过敏性哮喘患儿螨SCIT不良反应预测模型的构建与验证OACSTPCD
Construction and validation of a predictive model for adverse reactions to mite subcutaneous immunotherapy in children with allergic asthma
目的 构建过敏性哮喘患儿接受螨皮下注射免疫治疗(SCIT)出现不良反应的诺莫图预测模型,并加以评估和验证.方法 回顾性分析 2016 年 8 月至 2023 年 12 月于天津医科大学第二医院儿科接受螨SCIT的过敏性哮喘患儿的病历资料.根据SCIT初始治疗阶段出现不良反应情况将其分为不良反应组和无不良反应组,2 组共同组成建模组.通过单因素和多因素Logistic回归分析筛选独立危险因素,构建预测模型,绘制诺莫图,并对模型进行评估和验证.结果 共纳入 350 例患儿,不良反应组 176 例,无不良反应组 174 例.对患儿的基线资料进行单因素Logistic回归分析,结果显示,性别、年龄、近 1 年哮喘急性发作次数、嗜酸性粒细胞百分比(EOS%)、第一秒用力呼气容积占预计值百分比(FEV1%pred)、总IgE(tIgE)、屋尘螨(Der p)特异性IgE(sIgE)、粉尘螨(Der f)sIgE、其他吸入性过敏原种类数是SCIT不良反应发生的危险因素(均P<0.1).将其纳入多因素Logistic回归分析,结果显示,年龄、近 1 年哮喘急性发作次数、tIgE、Der p sIgE、Der f sIgE、其他吸入性过敏原种类数是独立危险因素(P均<0.05),基于此结果绘制莫诺图.绘制受试者操作特征曲线进行模型评价,曲线下面积为 0.877(灵敏度 73.9%,特异度 90.8%),且预测概率与实际发生概率一致性较好,内部验证表明该模型具有较好的预测效能.结论 年龄、近 1 年哮喘急性发作次数、tIgE、Der p sIgE、Der f sIgE、其他吸入性过敏原种类数为儿童螨SCIT不良反应的独立危险因素,基于此绘制的诺莫图具有较好的预测价值.
Objective To construct a nomogram prediction model for adverse reactions of mite sublingual immunotherapy(SCIT)in children with allergic asthma,and to evaluate and validate it.Methods Clinical data of children with allergic asthma who were managed by mite SCIT in Department of Pediatrics,the Second Hospital of Tianjin Medical University were retrospectively analyzed.According to the adverse reactions in the initial treatment stage of SCIT,they were divided into adverse reaction group and no adverse reaction group,which together formed the modeling group.Through univariate logistic regression analysis and multivariate logistic regression analysis,independent risk factors were screened out.Then construct the prediction model,draw a nomogram,eventually evaluate and validate the model.Results A total of 350 children were included,including 176 in the adverse reaction group and 174 in the no adverse reaction group.Univariate logistic regression analysis was performed on the baseline data of the children in the modeling group,and the results were as follows.Gender,age,number of asthma exacerbations in the past 1 year,percentage of eosinophils(EOS%),forced expiratory volume in the first second in percent predicted values(FEV1%pred),total IgE(tIgE),dermatophagoides pteronyssinus(Der p)sIgE,dermatophagoides farinae(Der p)sIgE,and the number of other inhaled allergenic species were the risk factors of SCIT-related adverse reactions(all P<0.1).These were included in the multivariate logistic regression analysis,and the results showed that:age,the number of asthma exacerbations in the past 1 year,tIgE,Der p sIgE,Der f sIgE,and the number of other inhaled allergen species were independent risk factors(all P<0.05).Based on the results,nomogram was drawn in R language.Model evaluation by receiver operating characteristic curve showed an area under curve of 0.877,a predictive model sensitivity of 73.9%,and a specificity of 90.8%.The predicted probability was consistent with actual probability of occurrence.The model has good prediction performance.Conclusions Age,number of asthma exacerbations in the past 1 year,tIgE,Der p sIgE,Der f sIgE,and the number of other inhaled allergen species were independent risk factors for adverse reactions to mite SCIT in children.The nomogram drawn in this study has good predictive value.
孙鑫雨;刘长山;王雪艳
天津医科大学第二医院儿科,天津 300211天津医科大学第二医院儿科,天津 300211||天津医科大学儿童呼吸及哮喘研究中心,天津 300211天津医科大学第二医院儿科,天津 300211||天津医科大学儿童呼吸及哮喘研究中心,天津 300211
过敏原免疫治疗舌下含服免疫治疗不良反应过敏性哮喘儿童诺莫图预测模型
Allergen immunotherapySublingual immunotherapyAdverse reactionsAllergic asthmaChildrenNomogramPredictive model
《新医学》 2024 (10)
801-809,9
天津市科技计划项目(22KPHDRC00280)
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