谢艾岑 史文倩 梁蓉蓉 吴葆菁 黄花荣

【摘要】目的 评估哮喘预测指数（API）和哮喘预测评分（APS）对儿童哮喘的预测价值。方法 分析266例年龄≥6岁既往有喘息患儿的问卷调查情况，调查表主要由API和APS的各项参数组成，包括患儿的一般情况、家族史、喘息情况、过敏情况和试验性治疗情况。利用腾讯问卷输入数据并进行整理，通过受试者工作特征（ROC）曲线下面积（AUC）评价API与APS对儿童哮喘的预测效能，通过Hosmer-Lemeshow检验评价校准度。结果 ROC曲线分析显示，API的宽松指标与严格指标的AUC分别为0.734与0.718，APS的AUC为0.975， APS的截断值为4.5分。Hosmer-Lemeshow拟合优度检验结果显示，2种哮喘预测工具的校准线图中的实测值与期望值贴合，校准度良好。结论 2种哮喘预测工具的校准度良好，APS对儿童哮喘的预测价值高于API。

【关键词】哮喘;哮喘预测指数;哮喘预测评分;预测价值;喘息儿童

Analysis of predictive value of asthma predictive index and asthma prediction score in children with asthma Xie Aicen， Shi Wenqian， Liang Rongrong， Wu Baojing， Huang Huarong. Department of Pediatrics， Sun Yat-sen Memorial Hospital， Sun Yat-sen University， Guangzhou 510120， China

Corresponding author， Huang Huarong， E-mail： hhrvivi@ 126. com

【Abstract】Objective To evaluate the predictive value of asthma prediction index （API） and asthma prediction score （APS） in children with asthma. Method In this study， 266 children aged≥6 years old with previous history of wheezing were investigated by questionnaire， which was mainly composed of different parameters of API and APS， including general condition， family history， wheezing condition， allergic condition， and response to anti-asthma therapy. The data input from Tencent questionnaire software was collected and analyzed. The predictive efficacy of API and APS was evaluated by the area under receiver operating characteristic （ROC） curve （AUC）， and the calibration was evaluated by Hosmer-Lemeshow good of fit test. Results ROC curve analysis demonstrated that the AUC of the loose index and stringent index of API were 0.734 and 0.718， respectively. The AUC of APS was 0.975. The cutoff value of APS was 4.5. Hosmer-Lemeshow goodness of fit test revealed no significant difference between the predicted value of the model and the actual value. Conclusion The calibration of these two asthma predictive tools is good， and the predictive value of APS is higher than that of API.

【Key words】Asthma;Asthma predictive index;Asthma prediction score;Predictive value;

Children with wheeze

哮喘是儿童常见的呼吸系统疾病之一，以反复发作的喘息、咳嗽、气促和胸闷为主要临床表现，往往由各种病原体感染或致敏原所触发[1-2]。统计资料显示，儿童哮喘患病率较前显著升高，且发病年龄提前[3-5]。多项长期、前瞻性队列研究显示，学龄前儿童喘息的预后并非完全良性，因此早期识别及诊断年幼儿童哮喘，并对其进行有效干预十分必要。然而目前国内外6岁以下儿童哮喘的诊断标准尚无明确定义。全球哮喘防治创议（GINA）中指出，6岁以下儿童哮喘的诊断面临巨大挑战[1]。由于对6岁以下儿童缺乏哮喘诊断的相关检测方法，造成儿童哮喘诊治的延误，最终导致患儿生存质量下降甚至是病死率升高。……