预测毛细支气管炎患儿反复喘息发生的模型构建与验证

Establishment and validation of a model for predicting recurrent wheezing in children with bronchiolitis

目的分析影响毛细支气管炎患儿发生反复喘息的危险因素并构建预测模型。方法采用前瞻性研究的方法,选取2017年2月至2019年2月合肥市第八人民医院接受治疗的180例毛细支气管炎患儿作为研究对象,将纳入患儿根据7∶3分为建模组(126例)及验证组(54例)。对患儿进行为期3年的随访,再将建模组根据患儿是否发生反复喘息分为喘息组(48例)和无喘息组(78例)。绘制Hosmer-Lemeshow拟合度曲线及受试者工作特征(ROC)曲线评估所构建预测模型的有效性及准确性。结果多因素Logistic回归分析显示,人工喂养(OR=8.838,95%CI 2.601~30.027)、家族过敏史(OR=6.709,95%CI 1.825~24.665)、合并基础疾病(OR=8.114,95%CI 1.638~40.184)、IgE水平较高(OR=1.020,95%CI 1.012~1.029)为毛细支气管炎患儿发生反复喘息的独立危险因素(P<0.05)。建模组ROC曲线下面积为0.917(95%CI 0.855~0.959),灵敏度、特异度分别为83.33%、85.90%;验证组ROC曲线下面积为0.911(95%CI 0.847~0.954),灵敏度、特异度分别为89.58%、79.49%。结论人工喂养、过敏家族史、合并基础疾病、IgE水平较高为毛细支气管炎患儿发生反复喘息的独立危险因素,所构建的预测模型准确性及有效性较好,能够作为临床预测毛细支气管炎患儿发生反复喘息的有效工具。

Objective To analyze the risk factors of recurrent wheezing in children with bronchiolitis and to construct a predictive model.Methods Prospective research methods was used.One hundred and eighty children with bronchiolitis who were treated in Hefei Eighth People's Hospital from February 2017 to February 2019 were selected as the study subjects,and the included children were separated into a modeling group(126 cases)and a validation group(54 cases)according to 7∶3.The children were followed up for 3 years,and then the modeling group was divided into wheezing group(48 cases)and no wheezing group(78 cases)according to whether the children had recurrent wheezing.The Hosmer-Lemeshow fitting curve and receiver operating characteristic(ROC)curve were drawn to evaluate the validity and accuracy of the constructed prediction model.Results Multivariate Logistic regression analysis showed that artificial feeding(OR=8.838,95%CI 2.601 to 30.027),family history of allergies(OR=6.709,95%CI 1.825 to 24.665),underlying diseases(OR=8.114,95%CI 1.638 to 40.184),and higher IgE level(OR=1.020,95%CI 1.012 to 1.029)were the independent risk factors for recurrent wheezing in children with bronchiolitis(P<0.05).The area under the curve of the modeling group was 0.917(95%CI 0.855 to 0.959),and the sensitivity and specificity were 83.33%and 85.90%,respectively;the area under the curve of the validation group was 0.911(95%CI 0.847 to 0.954),and the sensitivity and specificity were 89.58%and 79.49%,respectively.Conclusions Artificial feeding,family history of allergies,underlying diseases,and higher IgE level are the independent risk factors for recurrent wheezing in children with bronchiolitis.The constructed prediction model has good accuracy and validity,and can be used as an effective tool for clinical prediction of recurrent wheezing in children with bronchiolitis.