基于决策曲线和剂量反应分析评估腺病毒载量对儿童感染重症腺病毒肺炎后发展为闭塞性细支气管炎的预测价值

目的 探讨腺病毒(ADV)载量对重症腺病毒肺炎(SAP)发展为闭塞性细支气管炎(BO)的预测价值。方法 选取2015年1月至2019年2月入重庆医科大学附属儿童医院的SAP患儿139例,发展为BO 34例,未发展为BO 105例。利用LASSO-logistic回归、限制性立方样条模型和决策曲线分析评估ADV载量对SAP发展为BO的临床预测价值。结果 两组患儿发热持续时间、呼吸衰竭、有创机械通气、鼻咽抽吸物ADV-DNA载量、PCT、合并细菌感染情况差异均有统计学意义(P均<0.05)。通过LASSO-logistic回归筛选变量,再经多因素logistic回归分析显示,鼻咽抽吸物ADV载量是SAP发展为BO的独立危险因素(OR=1.247,95%CI:1.088~1.459,P=0.01)。限制性立方样条分析结果显示,鼻咽抽吸物ADV载量的自然对数值与SAP后发展为BO的关联强度呈线性剂量反应关系(线性检验,P=0.69)。决策曲线分析显示ADV载量对SAP发展为BO的预测有重要临床价值。结论 ADV载量是儿童SAP发展为BO的独立、剂量依赖的危险因素,对SAP发展为BO的预测有重要的临床价值。

Evaluation of adenovirus DNA load and the development of bronchiolitis obliterans in children with severe adenovirus pneumonia based on decision curve analysis and dose-response analysis

Objective To investigate the predictive value of adenovirus (ADV) load in the development of severe adenovirus pneumonia (SAP) to bronchiolitis obliterans (BO).Methods A total of 139 SAP children admitted to Children's Hospital of Chongqing Medical University from January 2015 to February 2019 were enrolled, of which 34 developed into BO and 105 did not. LASSO-logistic regression, restricted cubic spline model and decision curve analysis were used to evaluate the clinical predictive value of ADV load in the development of SAP to BO.Results The duration of fever, respiratory failure, invasive mechanical ventilation, ADV-DNA load of nasopharyngeal aspirate, PCT and bacterial infection were compared between the two groups (P<0.05). The variables were screened by LASSO-logistic regression, and multivariate logistic regression analysis showed that the ADV load of nasopharyngeal aspirate was an independent risk factor for SAP developing into BO (OR=1.247, 95% CI: 1.088~1.459, P=0.01). Restricted cubic spline analysis showed a linear dose-response relationship between the natural logarithm of the nasopharyngeal aspirate ADV load and the post-SAP developmental BO (linear test, P=0.69). Decision curve analysis showed that ADV load had important clinical value for the prediction of SAP developing into BO.Conclusion ADV load is an independent, dose-dependent risk factor for the development of childhood SAP to BO, and has important clinical value for the prediction of SAP developing into BO.