天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (3): 277-282.doi: 10.11958/20241912

• 临床研究 • 上一篇    下一篇

支气管哮喘患儿小气道功能障碍预测模型的构建与验证

刘艳丽(), 徐文付(), 房红娟   

  1. 合肥市第二人民医院儿科（邮编230011）
  • 收稿日期:2024-11-19 修回日期:2025-01-06 出版日期:2025-03-15 发布日期:2025-03-31
  • 通讯作者: E-mail：yougu1980@126.com
  • 作者简介:刘艳丽（1992），女，医师，主要从事呼吸系统疾病方面研究。E-mail：1551785183@qq.com

Construction and validation of a prediction model for small airway dysfunction in children with bronchial asthma

LIU Yanli(), XU Wenfu(), FANG Hongjuan   

  1. Department of Pediatrics, the Second People's Hospital of Heifei, Hefei 230011, China
  • Received:2024-11-19 Revised:2025-01-06 Published:2025-03-15 Online:2025-03-31
  • Contact: E-mail：yougu1980@126.com

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摘要：

目的 分析支气管哮喘患儿小气道功能障碍（SAD）的影响因素，并构建SAD风险预测模型。方法 回顾性选取221例支气管哮喘肺通气功能正常患儿作为建模组，根据是否存在SAD将患儿分成SAD组（43例）和非SAD组（178例），通过单因素分析及多因素Logistic回归分析影响SAD发生的相关因素，并构建SAD风险预测模型。另抽取74例支气管哮喘肺通气功能正常患儿作为验证组，采用Hosmer-Lemeshow检验评估模型的校准度，绘制受试者工作特征（ROC）曲线及计算曲线下面积（AUC）评价预测模型的预测效能。结果 多因素Logistic回归分析显示，哮喘控制不佳（OR=10.722，95%CI：4.044~28.428）、变应性鼻炎处于发作期（OR=4.816，95%CI：1.929~12.023）及使用吸入性糖皮质激素（ICS）或ICS+长效β2受体激动剂（LABA）/白三烯受体拮抗剂（LTRA）时间较长（OR=2.903，95%CI：1.269~6.643）是患儿发生SAD的独立危险因素（P<0.05），首次出现疑似哮喘症状时年龄较大（OR=0.599，95%CI：0.395~0.907）是保护因素。Hosmer-Lemeshow检验显示，预测模型校准度良好（χ2=8.301，P=0.307），建模组中模型预测支气管哮喘患儿发生SAD的AUC（95%CI）为0.820（0.749~0.892），敏感度为74.42%，特异度为78.65%；在验证组中AUC（95%CI）为0.849（0.718~0.981），敏感度为75.00%，特异度为94.83%，准确度为90.54%（67/74）。结论 支气管哮喘患儿首次出现疑似哮喘症状时年龄较小、哮喘控制不佳、变应性鼻炎处于发作期及使用ICS或ICS+LABA/LTRA时间较长时，其发生SAD的风险较高，以此构建的SAD风险预测模型具有较好的预测能力。

关键词: 哮喘, 儿童, 小气道功能障碍, 预测模型

Abstract:

Objective To analyze influencing factors of small airway dysfunction (SAD) in children with bronchial asthma, and construct a risk prediction model for SAD. Methods A total of 221 bronchial asthma children with normal pulmonary ventilation function were retrospectively selected as the modeling group. According to the presence of SAD, children were divided into the SAD group (43 cases) and the non-SAD group (178 cases). The related factors affecting the occurrence of SAD were analyzed by univariate analysis and multivariate Logistic regression analysis, and risk prediction model of SAD was constructed. In addition, 74 bronchial asthma children with normal pulmonary ventilation function were collected and used as the validation group. Hosmer-Lemeshow test was adopted to evaluate the calibration of the model. Receiver operating characteristic (ROC) curve was drawn and area under the curve (AUC) was calculated to evaluate the predictive efficiency of the prediction model. Results Multivariate Logistic regression analysis showed that poor asthma control (OR=10.722, 95%CI: 4.044-28.428), allergic rhinitis in the attack stage (OR=4.816, 95%CI: 1.929-12.023) and long use of inhaled corticosteroids (ICS) or ICS/long-acting β2 receptor agonist (LABA, OR=2.903, 95%CI: 1.269-6.643) were independent risk factors for SAD in children (P<0.05), and older age at first onset of suspected asthma symptoms (OR=0.599, 95% CI: 0.395-0.907) was a protective factor. Hosmer-Lemeshow test showed good calibration (χ2=8.301, P=0.307). The AUC, sensitivity and specificity of the model in the modeling group for predicting the occurrence of SAD in children with bronchial asthma were 0.820 (95%CI: 0.749-0.892), 74.42% and 78.65%, and the AUC, sensitivity, specificity and accuracy of the model in the validation group were 0.849 (95%CI: 0.718-0.981), 75.00%, 94.83% and 90.54% (67/74). Conclusion Children with bronchial asthma who are younger at the time of their first suspected asthma symptoms, poor asthma control, allergic rhinitis in the exacerbation phase, and longer duration of use of ICS or ICS+LABA/LTRA are at higher risk of SAD. Therefore, SAD risk prediction model constructed on this basis has good predictive ability.

Key words: asthma, child, small airway dysfunction, prediction model

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