Establishment and validation of an individual nomogram model for predicting the risk of allergic rhinitis in children with bronchial asthma
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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。 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. -
Key words:
- Bronchial asthma /
- Children /
- Allergic rhinitis /
- Column chart model
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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(%)] 0.068a 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 0.547b 0.585 BMI(x ± s) 17.13±2.04 17.22±2.15 0.369b 0.712 身高(x ± s,cm) 110.36±11.08 112.47±10.56 1.710b 0.088 居住地[例(%)] 0.002a 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(%)] 0.015a 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(%)] 84.679a <0.001 是 160 88(55.00) 72(45.00) 否 198 20(10.10) 178(89.90) 早产[例(%)] 1.344a 0.246 是 101 35(34.65) 66(65.35) 否 257 73(28.40) 184(71.60) 母乳喂养[例(%)] 2.001a 0.157 是 238 66(27.73) 172(72.27) 否 120 42(35.00) 78(65.00) 哮喘家族史[例(%)] 0.473a 0.492 有 159 45(28.30) 114(71.70) 无 199 63(31.66) 136(68.34) 挑食[例(%)] 0.802a 0.370 是 196 63(32.14) 133(67.86) 否 162 45(27.78) 117(72.22) 营养不良[例(%)] 0.009a 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(%)] 2.984a 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(%)] 0.508a 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(%)] 0.229a 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) 0.205c 0.741 院内感染[例(%)] 0.193a 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) 0.306c 0.610 发热程度[例(%)] 3.567a 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(%)] 2.449a 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(%)] 47.496a <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 17.745b <0.001 CRP(x ± s,mg/L) 51.88±5.20 42.30±4.85 16.781b <0.001 WBC(x ± s,×109/L) 12.11±2.15 11.23±2.07 3.649b <0.001 注:a为χ2值,b为t值,c为Z值。 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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