目的 分析儿童难治性肺炎支原体肺炎（refractory mycoplasma pneumoniae pneumonia， RMPP）的临床特征和危险因素，确定RMPP患儿的联合预测因子，同时构建预测模型，为早期识别RMPP并制定精准治疗和用药方案提供科学依据。 方法 回顾性分析2023年8月1日至2024年2月29日在中国人民解放军总医院第七医学中心儿内一科住院的282例MPP患儿临床资料，其中119例RMPP患儿作为RMPP组，其余163例普通MPP（GMPP）患儿作为GMPP组。对比分析两组患儿的临床资料（包括年龄、性别、发热持续时间、症状、实验室检验指标、胸部影像学资料、并发症等），构建联合应用的逻辑概率模型（LogP模型），采用受试者工作特征（ROC）曲线下面积（AUC）评价模型的区分度；采用校准曲线评估模型的一致性。 结果 与GMPP组相比，RMPP组患儿的发热时长更长（P = 0.002），并发症如心肌损害、凝血功能异常的发生率更高（P < 0.05）。在炎症指标方面，RMPP组的C反应蛋白（CRP）、降钙素原（PCT）、乳酸脱氢酶（LDH）水平显著高于GMPP组（P < 0.05），而白蛋白（Alb）水平低于GMPP组（P = 0.001）。RMPP组的白介素-2（IL-2）、白介素-5（IL-5）、白介素-8（IL-8）、白介素-1β（IL-1β）、D-二聚体（D-Dimer）水平升高，白介素-6（IL-6）、白介素-17（IL-17）水平降低（P < 0.05）。胸部CT检查显示，RMPP组患儿肺实变、胸腔积液和肺不张的比例高于GMPP组（P < 0.05）。多变量logistic回归分析显示，CRP、总胆红素（T-BIL）、LDH、IL-17、凝血酶原时间（PT）是RMPP的独立危险因素（P < 0.05）。基于这些因素建立的ROC预测模型，其曲线下面积（AUC）为0.787（95%CI：0.693～0.880），截断值为0.421，敏感度为0.786，特异度为0.660。校准曲线显示，预测概率与参考概率拟合度良好，Hosmer-Lemeshow检验结果差异无统计学意义（P > 0.05）。 结论 RMPP患儿的临床特征主要表现为发热持续时间长、肺部病变重、合并其他脏器损伤、炎症指标高。CRP、T-BIL、LDH、IL-17、PT可作为RMPP的独立危险因素。

Objective To comprehensively analyze the clinical characteristics and risk factors of children with refractory mycoplasma pneumonia （RMPP）， precisely identify the joint predictors in these children， and construct a prediction model. This aims to offer a scientific foundation for the early identification of RMPP and the formulation of accurate treatment and medication strategies. Methods A retrospective analysis was performed on the clinical data of 282 children diagnosed with mycoplasma pneumoniae pneumonia （MPP） who were admitted to the Pediatric Department of the Seventh Medical Center of the Chinese People's Liberation Army General Hospital between August 1， 2023， and February 29， 2024. Among these children， 119 with RMPP were classified into the RMPP group， while the remaining 163 with general MPP （GMPP） were assigned to the GMPP group. The clinical data of both groups， encompassing age， gender， duration of fever， symptoms， laboratory test indices， chest imaging data， complications， etc.， were compared. A logistic probability model （LogP model） for joint application was constructed. The discriminatory ability of the model was evaluated using the area under the receiver operating characteristic （ROC） curve， and the calibration of the model was assessed by means of a calibration curve. Results In comparison with the GMPP group， children in the RMPP group exhibited a significantly longer duration of fever （P = 0.002）. Moreover， they had a higher incidence of complications， including myocardial damage and coagulation dysfunction （P < 0.05）. Regarding inflammatory markers， the levels of C-reactive protein （CRP）， procalcitonin （PCT）， and lactate dehydrogenase （LDH） were notably elevated in the RMPP group （P < 0.05）， whereas the level of albumin （Alb） was lower （P = 0.001）. In the RMPP group， the levels of interleukin-2 （IL-2）， interleukin-5 （IL-5）， interleukin-8 （IL-8）， interleukin-1β （IL-1β）， and D-Dimer were increased， while the levels of interleukin-6 （IL-6） and interleukin-17 （IL-17） were decreased （P < 0.05）. Chest computed tomography （CT） scans revealed a higher proportion of lung consolidation， pleural effusion， and atelectasis in the RMPP group （P < 0.05）. Multivariate logistic regression analysis demonstrated that CRP， total bilirubin （T-BIL）， LDH， IL-17， and prothrombin time （PT） were independent risk factors for RMPP （P < 0.05）. The receiver operating characteristic （ROC） predictive model established based on these factors had an area under the curve （AUC） of 0.787 （95% confidence interval ［CI］： 0.693 ~ 0.880）， with a cutoff value of 0.421， a sensitivity of 0.786， and a specificity of 0.660. The calibration curve indicated that the predicted probability matched well with the reference probability， and there was no statistical difference in the results of the Hosmer-Lemeshow test （P > 0.05）. Conclusions The clinical features of children with RMPP are predominantly characterized by prolonged fever， moderate lung lesions， other organ injuries， and high inflammatory markers. CRP， T-BIL， LDH， IL-17， and PT can act as independent risk factors for RMPP.