小儿细菌性肺炎的高效识别模型及临床价值研究

发布时间：2018-03-25 15:05

本文选题：肺炎　切入点：细菌性　出处：《中国全科医学》2017年03期

【摘要】：背景目前国内尚缺乏对发热就诊的肺炎患儿是否为细菌感染做出快速判断的简易方法,容易引起漏诊及抗生素的滥用。目的建立预判发热就诊的肺炎患儿是否为细菌感染的简单模型。方法回顾性选取2012—2013年温州医科大学附属第二医院育英儿童医院符合纳入标准的以发热就诊的肺炎患儿538例为研究对象。根据疾病原因将患儿分为细菌感染组(133例)和非细菌感染组(405例)。从538例患儿中随机选取54例作为验证集(细菌性肺炎13例,非细菌性肺炎41例)。收集患儿一般资料、实验室检测结果,建立5个诊断细菌性肺炎的模型〔F1=C反应蛋白(CRP)×降钙素原(PCT)、F2=CRP2×PCT、F3=CRP×PCT2、F4=性别权重×就诊季节权重×喘息症状系数×(CRP×PCT)、F5=性别权重×就诊季节权重×喘息症状系数×(CRP×PCT2)〕,绘制其诊断细菌性肺炎的ROC曲线,确定最优模型。结果两组患儿性别、就诊季节、寒战发生率、呼吸加快发生率、喘息发生率、呕吐发生率、腹泻发生率、哭闹发生率、干Up音发生率、湿Up音发生率、发热持续天数、最高体温、白细胞计数(WBC)、CRP水平、PCT水平比较,差异有统计学意义(P0.05)。单独CRP诊断细菌性肺炎的ROC曲线下面积(AUC)为0.969,95%CI(0.955,0.979),临界值为48.5 mg/L,灵敏度为88.0%,特异度为93.6%;单独PCT诊断细菌性肺炎的AUC为0.974,95%CI(0.959,0.989),临界值为0.5 g/L,灵敏度为92.5%,特异度为84.0%;F1诊断细菌性肺炎的AUC为0.983,95%CI(0.973,0.993),临界值为17.4,灵敏度为92.5%,特异度为96.3%;F2诊断细菌性肺炎的AUC为0.981,95%CI(0.971,0.992),临界值为241.1,灵敏度为97.7%,特异度为90.6%;F3诊断细菌性肺炎的AUC为0.983,95%CI(0.973,0.993),临界值为6.3,灵敏度为94.0%,特异度为96.3%;F4诊断细菌性肺炎的AUC为0.987,95%CI(0.980,0.996),临界值为1.1,灵敏度为94.7%,特异度为95.6%;F5诊断细菌性肺炎的AUC为0.988,95%CI(0.981,0.997),临界值为0.2,灵敏度为97.7%,特异度为94.3%。根据单独CRP、单独PCT、F5的临界值,对验证集患儿进行诊断,结果显示,单独CRP诊断验证集患儿细菌性肺炎的灵敏度为76.9%,特异度为97.6%,正确率为92.6%;单独PCT诊断验证集患儿细菌性肺炎的灵敏度为84.6%,特异度为97.6%,正确率为94.4%;F5诊断验证集患儿细菌性肺炎的灵敏度为92.3%,特异度为97.6%,正确率为96.3%。结论对于因发热就诊的肺炎患儿,可以通过F5模型〔F5=性别权重×就诊季节权重×喘息症状系数×(CRP×PCT2)〕计算得到相应的结果,若结果大于0.2,可诊断细菌性肺炎,建议早期使用抗生素治疗。
[Abstract]:Background at present, there is a lack of a simple method for the rapid diagnosis of bacterial infection in children with pneumonia. Objective to establish a simple model for predicting bacterial infection in children with febrile pneumonia. Methods A retrospective study was conducted to select Yuying Children's Hospital of the second affiliated Hospital of Wenzhou Medical University in 2012-2013. A total of 538 children with pneumonia with fever were included in the study. According to the causes of the disease, the children were divided into bacterial infection group (133 cases) and non-bacterial infection group (405 cases). From 538 children, 54 cases were randomly selected as the validation set. (13 cases of bacterial pneumonia). General data and laboratory results of 41 cases of non-bacterial pneumonia were collected. To establish five models for the diagnosis of bacterial pneumonia: CRP) 脳 procalcitonin, CRP2 脳 PCT _ 2, CRP 脳 PCT _ 2F _ 4 = sex weight 脳 seasonal weight 脳 wheezing symptom coefficient 脳 sex weight 脳 seasonal weight 脳 wheezing symptom coefficient 脳 panting symptom coefficient 脳 CRP 脳 PCT _ 2, and its diagnostic bacteria were plotted. ROC curve of pneumonia, Results Sex, consultation season, shivering rate, respiratory acceleration rate, wheezing rate, vomiting rate, diarrhea rate, crying rate, dry up sound rate, wet up sound rate were determined in the two groups. The duration of fever, the highest body temperature, the WBCU CRP level and the PCT level were compared. The area under the ROC curve of CRP alone for the diagnosis of bacterial pneumonia was 0.969 ~ 95%, the critical value was 48.5 mg / L, the sensitivity was 88.0 and the specificity was 93.60.The AUC of single PCT for the diagnosis of bacterial pneumonia was 0.9749% CI0.95999, the critical value was 0.5 g / L, the sensitivity was 92.5 mg / L, the sensitivity was 92.5 mg / L, the critical value was 0.5 g / L, and the sensitivity was 92.5 mg / L, respectively. The AUC for diagnosing bacterial pneumonia in F _ 1 was 0.983C _ (95), the critical value was 17.4, the sensitivity was 92.5, the AUC for F _ 2 was 0.981C _ (95) CI 0.9922.The critical value was 241.1, the sensitivity was 97.7m, the AUC for diagnosis of bacterial pneumonia was 0.98395 C _ (3) 0.9730.993T, the critical value for diagnosis of bacterial pneumonia was 0.98395 C _ (2), the critical value was 0.9921, the critical value was 97.7%, and the specificity was 0.98395% (0.9730.993N). The AUC, the critical value, the sensitivity, the specificity, the critical value, the sensitivity, the AUC, the critical value, the sensitivity, the AUC, the critical value and the specificity for the diagnosis of bacterial pneumonia were 0.98895CI0.9810.997, 0.98895CI0.991, 0.98895CI0.991, 0.98895CI0.991, 0.98895CI0.991, 0.98895CI0.9810.997and 0.98895CI0.9810.997.The critical value, sensitivity and specificity were 0.98895CI0.9810.997and 0.98895CI0.9810.997. Critical value of individual PCTN F5, The diagnosis of children with validation set showed that, The sensitivity, specificity and accuracy of single CRP diagnostic verification set were 76.9, 97.6and 92.6percent respectively, and the sensitivity, specificity and accuracy of single PCT diagnosis and verification set were 84.6, 97.6and 94.4g respectively. The sensitivity, specificity and accuracy of bacterial pneumonia were 92.3%, 97.6 and 96.3.Conclusion for pneumonia children with fever, the sensitivity is 92.3%, the specificity is 97.6%, and the accuracy rate is 96.3.Conclusion:. The corresponding results can be calculated by F5 model: F5 = sex weight 脳 seasonal weight 脳 wheezing symptom coefficient 脳 CRP 脳 PCT2P). If the result is greater than 0.2, bacterial pneumonia can be diagnosed and antibiotics should be used early.
【作者单位】：温州医科大学附属第二医院育英儿童医院内分泌遗传代谢科;
【基金】：浙江省温州市科技局科研基金资助项目(Y20120122)
【分类号】：R725.6

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