肺部超声、CPIS与炎症指标联合预测MPP儿童BAL干预时机及RMPP结局的价值

朱江雯; 陈筱青; 陈辉; 庄思斯; 周晨; 左莉莉

doi:10.16766/j.cnki.issn.1674-4152.004520

肺部超声、CPIS与炎症指标联合预测MPP儿童BAL干预时机及RMPP结局的价值

doi: 10.16766/j.cnki.issn.1674-4152.004520

朱江雯^{1, 2},
陈筱青¹,
陈辉¹,
庄思斯¹,
周晨¹,
左莉莉^1, ,

1.
南京医科大学第一附属医院儿科，江苏南京 210029
2.
南京医科大学附属明基医院儿科，江苏南京 210019

基金项目:

江苏省卫生健康委员会医学科研重点项目 K2023007

江苏省人民医院临床能力提升工程项目 JSPH-MC-2023-30

详细信息

通讯作者:
左莉莉，E-mail：candynjxc@163.com

中图分类号: R563.15
计量
- 文章访问数: 13
- HTML全文浏览量: 7
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-05-16
- 网络出版日期: 2026-11-10

Value of combined lung ultrasound, CPIS, and inflammatory markers for predicting the timing of lbronchoalveolar avage intervention and outcomes of refractory Mycoplasma pneumoniae pneumonia in children

1.
Department of Pediatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

摘要

摘要: 目的分析肺部超声评分(LUS)、临床肺部感染评分(CPIS)及血清炎症指标在指导肺炎支原体肺炎(MPP)儿童支气管肺泡灌洗术(BAL)介入时机及判断难治性肺炎支原体肺炎(RMPP)结局的预测效能。方法采用前瞻性巢式病例对照研究，选取2023年5月—2024年5月于南京医科大学第一附属医院儿科接受治疗的50例MPP患儿为研究对象，依据是否接受BAL干预将患儿分为纤支镜组(BAL组，28例)和非纤支镜组(non-BAL组，22例)，比较2组间基线资料、LUS、CPIS、血清炎症指标，构建多因素logistic回归模型，绘制ROC曲线预测实施BAL干预时机及RMPP临床结局。结果 2组MPP患儿性别、年龄、体重、平均动脉压、血气[pH、动脉血氧饱和度(SaO₂)、乳酸(Lac)]以及乳酸脱氢酶(LDH)差异均无统计学意义(P＞0.05)；BAL组LUS、CPIS、IL-6、D-二聚体、发热时间、住院时间高于non-BAL组，差异均有统计学意义(P＜0.05)。ROC分析提示联合LUS≥26.5分、CPIS≥5.5分、IL-6≥25.1 ng/L预测实施BAL干预时机AUC为0.950，灵敏度89.3%，特异度95.0%(P < 0.05)。联合LUS≥27.5分、CPIS≥6.5分、IL-6≥30.6 ng/L预测RMPP临床结局的AUC为0.915，灵敏度为88.9%，特异度为86.7%(P < 0.05)。结论 LUS联合CPIS、血清炎症指标可有效预测儿童MPP实施BAL干预时机及RMPP临床结局，敏感、无创、精准，值得临床推广。
- 肺炎支原体肺炎 /
- 肺部超声评分 /
- 临床肺部感染评分 /
- 血清炎症指标 /
- 儿童 /
- ROC曲线
Abstract: Objective To evaluate the value of the lung ultrasound score (LUS), clinical pulmonary infection score (CPIS), and serum inflammatory markers in predicting the timing for bronchoalveolar lavage (BAL) intervention and the outcomes of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. Methods A prospective nested case-control study was conducted. Fifty children with MPP treated in the Department of Pediatrics of the First Affiliated Hospital of Nanjing Medical University from May 2023 to May 2024 were selected as the research subjects. The children were divided into the bronchoscopy group (BAL group, n=28) and the non-bronchoscopy group (non-BAL group, n=22) based on whether they received BAL intervention. Baseline data, LUS, CPIS, and serum inflammatory markers were compared between the two groups. A multivariate logistic regression model was constructed by combining the above indicators, and the receiver operating characteristic curve (ROC) was drawn to predict the timing of BAL intervention and the outcome of RMPP. Results There were no statistically significant differences in gender, age, weight, mean arterial pressure, blood gas [pH, arterial oxygen saturation (SaO₂), lactic acid (Lac)], and lactate dehydrogenase (LDH) between the two groups (P>0.05). The BAL group had higher LUS, CPIS, IL-6, D-dimer, fever days, and hospitalization days than the non-BAL group (P < 0.05). ROC analysis indicated that the area under the curve (AUC) of the model combining LUS≥26.5 points, CPIS≥5.5 points, and IL-6≥25.1 ng/L for predicting the timing of BAL intervention was 0.950, with a sensitivity of 89.3% and a specificity of 95.0% (P < 0.05). The AUC of the model combining LUS≥27.5 points, CPIS≥6.5 points, and IL-6 ≥ 30.6 ng/L for predicting the outcome of RMPP was 0.915, with a sensitivity of 88.9% and a specificity of 86.7% (P < 0.05). Conclusion The combination of LUS, CPIS, and serum inflammatory markers can effectively predict the timing of BAL intervention and the outcome of RMPP in children with MPP, which is sensitive, non-invasive, and precise, and is worthy of clinical promotion.
- Mycoplasma pneumoniae pneumonia /
- Lung ultrasound score /
- Clinical pulmonary infection score /
- Serum inflammatory markers /
- Children /
- ROC curve

HTML全文

图 1 难治性肺炎支原体肺炎的影像学表现

注：A为胸部CT示右肺中叶不张伴胸腔积液；肺部超声示右肺实变伴胸腔积液、探及支气管充气征、水母征。B为胸部CT示右肺上叶实变；肺部超声示右肺实变伴支气管充气、充液征，探及不张肺组织内血流信号。

Figure 1. The imaging manifestations of refractory mycoplasma pneumoniae pneumonia

下载: 全尺寸图片幻灯片

图 2 LUS、CPIS及IL-6预测实施BAL干预的ROC曲线

Figure 2. ROC curves for predicting BAL intervention using LUS, CPIS and IL-6

下载: 全尺寸图片幻灯片

图 3 LUS、CPIS及IL-6预测RMPP临床结局的ROC曲线

Figure 3. ROC curves of LUS, CPIS and IL-6 for predicting clinical outcomes of RMPP

下载: 全尺寸图片幻灯片

表 1 临床肺部感染评分标准

Table 1. The clinical pulmonary infection score

评分 (分)	体温 (℃)	血白细胞计数 (×10⁹)	分泌物性状	氧合指数 (kPa)	胸片浸润影	病原学
0	36.0~37.9	4~10	无痰或少许	≥33	无	无
1	38.0~39.9	11~16	中大量非脓性	-	斑片状	-
2	＜36.0或＞39.9	≥17或＜4	中大量脓性	＜33	融合片状	肺泡灌洗液或血清支原体实验阳性
注：“-”表示无对应的赋值内容。

下载: 导出CSV

表 2 2组MPP患儿基线资料比较

Table 2. Comparison of baseline data between the two groups in children with MPP

组别	例数	性别 (男/女，例)	年龄 [M(P₂₅, P₇₅)，岁]	体重 [M(P₂₅, P₇₅)，kg]	平均动脉压 (x±s，mmHg)	pH (x±s)	SaO₂ [M(P₂₅, P₇₅)，%]	Lac [M(P₂₅, P₇₅)，mmol/L]
BAL组	28	16/12	6.5(4.0, 8.0)	23.0(18.3, 27.8)	76.9±10.3	7.4±0.0	0.9(0.9, 1.0)	1.4(1.1, 2.8)
non-BAL组	22	14/8	4.5(3.0, 9.0)	20.5(15.8, 37.3)	71.5±12.4	7.4±0.0	1.0(0.9, 1.0)	1.2(0.9, 1.6)
统计量		0.220^a	1.111^b	0.166^b	0.817^c		1.260^b	1.755^b
P值		0.640	0.267	0.868	0.100		0.208	0.079
注：^a为χ²值，^b为Z值，^c为t值；1 mmHg=0.133 kPa。

下载: 导出CSV

表 3 2组MPP患儿LUS、CPIS、血清炎症指标及临床资料比较

Table 3. Comparison of LUS, CPIS, serum inflammatory markers and clinical data between the two groups in children with MPP

组别	例数	LUS (x±s，分)	CPIS [M(P₂₅, P₇₅)，分]	LDH [M(P₂₅, P₇₅)，U/L]	IL-6 [M(P₂₅, P₇₅)，ng/L]	D-二聚体 [M(P₂₅, P₇₅)，mg/dL]	发热时间 (x±s，d)	住院时间 (x±s，d)
BAL组	28	30.4±3.2	6.0(6.0, 7.0)	320.5(248.0, 441.0)	16.5(5.6, 44.7)	0.6(0.4, 0.8)	7.4±3.4	13.3±3.6
non-BAL组	22	22.2±2.9	4.0(3.0, 5.0)	318.5(255.5, 396.5)	7.1(3.3, 17.9)	0.4(0.2, 0.5)	5.3±3.3	9.1±2.9
统计量		9.290^a	4.525^b	0.127^b	2.170^b	2.757^b	2.192^a	4.459^a
P值		＜0.001	＜0.001	0.899	0.030	0.006	0.030	＜0.001
注：^a为t值，^b为Z值。

下载: 导出CSV

参考文献(20)

[1]	LENGLART L, TITOMANLIO L, BOGNAR Z, et al. Surge of pediatric respiratory tract infections after the COVID-19 pandemic and the concept of "immune debt"[J]. J Pediatr, 2025, 284: 114420. DOI: 10.1016/j.jpeds.2024.114420.
[2]	GONG C, HUANG F, SUO L D, et al. Increase of respiratory illnesses among children in Beijing, China, during the autumn and winter of 2023[J]. Eur Commun Dis Bull, 2024, 29(2): 2300704. DOI: 10.2807/1560-7917.ES.2024.29.2.2300704.
[3]	SINGH Y, TISSOT C, FRAGA M V, et al. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)[J]. Crit Care, 2020, 24(1): 65. DOI: 10.1186/s13054-020-2787-9.
[4]	赵顺英, 钱素云, 陈志敏, 等. 儿童肺炎支原体肺炎诊疗指南(2023年版)[J]. 传染病信息, 2023, 36(4): 291-297. Zhao S Y, Qian S Y, Zhao Z M, et al. Guidelines for the diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children (2023)[J]. Journal of Infectious Diseases, 2023, 36(4): 291-297.
[5]	刘敬, 胡才宝, 叶瑞忠, 等. 感染性肺炎超声诊断专家建议[J]. 中华医学超声杂志(电子版), 2020, 17(3): 244-250. Liu J, Hu C B, Ye R Z, et al. Expert recommendations for ultrasound diagnosis of pneumonia[J]. Chinese Journal of Medical Ultrasound(Electronic Edition), 2020, 17(3): 244-250.
[6]	王永军, 王文媛, 易彬, 等. 中国儿童支气管肺泡灌洗术临床实践指南(2024)[J]. 中国当代儿科杂志, 2024, 26(1): 1-13. Wang Y J, Wang W Y, Yi B, et al. Clinical practice guidelines for bronchoalveolar lavage in Chinese children (2024)[J]. Chinese Journal of Contemporary Pediatrics, 2024, 26(1): 1-13.
[7]	薛红元, 赵浩天. 急性呼吸困难床旁肺超声诊断规范专家建议[J]. 疑难病杂志, 2024, 23(3): 257-265. Xue H Y, Zhao H T. Expert advice on the standardization of bedside lung ultrasound diagnosis of acute respiratory distress[J]. Chinese Journal of Difficult and Complicated Cases, 2024, 23(3): 257-265.
[8]	张松林, 熊蕾蕾, 余燕娟, 等. 血清IL-6、RANTES与儿童难治性肺炎支原体肺炎的关系[J]. 中华全科医学, 2023, 21(4): 619-621. doi: 10.16766/j.cnki.issn.1674-4152.002944 Zhang S L, Xiong L L, Yu Y J, et al. Expression of serum IL-6 and RNATES in children with refractory pneumonia caused by Mycoplasma pneumonias and their relationship with prognosis[J]. Chinese Journal of General Practice, 2023, 21(4): 619-621. doi: 10.16766/j.cnki.issn.1674-4152.002944
[9]	佘丹阳. 重视支原体肺炎诊治中面临的困难和挑战[J]. 中华结核和呼吸杂志, 2021, 44(1): 8-10. She D Y. Focus on the difficulties and challenges in the diagnosis and treatment of Mycoplasma pneumoniae pneumonia[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2021, 44(1): 8-10.
[10]	左莉莉, 陈筱青, 周洁, 等. 重症心肺超声评估新生儿呼吸窘迫综合征机械通气的应用价值[J]. 中华超声影像学杂志, 2022, 31(11): 953-959. Zuo L L, Chen X Q, Zhou J, et al. Application of point-of-care cardiopulmonary ultrasound in mechanical ventilation of neonatal respiratory distress syndrome[J]. Chinese Journal of Ultrasonography, 2022, 31(11): 953-959.
[11]	齐彩英, 刘振华, 刘建英. 肺部超声对阿奇霉素联合甲泼尼龙治疗重症支原体肺炎的效果评估[J]. 中国急救复苏与灾害医学杂志, 2024, 19(5): 632-635. Qi C Y, Liu Z H, Liu J Y. Application of lung ultrasound in the evaluation of the efficacy of azithromycin combined with methylprednisolone in the treatment of mycoplasma severe pneumonia[J]. China Journal of Emergency Resuscitation and Disaster Medicine, 2024, 19(5): 632-635.
[12]	LI S, ZHANG Q L, GUO R J, et al. Quantitative evaluation and significance of ultrasound in bronchoalveolar lavage for lung consolidation in children with severe Mycoplasma pneumonia[J]. Transl Pediatr, 2021, 10(9): 2325-2334. doi: 10.21037/tp-21-381
[13]	万钟予, 戚惠霏, 卢燕鸣. 肺部超声评分联合外周血参数比值在儿童重症肺炎支原体肺炎中的意义[J]. 临床肺科杂志, 2023, 28(10): 1505-1510. Wan Z Y, Qi H F, Lu Y M. Value of lung ultrasound score combined with peripheral blood parameter ratio in pediatric severe Mycoplasma pneumoniae pneumonia[J]. Journal of Clinical Pulmonary Medicine, 2023, 28(10): 1505-1510.
[14]	BECERRA-HERVáS J, GUITART C, COVAS A, et al. The clinical pulmonary infection score combined with procalcitonin and lung ultrasound (CPIS-PLUS), a good tool for ventilator associated pneumonia early diagnosis in pediatrics[J]. Children (Basel), 2024, 11(5): 592. DOI: 10.3390/children11050592.
[15]	张祥, 李立学, 陈雅祺, 等. 血清PCT、BNP、DD与PCIS评分对重症肺部感染儿童的评估效果[J]. 中华医院感染学杂志, 2019, 29(16): 2510-2514. Zhang X, Li L X, Chen Y Q, et al. effect of serum PCT, BNP, DD and PCIS scores on children with severe pulmonary infection[J]. Chinese Journal of Nosocomiology, 2019, 29(16): 2510-2514.
[16]	闫静, 侯艳苗, 王振华. 难治性支原体肺炎患儿血清LncRNA NNT-AS1、IL-17A水平变化及临床意义[J]. 中华全科医学, 2024, 22(3): 447-450. doi: 10.16766/j.cnki.issn.1674-4152.003423 Yan J, Hou Y M, Wang Z H. Changes and clinical significance of serum LncRNA NNT-AS1, IL-17A levels in children with refractory Mycoplasma pneumonia[J]. Chinese Journal of General Practice, 2024, 22(3): 447-450. doi: 10.16766/j.cnki.issn.1674-4152.003423
[17]	张立霞, 朱峰, 李传景, 等. 重症肺炎支原体肺炎患儿CRP、LDH等实验室指标的预警价值及支气管镜下特点[J]. 中华全科医学, 2024, 22(7): 1098-1101, 1107. doi: 10.16766/j.cnki.issn.1674-4152.003575 Zhang L X, Zhu F, Li C J, et al. Early warning value and bronchoscopic characteristics of experimental indicators such as CRP and LDH in sever Mycoplasma pneumoniae[J]. Chinese Journal of General Practice, 2024, 22(7): 1098-1101, 1107. doi: 10.16766/j.cnki.issn.1674-4152.003575
[18]	ZHANG X, SUN R Y, HOU J P, et al. Clinical characteristics and risk factors of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children[J]. Sci Rep, 2024, 14(1): 24043. DOI: 10.1038/s41598-024-74302-x.
[19]	张博, 朱玉林, 熊玉红, 等. 儿童重症肺炎支原体肺炎的危险因素探讨[J]. 中华全科医学, 2024, 22(7): 1094-1097. doi: 10.16766/j.cnki.issn.1674-4152.003574 Zhang B, Zhu Y L, Xiong Y H, et al. Exploration of risk factors for severe Mycoplasma pneumoniae pneumonia in children[J]. Chinese Journal of General Practice, 2024, 22(7): 1094-1097. doi: 10.16766/j.cnki.issn.1674-4152.003574
[20]	DENG F, CAO H, LIANG X, et al. Analysis of cytokine levels, cytological findings, and MP-DNA level in bronchoalveolar lavage fluid of children with Mycoplasma pneumoniae pneumonia[J]. Immun Inflamm Dis, 2023, 11(5): e849. DOI: 10.1002/iid3.849.