摘要目的:探讨儿童肺炎支原体肺炎（MPP）合并肺血栓栓塞症（PTE）的危险因素、预后及对患儿出院3个月后的相关生活质量影响。方法:收集2013年1月至2024年12月在山东第一医科大学附属省立医院小儿呼吸科诊断为MPP合并PTE(MPP合并PTE组)的68例患儿临床资料及PTE治疗方案，选取同期不合并PTE的MPP（MPP无PTE组）患儿123例为对照，建立列线图风险预测模型，并分析PTE对患儿心肺功能和生活质量的影响。结果:（1）68例MPP合并PTE患儿中，男39例（57.4%），女29例（42.6%），中位年龄为7.9（6.3，9.7）岁，肺栓塞危险分层高危2例（2.9%），中危5例（7.4%），低危61例（89.7%）。临床表现中胸痛13例（19.1%），咯血7例（10.3%），呼吸困难10例（14.7%），未见胸痛、咯血和呼吸困难典型三联征。接受溶栓治疗5例（7.4%），抗凝治疗中肝素/低分子肝素68例（100.0%），序贯口服利伐沙班50例（73.5%）、华法林2例（2.9%）、达比加群1例（1.4%）。（2）肺栓塞危险分层高危患儿2例均死亡，66例中危及低危患儿血栓消失中位时间为42（30，68）d，随访期间无血栓复发、进展及慢性血栓栓塞性肺动脉高压后遗症，无明显心功能下降，肺通气功能障碍10例。（3）多元Logistic回归分析显示，住院时间≥8.5 d、年龄>7.65岁、乳酸脱氢酶≥409.9 U/L、合并胸腔积液是MPP患儿合并PTE的危险因素，基于以上因素建立MPP合并PTE列线图预测模型（敏感度82.5%，特异度91.1%）。（4）应用36条目简明健康量表评估MPP合并PTE患儿治疗3个月后生活质量，各维度得分均处于较高水平（≥85分），恢复正常生活。结论:儿童MPP合并PTE的临床表现不典型，根据MPP合并PTE患儿的危险因素分析建立的列线图预测模型用于早期识别PTE具有较高临床价值。根据PTE危险分层，选择合理治疗方案并定期随访心肺功能，有助于减少后遗症发生，改善患儿预后。

abstractsObjective:To investigate the risk factors,prognosis,and impact on the related quality of life 3 months after discharge of children with Mycoplasma pneumoniae pneumonia (MPP) complicated with pulmonary thromboembolism (PTE).Methods:Clinical data and PTE treatment regimens were collected from 68 pediatric patients diagnosed with MPP complicated by PTE in the Department of Pediatric Respiratory Medicine at Shandong Provincial Hospital Affiliated to Shandong First Medical University between January 2013 and December 2024.A control group of 123 MPP patients without PTE during the same period was selected.A risk prediction nomogram was established,and the effects of PTE on cardiopulmonary function and quality of life were analyzed.Results:(1) Among the 68 MPP patients with PTE,39 were male (57.4%) and 29 were female (42.6%),with a median age of 7.9(6.3,9.7) years.The risk stratification of pulmonary embolism was as follows:high risk in 2 cases (2.9%),intermediate risk in 5 cases (7.4%),and low risk in 61 cases (89.7%).Clinical manifestations included chest pain in 13 cases (19.1%),hemoptysis in 7 cases (10.3%),and dyspnea in 10 cases (14.7%).No cases presented with the classic triad of chest pain,hemoptysis,and dyspnea.Treatments included thrombolysis in 5 cases (7.4%) and anticoagulation therapy:heparin/low molecular weight heparin in 68 cases (100.0%),sequential oral rivaroxaban in 50 cases (73.5%),warfarin in 2 cases (2.9%),and dabigatran in 1 case (1.4%).(2) Two high-risk patients died.Among the remaining 66 patients in the intermediate- and low-risk groups,the median time to thrombus resolution was 42 (30,68) days.During follow-up,there were no recurrences,progressions of thrombosis,or sequelae of thrombotic pulmonary hypertension,no significant decline in cardiac function,and 10 cases of pulmonary ventilation dysfunction.(3) Multiple Logistic regression analysis indicated that hospital stay ≥8.5 days,age>7.65 years,lactate dehydrogenase ≥409.9 U/L,and pleural effusion were significant risk factors for PTE in children with MPP,and a prediction nomogram of MPP with PTE was established based on above factors(sensitivity 82.5%,specificity 91.1%).(4) The SF-36 scale was utilized to assess the quality of life in children with MPP complicated with PTE following three months of treatment.Scores across all dimensions were found to be at a high level (≥85 points),indicating a restoration to normal life.Conclusion:The clinical manifestations of PTE in children with MPP are atypical.The prediction nomogram developed based on risk factor analysis for MPP patients with PTE holds significant clinical value for early PTE identification.Treatment according to PTE risk stratification and regular cardiopulmonary follow-up can help reduce sequelae and improve patient prognosis.