老年过敏性鼻炎患者哮喘共病风险预测列线图:多因素模型的构建与临床验证

摘要/Abstract

摘要： 目的探讨老年过敏性鼻炎(allergic rhinitis, AR)患者共病支气管哮喘(bronchial asthma, BA)的影响因素,构建风险预测列线图模型,为早期识别高危人群及制定个体化预防策略提供科学依据。方法选取2019年1月至2024年12月于眉山市人民医院就诊的老年AR患者523例,按7︰3的比例随机分为训练集(366例)和验证集(157例)。根据是否共病BA,将患者分为AR共病BA组与单纯AR组。采用LASSO回归对潜在影响因素进行初步筛选,再纳入多因素logistic回归分析确定独立影响因素,据此构建列线图预测模型。采用受试者工作特征曲线评估模型区分度,Hosmer-Lemeshow拟合优度检验及校准曲线评估模型校准度,决策曲线分析评估模型临床适用性。结果 523例老年AR患者中,共病BA者138例(26.39%)。多因素logistic回归分析显示,BA家族史(OR=2.224,95%CI:1.322~3.744)、职业粉尘接触史(OR=3.614,95%CI:2.107~6.199)、多重过敏原(OR=2.787,95%CI:1.585~4.900)及未规律使用鼻用糖皮质激素或抗组胺药(OR=2.381)是老年AR患者共病BA的独立影响因素(P<0.05)。基于上述因素构建的列线图模型在训练集的AUC为0.759(95%CI:0.704~0.813),验证集的AUC为0.745(95%CI:0.650~0.832)。Hosmer-Lemeshow检验显示模型拟合良好(训练集P=0.244,验证集P=0.958),校准曲线显示预测概率与实际观察概率具有较好一致性。决策曲线分析显示,模型在训练集(阈值概率0.090~0.610)和验证集(阈值概率0.080~0.900)范围内均具有正向临床净获益。结论 BA家族史、职业粉尘接触史、多重过敏原及未规律用药是老年AR患者共病BA的独立危险因素,基于此构建的列线图模型具有良好的预测效能与临床适用性。该模型为早期识别高危人群提供了可视化工具,有助于实现个体化预防与社区分级管理。

关键词: 老年, 过敏性鼻炎, 支气管哮喘, 列线图模型

Abstract: Objective To investigate the influencing factors of bronchial asthma(BA)comorbidity in elderly patients with allergic rhinitis(AR)and to develop a nomogram prediction model for early identification of high-risk individuals and individualized prevention. Methods A total of 523 elderly patients with AR were enrolled from Meishan People's Hospital between January 2019 and December 2024. They were randomly divided into a training set(n=366)and a validation set(n=157)at a 7∶3 ratio. Patients were categorized into AR with BA comorbidity group and AR alone group based on the presence of BA. Least absolute shrinkage and selection operator(LASSO)regression was used for preliminary variable selection, followed by multivariate logistic regression to identify independent influencing factors. A nomogram was constructed based on these factors. Model discrimination was evaluated using receiver operating characteristic(ROC)curve, calibration was assessed using Hosmer-Lemeshow test and calibration curves, and clinical applicability was evaluated using decision curve analysis(DCA). Results Among the 523 elderly AR patients, 138(26.39%)had BA comorbidity. Multivariate logistic regression showed that family history of BA(OR=2.224, 95%CI:1.322-3.744), occupational dust exposure(OR=3.614, 95%CI:2.107-6.199), multiple allergens(OR=2.787, 95%CI:1.585-4.900), and irregular use of intranasal corticosteroids or antihistamines(OR=2.381)were independent influencing factors for BA comorbidity(P<0.05). The nomogram yielded an AUC of 0.759(95%CI:0.704-0.813)in the training set and 0.745(95%CI:0.650-0.832)in the validation set. The Hosmer-Lemeshow test indicated good model fit(training set P=0.244; validation set P=0.958), and calibration curves showed good agreement between predicted and observed probabilities. DCA demonstrated positive net clinical benefit across threshold probabilities of 0.090-0.610 in the training set and 0.080-0.900 in the validation set. Conclusion Family history of BA, occupational dust exposure, multiple allergens, and irregular medication use are independent risk factors for BA comorbidity in elderly AR patients. The nomogram constructed based on these factors exhibits good predictive performance and clinical applicability, providing a visual tool for early identification of high-risk individuals and facilitating individualized prevention and community-based stratified management.

Key words: Elderly, Allergic rhinitis, Bronchial asthma, Nomogram model

中图分类号:

R763

刘丹凤,潘庆春,封雪飞,李昊佚,任健,李代波. 老年过敏性鼻炎患者哮喘共病风险预测列线图:多因素模型的构建与临床验证[J]. 山东大学耳鼻喉眼学报, 2026, 40(6): 54-62.

LIU Danfeng, PAN Qingchun, FENG Xuefei, LI Haoyi, REN Jian, LI Daibo. Development and validation of a nomogram for predicting asthma comorbidity in elderly patients with allergic rhinitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2026, 40(6): 54-62.

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