儿童重症肺炎支原体肺炎的外周血炎症指标与肺部影像学关系的探讨

Exploring the Association between Peripheral Blood Inflammatory Indicators and Pulmonary Imaging Findings in Children with Severe Mycoplasma pneumoniae Pneumonia

摘要: 目的：探讨外周血炎症指标对儿童重症肺炎支原体肺炎(Severe Mycoplasma pneumoniae pneumonia, SMPP)肺部影像学变化的预测价值。方法：回顾性分析2023年6月至2024年6月青岛大学附属医院黄岛院区收治的112例SMPP患儿临床资料，根据治疗前后肺部影像学变化分为CT评分较前无下降的观察组54例和评分较前下降的对照组58例，采用Logistic回归及ROC曲线分析评估，比较两组中性粒细胞/淋巴细胞比值(Neutrophil-lymphocyte ratio, NLR)、血小板/淋巴细胞比值(Platelet-lymphocyte ratio, PLR)、淋巴细胞/单核细胞比值(Lymphocyte-monocyte ratio, LMR)、全身免疫炎症指数(Systemic immune inflammatory index, SII)等指标差异，对两组的预测效能进行评估。结果：观察组54例NLR、PLR、SII、C-反应蛋白(C-reactive protein, CRP)、D-二聚体均显著高于共58例的对照组，LMR低于对照组，差异均具有统计学意义(P < 0.05)。多因素回归显示，LMR (OR = 8.21,95%CI: 1.33~50.77)与肺部CT评分变化呈负相关；PLR (OR = 0.89, 95%CI: 0.82~0.96)，SII (OR = 0.98, 95%CI: 0.96~0.99)，NLR (OR = 0.90, 95%CI: 0.88~0.94)与肺部CT评分变化呈正相关。ROC曲线表明PLR预测效能最佳(AUC = 0.953)，其次为NLR (AUC = 0.913)，再次为SII (AUC = 0.897)。结论：外周血炎症指标PLR、NLR、SII及LMR与儿童SMPP的影像学改善程度存在一定关联，可能为评估病情变化提供一定的参考。

Abstract: Objective: This paper aims to investigate the predictive value of peripheral blood inflammatory indicators for pulmonary imaging changes in children with Severe Mycoplasma pneumoniae pneumonia (SMPP). Methods: Clinical data from 112 SMPP patients admitted to the Huangdao Branch of the Affiliated Hospital of Qingdao University (June 2023-June 2024) were retrospectively analyzed. Based on the changes in pulmonary imaging before and after treatment, the patients were divided into an observation group of 54 cases with no decline in CT scores compared to the pre-treatment period and a control group of 58 cases with a decline in scores. Logistic regression and receiver operating characteristic (ROC) curve analyses were employed to compare neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) between groups, and evaluate the predictive performance of the two groups. Results: In the observation group of 54 cases, NLR, PLR, SII, C-reactive protein (CRP), and D-dimer were significantly higher than those in the control group of 58 cases, while LMR was lower than that in the control group, and the differences were statistically significant (P < 0.05). Multivariate analysis revealed LMR as negatively correlated with CT score changes (OR = 8.21, 95%CI: 1.33~50.77), while PLR (OR = 0.89, 95%CI: 0.82~0.96), SII (OR = 0.98, 95%CI: 0.96~0.99), and NLR (OR = 0.90, 95%CI: 0.88~0.94) showed positive correlations. The ROC curve indicates that PLR demonstrates the best predictive performance (AUC = 0.953), followed by NLR (AUC = 0.913), and then SII (AUC = 0.897). Conclusion: The peripheral blood inflammatory indices PLR, NLR, SII, and LMR show certain associations with the degree of radiographic improvement in children with Severe Mycoplasma pneumoniae pneumonia (SMPP) and may provide some reference for evaluating disease progression.