儿童咳嗽变异性哮喘规律治疗后停药1年内复发的影响因素及预测模型构建

Influencing factors and predictive model construction of recurrence within one year after discontinuation of medication in children with cough variant asthma after regular treatment

目的分析儿童咳嗽变异性哮喘(CVA)规律治疗后停药1年内复发的影响因素并构建预测模型,以期为医生评估儿童CVA治疗后的复发风险和制订预防策略提供指导。方法选取收治的CVA患儿215例作为研究对象,依据患儿规律治疗后停药1年内是否出现复发分为复发组(n=89)和非复发组(n=126)。收集2组资料进行单因素和多因素Logistic回归分析筛选出CVA患儿复发的影响因素。采用R软件运行梯度提升机(GBM)算法构建GBM预测模型。采用受试者工作特征(ROC)曲线分析并比较GBM模型与Logistic回归模型的预测效能。结果215例CVA患儿经规律治疗后停药1年内复发率为41.40%(89/215)。过敏史(OR=2.870,95%CI:1.442~5.714)、反复呼吸道感染史(OR=4.132,95%CI:2.045~8.348)、家长对CVA防控认知度(OR=1.063,95%CI:1.011~1.118)、嗜酸性粒细胞(OR=0.801,95%CI:0.674~0.952)、用力呼出50%肺活量时的瞬间流量(FEF_(50))(OR=1.055,95%CI:1.012~1.099)、最大呼气中期流量(MMEF_(75/25))(OR=1.054,95%CI:1.009~1.102)、呼出气一氧化氮(FeNO)(OR=0.883,95%CI:0.834~0.935)是儿童CVA规律治疗后停药1年内复发的影响因素(P<0.05)。经ROC曲线分析发现,GBM模型的曲线下面积为0.872,大于Logistic回归模型的0.827。结论基于儿童CVA规律治疗后停药1年内复发的影响因素构建的GBM预测模型,可作为临床采取措施预防CVA患儿治疗后复发的参考依据。

Objective To analyze the influencing factors of recurrence within one year after discontinuation of regular treatment of children′s cough variant asthma(CVA)and to construct a predictive model,in order to provide guidance for doctors to evaluate the risk of recurrence after CVA treatment in children and develop prevention strategies.Methods A total of 215 children with CVA were selected as the study objects.According to whether recurrence occurred within one year after discontinuation of regular treatment,the patients were divided into recurrence group(n=89)and non-recurrence group(n=126).Data of two groups were collected for univariate and multivariate Logistic regression analysis to screen out the influencing factors of recurrence in children with CVA.The GBM prediction model was constructed by using R software to run the gradient boosting model(GBM)algorithm.Receiver operating characteristic(ROC)curve was used to analyze and compare the predictive efficiency of GBM model and Logistic regression model.Results The recurrence rate of 215 children with CVA within one year after regular treatment was 41.40%(89/215).Allergy history(OR=2.870,95%CI,1.442 to 5.714),repeated respiratory infection history(OR=4.132,95%CI,2.045 to 8.348),parents′cognitive level of CVA prevention and control(OR=1.063,95%CI,1.011 to 1.118),eosinophils(OR=0.801,95%CI,0.674 to 0.952),forced expiratory flow at 50%of vital capacity(FEF_(50))(OR=1.055,95%CI,1.012 to 1.099),maximal midexpiratory flow rate 75/25(MMEF_(75/25))(OR=1.054,95%CI,1.009 to 1.102),and fractional exhaled nitric oxide(FeNO)(OR=0.883,95%CI,0.834 to 0.935)were influencing factors for recurrence within one year after regular treatment of children′s CVA(P<0.05).According to ROC curve analysis,the area under the curve of GBM model was 0.872,which was larger than 0.827 of Logistic regression model.Conclusion GBM prediction model is established based on the influencing factors of recurrence within one year after regular treatment of CVA in children,which can be used as a reference for clinical measures to prevent recurrence in children after treatment of CVA.