咳嗽患者百日咳感染特征分析及症状组合预测模型的构建与验证  

Construction and verification of pertussis infection characteristic analysis and symptom combination prediction model in patients with cough

作　　者：赵晶晶[1,2] 刘亚敏 索睿 茹仙古丽·吾买尔 刘双君 李颖 赵晓赟[1,4] ZHAO Jingjing;LIU Yamin;SUO Rui;WUMAIER Ruxianguli;LIU Shuangjun;LI Ying;ZHAO Xiaoyun(Clinical School of Thoracic,Tianjin Medical University,Tianjin 300222,China;Department of Respiratory&Critical Care Medicine,Tianjin Binhai New Area Dagang Hospital;Department of Infectious Diseases,Clinical School of the Second People's Hospital,Tianjin Medical University;Department of Respiratory&Critical Care Medicine,Tianjin Chest Hospital)

机构地区：[1]天津医科大学胸科临床学院,300222 [2]天津市滨海新区大港医院呼吸与重症医学科 [3]天津医科大学附属第二人民医院感染科 [4]天津市胸科医院呼吸与危重症医学科

出　　处：《天津医药》2025年第4期434-439,共6页Tianjin Medical Journal

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-049A);天津市卫生健康委员会、天津市中医药管理局、中医中西医结合科研课题(2021138);天津市卫生科技临床重点专科项目(TJWJ2024ZK003)。

摘　　要：目的探讨咳嗽患者中百日咳的阳性率、症状,并基于症状组合预测个体患病风险。方法纳入1025例因咳嗽或接触百日咳患者的就诊者,通过鼻咽拭子PCR确诊百日咳。按年龄分为未成年组(278例)和成年组(747例),比较2组的发病至参加研究咳嗽持续时间,咳嗽程度视觉模拟(VAS)评分,基本症状(阵发性咳嗽、咳后呕吐、鸡鸣样咳嗽、咳嗽后吸气暂停、发热)。确诊患者按年龄进一步分组,比较不同症状表现。将样本的70%作为训练集,基于症状组合(阵发性咳嗽、咳嗽后呕吐、鸡鸣样咳嗽、咳嗽后吸气暂停),采用多因素Logistic回归建立预测模型,并绘制列线图;30%样本为验证集,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)评价模型的区分度,经Hosmer-Lemeshow检验并绘制校准曲线评价模型的校准度。结果经PCR检测,163例(15.9%)确诊为百日咳。未成年组比成年组发病至参加研究咳嗽持续时间更长(P<0.05),咳嗽程度VAS评分更高,百日咳基本症状的数量更多(P<0.01)。确诊病例中<1岁组、1~9岁组的阵发性咳嗽、咳嗽后呕吐症状发生率高于≥10岁组(P<0.05);<1岁组鸡鸣样咳嗽、咳嗽后吸气暂停症状发生率高于1~9岁组及≥10组(P<0.05)。以Logistic回归分析筛选出的阵发性咳嗽、咳嗽后呕吐、鸡鸣样咳嗽、咳嗽后吸气暂停症状组合建立列线图模型。该模型在训练集的AUC为0.852(Hosmer-Lemeshow检验χ^(2)=0.208,P=0.901),在验证集的AUC为0.899(Hosmer-Lemeshow检验χ^(2)=4.202,P=0.122)。校准曲线中预测值与训练集、验证集中的理论值非常接近,拟合度较高。结论咳嗽患者中百日咳的感染率较高,基于症状组合的列线图模型对百日咳区分的预测效果较佳,可为百日咳的监测提供借鉴与参考。Objective To investigate the prevalence and symptoms of pertussis in patients with cough,and to predict individual risk based on the combination of symptoms.Methods A total of 1025 patients with cough or contact with pertussis patients were included.Pertussis was confirmed by nasopharyngeal swab PCR.Patients were divided into the juvenile group(278 cases)and the adult group(747 cases)according to age.The duration of cough from onset to study participation,the visual analogue(VAS)score of cough degree and the number of basic symptoms(paroxysmal cough,vomiting after cough,crowing cough,pauses in breathing after cough and fever)were compared between the two groups.The confirmed patients were further grouped by age,and the different symptoms were compared.70%of the sample was used as the training set.Based on the combination of symptoms(paroxysmal cough,post-cough vomiting,chick-crooning cough and pauses in inspirations after coughing),multivariate Logistic regression was used to establish the prediction model and draw the nomogram.30%of the sample was used as the validation set,and the receiver operating characteristic(ROC)curve was drawn.The differentiation of the area under the curve(AUC)evaluation model was calculated.The calibration degree of the model was evaluated by Hosmer-Lemeshow test,and calibration curve was drawn to evaluate the model.Results By PCR,163 cases(15.9%)were confirmed as pertussis.The juvenile group had a longer duration of cough from onset to study participation than the adult group(P<0.05).The VAS score of cough severity was higher,and the number of basic symptoms of pertussis was more(P<0.01).In confirmed cases,the proportion of paroxysmal cough,vomiting after cough,crowing cough and inspiratory pause after cough was higher in the juvenile group than that in the adult group(P<0.01).In the diagnosed cases,the incidence of paroxysmal cough and post-cough vomiting were higher in the<1-year-old group compared to the 1-9-year-old group and the≥10-year-old group(P<0.05).The combination of paro

关 键 词：百日咳 咳嗽 预测 列线图 聚合酶链反应 

分 类 号：R516.6[医药卫生—内科学]