过敏性鼻炎儿童发生支气管哮喘风险预测模型构建与验证

Construction and validation of a risk prediction model for bronchial asthma in children with allergic rhinitis

目的探究影响过敏性鼻炎(AR)儿童发生支气管哮喘的危险因素,以此构建风险预测模型并行验证。方法以2019年1月—2021年6月于本院就诊的AR继发或未继发支气管哮喘患儿作为建模组(n=246),2021年7月—2022年6月收治的过敏性鼻炎继发或未继发哮喘患儿作为预测模型验证组(n=112),根据AR患儿是否继发哮喘进行分组,收集患儿的基本资料,包括性别、年龄、过敏原种类、临床特征等相关因素,采用单因素及多因素logistic回归方式分析影响AR患儿继发哮喘的相关因素,以此构建风险预测模型,并以R软件绘制风险预测模型Nomogram图(即列线图)及建模组和验证组患者的验证校准图;以受试者工作特性曲线(ROC)评估风险预测模型的预测价值。结果作为建模的246例患儿中,有160例为单纯AR(AR组),有86例AR继发哮喘(AR继发哮喘组),AR继发哮喘率为34.96%。单因素分析结果显示,患儿的年龄、鼻炎病程、鼻炎类型、鼻炎严重度、季节特征、生活环境、过敏性疾病家族史、宠物接触史、粉尘螨、豚草、霉菌情况在2组患儿之间差异有统计学意义(P<0.05)。多因素分析结果显示,鼻炎病程、季节特征、过敏性疾病家族史、粉尘螨、豚草、霉菌均为影响AR患儿继发哮喘的独立影响因素(P<0.05)。ROC结果示,内部验证ROC曲线下面积(AUC)为0.760(95%CI:0.699~0.821),其敏感度为75.4%,特异度为73.1%;外部验证AUC为0.735(95%CI:0.640~0.831),其敏感度为72.5%,特异度为70.4%;且两者校准一致性均较为良好。结论鼻炎病程、过敏性疾病家族史、粉尘螨、豚草、霉菌均为影响AR患儿继发哮喘的独立影响因素,以此构建风险预测模型具有一定的预测效能。

Objective This paper aims to explore the risk factors of bronchial asthma in children with allergic rhinitis(AR)and construct a risk prediction model for parallel validation.Methods AR patients with secondary or non-secondary bronchial asthma who were admitted to our hospital from January 2019 to June 2021 were selected as the modeling group(n=246),and allergic rhinitis patients with secondary or non-secondary asthma who received treatment from July 2021 to June 2022 as the predictive model validation group(n=112).AR patients were grouped based on whether they had secondary asthma,and basic data of the patients,including gender,age,allergen types,were collected.Clinical characteristics and other related factors were analyzed using univariate and multivariate logistic regression methods,and a risk prediction model was constructed.The Nomogram(column chart)of the risk prediction model and the validation calibration charts of the modeling and validation groups were drawn using R software.The predictive value of the risk prediction model was evaluated using the receiver operating characteristic curve(ROC).Results Among the 246 modeled children,160 were isolated from AR(AR group)and 86 were secondary to AR asthma(AR secondary asthma group),with an AR secondary asthma rate of 34.96%.The results of univariate analysis showed that there was statistical significance on the differences between the two groups in terms of age,duration of rhinitis,type of rhinitis,severity of rhinitis,seasonal characteristics,living environment,family history of allergic diseases,pet contact history,dermatophagoides farinae,ragweed and mold(P<0.05).Multivariate analysis showed that the course of rhinitis,seasonal characteristics,family history of allergic diseases,dermatophagoides farinae,ragweed and mold were all independent factors for secondary asthma in children with AR(P<0.05).ROC results showed that the area under the internal validation ROC curve(AUC)was 0.760(95%CI:0.699-0.821),with a sensitivity of 75.4%and a specificity of 73.1%.The AUC of external validation was 0.735(95%CI:0.640-0.831),with a sensitivity of 72.5%and a specificity of 70.4%.Both have good calibration consistency.Conclusion The course of rhinitis,family history of allergic diseases,dermatophagoides farinae,ragweed and mold are independent factors for secondary asthma in children with AR,and the risk prediction model constructed by this model has certain predictive efficacy.