山东医药2026，Vol.66Issue(1)：38-43,6.DOI:10.3969/j.issn.1002-266X.2026.01.008
儿童肺炎合并塑形性支气管炎危险因素分析与预测模型构建
Analysis of risk factors for pneumonia complicated with plastic bronchitis in children and construction of a prediction model
摘要
Abstract
Objective To investigate the risk factors for pneumonia complicated with plastic bronchitis(PB)in chil-dren,to construct a decision tree prediction model,and to evaluate its clinical predictive performance,providing a refer-ence for early identification of PB.Methods A total of 533 children diagnosed with pneumonia were retrospectively en-rolled as the training cohort,and an additional 103 children were collected as a same-center temporal external validation cohort.PB was diagnosed when bronchial casts were observed by bronchoscopy.Forty-seven multidimensional clinical variables were collected,including general characteristics,clinical manifestations,physical signs,imaging findings,and laboratory indicators.Univariate analysis,Spearman rank correlation analysis,and multivariate Logistic regression were used to identify independent risk factors for PB.Based on these factors,a decision tree prediction model was constructed.The predictive performance of the model was evaluated using receiver operating characteristic(ROC)curves.Internal vali-dation was performed using the Bootstrap method with 1,000 resamples.Model calibration was assessed by the Hosmer-Lemeshow test,and clinical utility was evaluated by decision curve analysis(DCA).Results Among the 533 children with pneumonia,126 cases(23.64%)developed PB.Multivariate Logistic regression analysis showed that higher maxi-mum body temperature,higher neutrophil percentage,elevated D-dimer,decreased albumin,increased immunoglobulin A,increased immunoglobulin E,elevated serum ferritin,consolidation involving≥2/3 of a lung lobe,and pleural effusion were independent risk factors for PB(all P<0.05).A five-layer decision tree model was constructed based on these inde-pendent risk factors.In internal validation,the area under the ROC curve(AUC)was 0.860,indicating good discrimina-tive ability;the Hosmer-Lemeshow test demonstrated good calibration(P>0.05),and DCA showed a positive net clinical benefit across a wide range of threshold probabilities(8%-100%).In external validation,the model also exhibited good discrimination(AUC=0.926)and calibration(both P>0.05),with favorable net clinical benefit over threshold probabili-ties of 9%-100%.Conclusion The decision tree prediction model for plastic bronchitis constructed based on indepen-dent risk factors derived from multidimensional clinical indicators demonstrates good predictive performance and may pro-vide a useful reference for early identification of PB in children with pneumonia.关键词
塑形性支气管炎/儿童/肺炎/支气管镜/决策树模型Key words
plastic bronchitis/children/pneumonia/bronchoscopy/decision tree model分类
医药卫生引用本文复制引用
谢毓,许示沂,张俊艳,崔光焕,刘爱红..儿童肺炎合并塑形性支气管炎危险因素分析与预测模型构建[J].山东医药,2026,66(1):38-43,6.基金项目
山西省中医药管理局科研课题项目(2024ZYYB033). （2024ZYYB033）
