血小板分布宽度联合肌酸激酶同工酶检测对肺炎支原体肺炎患儿预后的预测价值

The predictive value of platelet distribution width combined with creatine kinase isoenzyme for the prognosis of children with mycoplasma pneumoniae pneumonia

摘要:

目的 探讨血小板分布宽度（PDW）和肌酸激酶同工酶（CK-MB）对肺炎支原体肺炎患儿预后预测的价值。方法 本研究为前瞻性队列研究。选取2020年1月—2023年12月于亳州市人民医院就诊的肺炎支原体肺炎确诊患儿127例作为研究对象。根据治疗后的临床转归，将患儿分为好转组和不良转归组。比较两组患者治疗前PDW和CK-MB水平的差异，采用Pearson法分析PDW、CK-MB与患儿临床肺部感染评分（CPIS）的相关性，绘制受试者工作特征（ROC）曲线分析PDW和CK-MB对肺炎支原体肺炎患儿预后的预测效能。结果 不良转归组的发热持续时间和临床肺部感染评分均高于好转组（P <0.05）。不良转归组血小板分布宽度、中性粒细胞比例、白细胞计数、单核细胞比例、肌酸激酶同工酶水平和C反应蛋白水平均高于好转组（P <0.05），淋巴细胞比例及血小板计数低于好转组（P <0.05）。临床肺部感染评分与血小板分布宽度、肌酸激酶同工酶呈正相关（r =0.426和0.260，均P <0.05）。ROC曲线结果表明，血小板分布宽度、肌酸激酶同工酶联合预测肺炎支原体肺炎患儿不良预后的曲线下面积为0.960（95% CI：0.931，0.989），敏感性为95.6%（95% CI：0.938，0.973），特异性为86.6%（95% CI：0.813，0.913），预测效能较好。结论 PDW和CK-MB水平与肺炎支原体肺炎患儿的预后密切相关，且两者联合检测对于预测患儿的不良预后具有更高的敏感性和特异性，提示PDW和CK-MB可以作为评估肺炎支原体肺炎患儿预后的有价值的生化标志物。

Abstract:

Objective To explore the predictive value of platelet distribution width (PDW) and creatine kinase isoenzyme (CK-MB) in the prognosis of children with mycoplasma pneumoniae pneumonia.Methods In this prospective cohort study, 127 pediatric patients with confirmed mycoplasma pneumoniae pneumonia were enrolled at our hospital from January 2020 to December 2023. Patients were classified into an improvement group or an adverse outcome group based on their response to treatment. We analyzed pre-treatment PDW and CK-MB levels, explored their correlation with the clinical pulmonary infection score (CPIS), and evaluated their predictive performance using ROC curve analysis.Results The duration of fever and clinical pulmonary infection score in the adverse outcome group were higher than those in the improvement group (P < 0.05). The platelet distribution width, neutrophil count, white blood cell, monocyte proportion, creatine kinase isoenzyme level, and CRP level in the adverse outcome group were higher than those in the improvement group (P < 0.05), while the lymphocyte proportion and platelet count were lower than those in the improvement group (P < 0.05).The clinical pulmonary infection score is positively correlated with platelet distribution width and creatine kinase isoenzymes (r =0.426 and 0.260, both P < 0.05). The ROC curve results showed that the area under the curve for predicting poor prognosis in children with mycoplasma pneumoniae pneumonia by combining platelet distribution width and creatine kinase isoenzymes was 0.960 (95% CI: 0.931, 0.989), with a sensitivity of 95.6% (95% CI: 0.938, 0.973) and a specificity of 86.6% (95% CI: 0.813, 0.913), indicating good predictive efficacy.Conclusion Elevated levels of PDW and CK-MB correlate strongly with poorer clinical outcomes in children with mycoplasma pneumoniae pneumonia. The combined application of these markers significantly enhances the precision of prognosis prediction, underscoring their potential as critical biochemical indicators in the clinical assessment of this condition.