个体化预测7~14岁学龄期哮喘儿童治疗预后的列线图模型建立和评价

Establishment and Evaluation of a Nomogram Model for Individualized Prediction of Treatment Outcome in Children with Asthma Aged 7 to 14 Years

目的分析影响7~14岁学龄期哮喘儿童治疗预后的危险因素,进而构建列线图模型,并评价该列线图模型的临床有效性和准确性。方法回顾性分析2016年1月1日-2021年1月1日就诊的7~14岁学龄期哮喘儿童1657例,随访1年失访11例,再根据哮喘控制测试(ACT)评分分为控制良好组(ACT评分≥20分)及控制不佳组(ACT评分<20分)。分析2组一般临床资料及临床生化指标,采用多因素Logistic回归分析影响7~14岁学龄期儿童哮喘治疗预后的独立危险因素,后基于上述危险因素构建列线图模型,并利用Bootstrap方法及临床决策曲线验证该模型的准确性和临床决策的获益性。结果影响7~14岁学龄期哮喘儿童治疗预后的危险因素为亲属哮喘病史、父母吸烟史、反复呼吸道感染史、变应性鼻炎史及不规范用药(P<0.01)。受试者工作特征曲线验证列线图模型显示:构建的列线图模型预测7~14岁学龄期哮喘儿童治疗预后的能力较强,其中曲线下面积为0.862,95%CI为0.71,0.93;采用Bootstrap方法验证列线图发现校准曲线与理想曲线贴合良好,平均绝对误差为0.017;临床决策曲线显示:列线图模型预测7~14岁学龄期哮喘儿童治疗预后的阈值为0.07~0.86时适用性最佳。结论构建的列线图模型可有效预测7~14岁学龄期儿童哮喘治疗预后,进而行促使患儿规范用药、促使其父母戒烟、预防呼吸道感染等针对性干预措施,可有效改善患儿预后。

Objective To analyze the risk factors affecting the prognosis of children with asthma aged 7 to 14 years,to construct a nomogram model based on the risk factors analyzed,and to evaluate the clinical effectiveness and accuracy of the nomogram model.Methods A retrospective analysis was performed on 1657 children with asthma aged 7 to 14 years who presented to our hospital from January 1,2016 to January 1,2021.They were followed up for one year,and 11 children were lost to follow-up.According to the score of Asthma Control Test(ACT),they were divided into two groups:well controlled group(ACT score≥20 points)and poorly controlled group(ACT score<20 points).The general clinical data and clinical biochemical indicators of the two groups were analyzed.Multivariate Logistic regression analysis was used to pinpoint the independent risk factors affecting the prognosis of asthma treatment in children aged 7 to 14 years.Then a nomogram model was constructed based on the above risk factors.The accuracy of the model and the benefits of clinical decision-making were verified by using Bootstrap method and clinical decision-making curve.Results The risk factors influencing the prognosis of children with asthma from 7 to 14 years were their relatives'history of asthma,their parents'smoking history,history of recurrent respiratory tract infection,history of allergic rhinitis and nonstandard drug use(P<0.01).The receiver operating characteristic(ROC)curve of validation of nomogram model showed that the constructed nomogram model had a strong ability to predict the treatment outcome of children with asthma aged 7 to 14 years.The area under the ROC curve was 0.862(95%CI:0.71,0.93).Bootstrap method was used to verify the nomogram,and it was found that the calibration curve fitted well with the ideal curve,with an average absolute error of 0.017.The clinical decision curve showed that the nomogram model had the best applicability in predicting the prognosis of children with asthma aged 7 to 14 years when the threshold value was 0.07-0.86.Conclusion The nomogram model can effectively predict the prognosis of asthma treatment in children aged 7 to 14 years,and can effectively improve the prognosis of children by taking targeted interventions such as promoting standardized drug use,encouraging their parents to quit smoking,and preventing respiratory infection.