个体化预测支气管哮喘患儿并发过敏性鼻炎风险的列线图模型建立及验证

商胜利; 姚雅君; 陈明; 徐淑芳

doi:10.16766/j.cnki.issn.1674-4152.003553

个体化预测支气管哮喘患儿并发过敏性鼻炎风险的列线图模型建立及验证

doi: 10.16766/j.cnki.issn.1674-4152.003553

1.
开滦总医院耳鼻咽喉头颈外科，河北唐山 063000
2.
开滦总医院唐家庄医院五官科，河北唐山 063000
3.
唐山市第三医院耳鼻咽喉科，河北唐山 063000

基金项目:

河北省中医药管理局科研计划项目 2022166

详细信息

通讯作者:
商胜利，E-mail：chenmton@126.com

中图分类号: R765.21
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- 被引次数: 0
出版历程
- 收稿日期: 2023-07-16
- 网络出版日期: 2024-07-22

Establishment and validation of an individual nomogram model for predicting the risk of allergic rhinitis in children with bronchial asthma

1.
Department of Otolaryngology, Head and Neck Surgery, Kailuan General Hospital, Tangshan, Hebei 063000, China

摘要

摘要: 目的分析支气管哮喘患儿并发过敏性鼻炎的影响因素，并构建个体化预测列线图模型。方法选取2019年7月—2022年11月唐山市第三医院收治的358例支气管哮喘患儿为研究对象，采用单因素及多因素logistic回归分析研究影响支气管哮喘患儿并发过敏性鼻炎的危险因素；利用R软件构建列线图模型，并通过校准曲线验证列线图模型的一致性，最后通过受试者工作特征曲线的曲线下面积评估模型预测价值及区分度。结果 358例支气管哮喘患儿并发过敏性鼻炎者108例，发生率为30.17%；单因素分析结果显示，支气管哮喘患儿并发过敏性鼻炎组的家庭人员抽烟、早期使用抗生素、白介素-8(IL-8)、C反应蛋白(CRP)、白细胞计数(WBC)与未并发过敏性鼻炎组比较差异有统计学意义(P < 0.05)；早期使用抗生素、IL-8、CRP、WBC均为支气管哮喘患儿并发过敏性鼻炎的影响因素(P＜0.05)；列线图模型预测支气管哮喘患儿并发过敏性鼻炎的校准曲线斜率接近1，且Hosmer-Lemeshow拟合优度检验χ²=3.107，P=0.927，一致性较好。结论本研究基于早期使用抗生素、IL-8、CRP、WBC四种危险因素构建预测支气管哮喘患儿并发过敏性鼻炎风险的列线图模型，区分度及一致性相对较好，可为临床上制定针对性的干预措施提供参考。
- 支气管哮喘 /
- 儿童 /
- 过敏性鼻炎 /
- 列线图模型
Abstract: Objective To analyze the influencing factors of children with bronchial asthma complicated with allergic rhinitis, and to build a personalized predictive nomogram model. Methods A total of 358 children with bronchial asthma admitted to Tangshan Third People' s Hospital from July 2019 to November 2022 were collected as the research objects. The risk factors of allergic rhinitis in children with bronchial asthma were analyzed by univariate and multivariate logistic regression. R software was used to build a nomogram model, and the consistency of the nomogram model was verified by calibration curves. Finally, two groups of clinical volumes were collected to evaluate the predictive value and differentiation of the model through the area under the curve of the subject' s working characteristic curve. Results One hundred ang eight of 358 children with bronchial asthma complicated with allergic rhinitis (30.17%); the results of the univariate analysis showed that there were obvious differences in smoking by family members, early use of antibiotics, interleukin-8 (IL-8), C-reactive protein (CRP), white blood cell count (WBC) between the allergic rhinitis group and the nonallergic rhinitis group (P < 0.05); that early use of antibiotics, IL-8, CRP, and WBC were influencing factors for children with bronchial asthma complicated with allergic rhinitis (P < 0.05); the slope of the calibration curve of nomogram model for predicting children with bronchial asthma complicated with Allergic rhinitis was close to 1, and the Hosmer-Lemeshow goodness of fit test was χ²=3.107, P=0.927, with good consistency. Conclusion This study constructs a nomogram model to predict the risk of allergic rhinitis in children with bronchial asthma based on the four risk factors of early use of antibiotics, IL-8, CRP, and WBC. It has relatively good differentiation and consistency and provides a reference for clinical intervention.
- Bronchial asthma /
- Children /
- Allergic rhinitis /
- Column chart model

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图 1 预测支气管哮喘患儿并发过敏性鼻炎的列线图模型

Figure 1. A nomographic model for predicting allergic rhinitis in children with bronchial asthma

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图 2 列线图模型预测支气管哮喘患儿并发过敏性鼻炎的ROC曲线

Figure 2. ROC curve of children with bronchial asthma complicated with allergic rhinitis predicted by a nomogram model

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图 3 列线图模型预测支气管哮喘患儿并发过敏性鼻炎的校准图

Figure 3. Calibration of a nomogram model to predict allergic rhinitis in children with bronchial asthma

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表 1 影响支气管哮喘患儿并发过敏性鼻炎的单因素分析

Table 1. Single factor analysis of allergic rhinitis in children with bronchial asthma

项目	例数	并发过敏性鼻炎组(n=108)	未并发过敏性鼻炎组(n=250)	统计量	P值
性别[例(%)]				0.068^a	0.794
男	196	58(29.59)	138(70.41)
女	162	50(30.86)	112(69.14)
年龄(x ± s，岁)		4.71±1.22	4.80±1.51	0.547^b	0.585
BMI(x ± s)		17.13±2.04	17.22±2.15	0.369^b	0.712
身高(x ± s，cm)		110.36±11.08	112.47±10.56	1.710^b	0.088
居住地[例(%)]				0.002^a	0.965
城市	185	56(30.27)	129(69.73)
农村	173	52(30.06)	121(69.94)
有无托班经历[例(%)]				0.015^a	0.903
是	164	50(30.49)	114(69.51)
否	194	58(29.90)	136(70.10)
家庭人员抽烟[例(%)]				84.679^a	＜0.001
是	160	88(55.00)	72(45.00)
否	198	20(10.10)	178(89.90)
早产[例(%)]				1.344^a	0.246
是	101	35(34.65)	66(65.35)
否	257	73(28.40)	184(71.60)
母乳喂养[例(%)]				2.001^a	0.157
是	238	66(27.73)	172(72.27)
否	120	42(35.00)	78(65.00)
哮喘家族史[例(%)]				0.473^a	0.492
有	159	45(28.30)	114(71.70)
无	199	63(31.66)	136(68.34)
挑食[例(%)]				0.802^a	0.370
是	196	63(32.14)	133(67.86)
否	162	45(27.78)	117(72.22)
营养不良[例(%)]				0.009^a	0.926
是	84	25(29.76)	59(70.24)
否	274	83(30.29)	191(69.71)
患儿个人过敏史[例(%)]				2.984^a	0.084
有	194	66(34.02)	128(65.98)
无	164	42(25.61)	122(74.39)
天气突然变冷[例(%)]				0.508^a	0.476
是	176	50(28.41)	126(71.59)
否	182	58(31.87)	124(68.13)
户外活动时间[例(%)]				0.229^a	0.632
≤5 h	149	47(31.54)	102(68.46)
＞5 h	209	61(29.19)	148(70.91)
住院时间[M(P₂₅, P₇₅)，d]		13.00(11.00，13.00)	13.00(11.00, 14.00)	0.205^c	0.741
院内感染[例(%)]				0.193^a	0.661
是	182	53(29.12)	129(70.88)
否	176	55(31.25)	121(68.75)
呼吸机使用时间[M(P₂₅, P₇₅)，d]		3.00(2.00，3.00)	3.00(1.00，3.00)	0.306^c	0.610
发热程度[例(%)]				3.567^a	0.168
高热	108	26(24.07)	82(75.93)
中高热	124	44(35.48)	80(64.52)
中热	126	38(30.16)	88(69.84)
过敏原[例(%)]				2.449^a	0.118
有	183	62(33.88)	121(66.12)
无	175	46(26.29)	129(73.71)
早期使用抗生素[例(%)]				47.496^a	＜0.001
是	130	68(52.31)	62(47.69)
否	228	40(17.54)	188(82.46)
IL-8(x ± s，pg/mL)		620.22±88.45	486.34±52.69	17.745^b	＜0.001
CRP(x ± s，mg/L)		51.88±5.20	42.30±4.85	16.781^b	＜0.001
WBC(x ± s，×10⁹/L)		12.11±2.15	11.23±2.07	3.649^b	＜0.001
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 影响支气管哮喘患儿并发过敏性鼻炎的多因素logistic回归分析

Table 2. Logistic regression analysis of multiple factors affecting allergic rhinitis in children with bronchial asthma

项目	B	SE	Waldχ²	P值	OR值	95% CI
家庭人员抽烟	0.235	0.570	0.171	0.680	1.265	0.414~3.863
早期使用抗生素	1.105	0.557	3.935	0.047	3.018	1.013~8.990
IL-8	0.032	0.005	36.666	＜0.001	1.032	1.022~1.043
CRP	0.467	0.072	41.736	＜0.001	1.595	1.384~1.838
WBC	0.410	0.136	9.054	0.003	1.507	1.154~1.969

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