儿童咳嗽变异性哮喘转为典型哮喘风险调查及列线图预测模型的构建和验证  

Investigation on the risk of children with cough variant asthma transforming into typical asthma and construction and validation of a column chart prediction model

作　　者：范良勤 张鸿 田鹏 蒙玲 尚彪 FAN Liangqin;ZHANG Hong;TIAN Peng;MENG Ling;SHANG Biao(Department of Paediatrics,Nanchong Central Hospital,the Second Clinical Medical College of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]南充市中心医院.川北医学院第二临床医学院儿科,四川南充637000

出　　处：《临床肺科杂志》2023年第12期1861-1867,共7页Journal of Clinical Pulmonary Medicine

摘　　要：目的构建儿童咳嗽变异性哮喘转为典型哮喘风险的列线图预测模型并进行验证。方法选择2020年1月至2022年12月我院接诊的306例咳嗽变异性哮喘患儿进行研究。收集可能影响儿童咳嗽变异性哮喘转为典型哮喘相关因素,患儿均随访1年,随访结束后根据《儿童支气管哮喘诊断与防治指南(2016年版)》中典型哮喘诊断标准对患儿进行评估,根据有无转变为典型哮喘将患儿分为两组,比较两组个体因素、环境相关因素及检测指标,以LASSO回归筛选出潜在变量后采用Logistic回归筛选出影响儿童咳嗽变异性哮喘转为典型哮喘的独立性影响因素,依此建立列线图模型并进行验证。结果模型组214例咳嗽变异性哮喘患儿中38例(17.76%)转变为典型哮喘,转变组与未转变组患儿病程、病情严重程度、特应性疾病史、哮喘家族史、治疗依从性、家中使用地毯、家中种养花草、居室酶斑、FVC、FEF 50%、MMEF、FeNO及EOS比较差异具有统计学意义(P<0.05)。以LASSO回归基础上行多因素Logisitc回归分析结果显示:特应性疾病史、哮喘家族史、治疗依从性、家中种养花草、MMEF、FeNO及EOS为儿童咳嗽变异性哮喘转为典型哮喘的独立性影响因素。根据多因素分析结果以R语言建立儿童咳嗽变异性哮喘转为典型哮喘预测列线图模型。ROC分析结果显示,模型组列线图模型预测儿童咳嗽变异性哮喘转为典型哮喘的AUC为0.929[95%CI(0.886~0.972)];验证组AUC为0.914[95%CI(0.864~0.964)]。采用Bootstrap法重复抽样1000次,并以验证组进行验证,校准曲线结果显示:模型组与验证组预测曲线与标准曲线基本拟合,提示模型预测准确度较高。模型组决策曲线分析结果显示:当该列线图模型预测儿童咳嗽变异性哮喘转为典型哮喘的概率阈值为0.15~1.00时,患者的净受益率大于0。结论儿童咳嗽变异性哮喘转为典型哮喘受患儿特应性疾病史、哮喘�Objective To construct a column chart prediction model for the risk of childhood cough variant asthma turning into typical asthma and to validate it.Methods A study was conducted on 306 children with cough variant asthma who were admitted to our hospital from January 2020 to December 2022.The relevant factors were collected that might affect the conversion of cough variant asthma to typical asthma in children.All children were followed up for 1 year.After the follow-up,the children were evaluated according to the diagnostic criteria for typical asthma in the"Guidelines for the Diagnosis and Treatment of Children′s Bronchial Asthma(2016 Edition)".The children were divided into two groups based on whether they had transitioned to typical asthma.The individual factors,environmental factors,and detection indicators were compared between the two groups.After screening potential variables using LASSO regression,logistic regression was used to identify independent influencing factors that affected the transition from cough variant asthma to typical asthma in children.Based on this,a column chart model was established and validated.Results 38(17.76%)of 214 children with cough variant asthma in the model group turned into typical asthma.There were significant differences in the course of disease,severity of disease,history of atopic disease,family history of asthma,treatment compliance,home use of carpets,home planting of flowers and plants,home enzyme spots,FVC,FEF 50%,MMEF,FeNO and EOS between the transition group and the non transition group(P<0.05).Multi-factor logisitc regression analysis based on LASSO regression showed that the history of atopic disease,family history of asthma,treatment compliance,home gardening,MMEF,FeNO and EOS were independent influencing factors for children with cough variant asthma to become typical asthma.Based on the results of multivariate analysis,a column chart model for predicting the transition from cough variant asthma to typical asthma in children was established using R language.

关 键 词：儿童 咳嗽变异性哮喘 典型哮喘 多因素分析 列线图 

分 类 号：R725.6[医药卫生—儿科]