呼吸道腺病毒感染患儿喘息发生的列线图预测模型构建与验证

Construction and validation of a column chart prediction model for the occurrence of wheezing in children with respiratory adenovirus infection

目的探讨呼吸道腺病毒(RAdV)感染患儿喘息发生的危险因素,构建预测患儿喘息发生的列线图,并验证其效果。方法选择2021年5月至2023年12月本院收治的186例RAdV感染患儿,了解有无喘息并分成喘息组和对照组。对两组16项资料予以比较,将检验P<0.05的指标引入多因素分析中,筛查出RAdV感染患儿发生的相关因素。并据此构建预测喘息发生的列线图模型,随后通过受试者工作特征(ROC)曲线、校准曲线和决策曲线对模型的预测能力予以验证。结果RAdV感染患儿喘息发生率为48.92%(91/186)。喘息组特应性体质比例、肥胖比例、重症肺炎比例、小气道病变比例、合并其他病毒感染比例、WBC计数分别为62.64%、32.97%、29.67%、48.35%、40.66%、(13.46±3.19)×10^(9)/L,均高于对照组的43.16%、12.63%、8.42%、24.21%、25.26%、(11.87±2.84)×10^(9)/L(P<0.05)。AdV感染患儿喘息发生的危险因素主要有特应性体质(OR=2.858)、肥胖(OR=2.602)、重症肺炎(OR=4.522)、小气道病变(OR=2.736)。内部验证显示,曲线下面积为0.821(95%CI:0.759~0.882),模型预测患儿喘息发生的概率接近实际概率,拟合优度HL检验(χ^(2)=6.710,P=0.348),阈值概率处于22%~97%时模型净获益率较好。结论根据特应性体质、肥胖、重症肺炎、小气道病变构建的列线图模型可有效预测AdV感染患儿喘息发生的概率。

Objective To explore the risk factors for wheezing in children with respiratory adenovirus(RAdV)infection,construct a column chart to predict wheezing in children,and verify its effectiveness.Methods A total of 186 children with RAdV infection admitted to our hospital from May 2021 to December 2023 were collected.The presence or absence of wheezing was investigated,and the patients were separated into a wheezing group and a control group.The 16 items of data were compared between the two groups,and indicators with P<0.05 were introduced into multivariate analysis to screen for relevant factors in the occurrence of RAdV infection in children.And based on this,a column chart model was constructed to predict the occurrence of wheezing,and then the predictive ability of the model was verified through receiver operating characteristic(ROC)curves,calibration curves,and decision curves.Results The incidence of wheezing in children with RAdV infection was 48.92%(91/186).The proportion of atopic constitution,obesity,severe pneumonia,small airway disease,other virus infection and WBC count in the asthmatic group were 62.64%,32.97%,29.67%,48.35%,40.66%,(13.46±3.19)10^(9)/L,which were higher than 43.16%,12.63%,8.42%,24.21%,25.26%,(11.87±2.84)10^(9)/L inthe control group(P<0.05).The risk factors for wheezing in children with AdV infection mainly included atopic constitution(OR=2.858,95%CI:1.485-5.497),obesity(OR=2.602,95%CI:1.371-5.459),severe pneumonia(OR=4.522,95%CI:1.811-11.291),and small airway lesions(OR=2.736,95%CI:1.131-5.985).Internal validation showed that the area under the curve was 0.821(95%CI:0.759-0.882),and the predicted probability of wheezing in the patient was close to the actual probability.The goodness of fit HL test showed(χ^(2)=6.710,P=0.348),and the net benefit rate of the model was good when the threshold probability was between 22%-97%.Conclusion A column chart model constructed based on atopic constitution,obesity,severe pneumonia,and small airway lesions can effectively predict the probability of wheezing in children with AdV infection.