【摘要】 目的 探讨肺部超声（LUS）相关指标对儿童重症肺炎支原体肺炎（SMPP）的预测价值。方法 收集2022年1月至2024年12月苏州大学附属第三医院儿科因肺炎支原体肺炎住院且入院后48 h内完善LUS的154例患儿的一般资料、临床特征及指标、LUS相关指标、LUS图像表现资料进行回顾性分析，按病情严重程度分为轻症组（103例）和重症组（51例）。采用Mann-Whitney U检验、χ~2检验比较两组临床特征及指标、LUS相关指标、LUS图像表现；采用二元logistic回归分析儿童SMPP的影响因素；采用受试者操作特征（ROC）曲线评价LUS相关指标预测儿童SMPP的价值。结果 重症组发热持续时间和住院时间均长于轻症组（P<0.05）。重症组C反应蛋白（CRP）、乳酸脱氢酶（LDH）、D-二聚体（D-D）高于轻症组（P<0.05）。重症组肺实变最长径长于轻症组，肺实变体积/体表面积比值大于轻症组（P<0.05）。LUS图像显示，重症组肺实变、支气管充气征占比高于轻症组（P<0.05）。多因素分析结果显示，发热持续时间、LDH、D-D、CRP、肺实变最长径、肺实变体积/体表面积比值是儿童SMPP的独立危险因素（P<0.05）。肺实变最长径为3.95 cm时，曲线下面积（AUC）为0.939，约登指数为0.77，灵敏度为92%，特异度为85%，诊断效能最高；肺实变体积/体表面积比值为25.80时，AUC为0.955，约登指数为0.81，灵敏度为96%，特异度为85%，诊断效能最高；肺实变体积/体表面积比值的AUC最大（P<0.05）。结论 肺实变最长径和肺实变体积/体表面积比值与儿童SMPP有显著正相关关系，在预测儿童SMPP方面具有较高的价值。更多还原

【Abstract】 Objective To explore the predictive value of lung ultrasound(LUS) related indicators for children with severe Mycoplasma pneumoniae pneumonia(SMPP). Methods A retrospective analysis was conducted on the general information, clinical characteristics and indicators, LUS related indicators, LUS image performance, and other data of 154 children who were hospitalized due to Mycoplasma pneumoniae pneumonia in the Department of Pediatrics, the Third Affiliated Hospital of Soochow University from January 2022 to December 2024 and completed LUS within 48 hours after admission. According to the severity of the condition, the children were divided into the mild group(103 cases) and the severe group(51 cases). The Mann-Whitney U test and chi-square test were used to compare the clinical characteristics and indicators, LUS related indicators, and LUS image performance between the two groups. The influencing factors of children with SMPP were analyzed using binary logistic regression analysis. The receiver operating characteristic(ROC) curve was used to evaluate the predictive value of LUS related indicators in children with SMPP. Results The duration of fever and hospitalization time in the severe group were longer than those in the mild group(P < 0.05). The levels of C-reactive protein(CRP), lactate dehydrogenase(LDH), and D-dimer(DD) in the severe group were higher than those in the mild group(P < 0.05). The longest diameter of lung consolidation in the severe group was larger than that in the mild group, and the ratio of lung consolidation volume to body surface area was larger than that in the mild group(P < 0.05). LUS imaging showed that the proportions of lung consolidation and air bronchogram in the severe group were higher than those in the mild group(P < 0.05). The multivariate analysis results showed that the duration of fever, LDH, D-D, CRP, the longest diameter of lung consolidation, and the ratio of lung consolidation volume to body surface area were the independent risk factors for children with SMPP(P < 0.05). When the longest diameter of lung consolidation was 3.95 cm, the area under the curve(AUC) was 0.939, the Youden index was 0.77, the sensitivity was 92%, the specificity was 85%, and the diagnostic efficiency was highest. When the ratio of lung consolidation volume to body surface area was 25.80, the AUC was 0.955, the Youden index was 0.81, the sensitivity was 96%, the specificity was 85%, and the diagnostic efficiency was highest. The AUC of the ratio of lung consolidation volume to body surface area was the largest(P < 0.05). Conclusion The longest diameter of lung consolidation and the ratio of lung consolidation volume to body surface area show a significant positive correlation with children with SMPP, which has a higher value in predicting children with SMPP.更多还原