPP group and healthy control, the levels of IgM, C3 and C4 in MPP group during their acute phase were significantly higher (P<0.05). And among the MPP group the levels of IgM were hisher and C4 were lower than that in the acute phase. Conclusion Immune function disturbance exists in children with MPP. From acute to recovery stage, the level of IgM increased while C4 increased firstly and then decreased. Immune injury may be involved in the pathophysiology of childhood MPP.

        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．