儿童肺炎并发塑型性支气管炎临床特征分析及风险预测模型建立与验证

doi:10.12372/jcp.2026.25e0439

临床儿科杂志 ›› 2026, Vol. 44 ›› Issue (6): 564-572.doi: 10.12372/jcp.2026.25e0439

儿童肺炎并发塑型性支气管炎临床特征分析及风险预测模型建立与验证

罗自豪¹, 李少军², 任佩珍¹, 王艳红¹, 耿刚¹()

¹ 重庆医科大学附属儿童医院呼吸科儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室（重庆 400014）
² 重庆医科大学附属儿童医院急诊科儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室（重庆 400014）

收稿日期:2025-04-22 修回日期:2025-11-04 录用日期:2026-04-23 出版日期:2026-06-15 发布日期:2026-06-04
通讯作者: 耿刚 E-mail:genggang550928@126.com
作者简介:第一联系人：作者贡献（Authors’ Contributions）
罗自豪、任佩珍负责临床资料收集、撰写论文初稿；王艳红负责数据分析；耿刚、李少军负责论文审阅及修改。

Analysis of clinical characteristics of children with pneumonia complicated with plastic bronchitis and establishment and validation of risk prediction model

LUO Zihao¹, LI Shaojun², REN Peizhen¹, WANG Yanhong¹, GENG Gang¹()

¹ Department of Respiratory, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
² Department of Emergency, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China

Received:2025-04-22 Revised:2025-11-04 Accepted:2026-04-23 Published:2026-06-15 Online:2026-06-04
Contact: GENG Gang E-mail:genggang550928@126.com

摘要/Abstract

摘要：

目的分析儿童肺炎并发塑型性支气管炎（PB）的临床特征及影响因素，并构建列线图预测模型，辅助临床早期识别高风险患儿。方法回顾性分析2018年1月至2025年1月住院治疗、确诊为肺炎并行支气管镜检查的患儿资料。采用分层抽样的方法，以7∶3的比例分为训练集和测试集，并使两组PB发生率接近7.0%。在共线性分析后，通过LASSO联合logistic回归筛选变量，再纳入加权logistic回归建立预测模型，并构建列线图，继而通过受试者工作特征（ROC）曲线、校准曲线、决策曲线分析（DCA）对模型进行验证。结果本研究共纳入2 697例患儿，其中确诊PB者190例。加权logistic回归模型的Bootstrap分析显示，哮喘病史（OR=1.67，95%CI：1.24~2.15，P<0.001）、气促（OR=2.01，95% CI：1.54~2.64，P<0.001）、发热时间（OR=4.00，95%CI：3.24~5.8，P<0.001）、胸腔积液(OR=1.53，95% CI：1.19~1.94，P<0.001）、气道重建显示不通畅（OR=2.42，95%CI：1.77~3.88，P<0.001）、中性粒细胞-淋巴细胞比值（OR=1.63，95%CI：1.28~2.25，P<0.001）、血小板计数（OR=0.54，95%CI：0.33~0.72，P<0.001）、纤维蛋白原（OR=1.48，95%CI：1.12~2.08，P=0.004）、D-二聚体（OR=1.46，95%CI：1.20~1.80，P=0.006）与PB发生相关。列线图模型在测试集的RoC曲线下面积（AUC）为0.921 (95%CI：0.88~0.96，P<0.05），显示较好的预测性能。结论肺炎并发PB高风险患儿具有一些早期临床特征，本研究构建的列线图可用于此类患儿的早期识别，具有一定的实用价值。

关键词: 塑型性支气管炎, 临床特征, 危险因素, 预测模型, 儿童

Abstract:

Objective To characterize the clinical features and independent risk factors for plastic bronchitis (PB) in children with pneumonia, and to develop and validate a clinically applicable nomogram for early risk stratification. Methods A retrospective analysis was conducted on the data of children hospitalized from January 2018 to January 2025, who were diagnosed with pneumonia and underwent bronchoscopy. Stratified sampling was used to divide the data into a training set and a test set at a ratio of 7∶3, ensuring that the PB incidence rate in both sets was approximately 7.0%. After collinearity analysis, variables were selected using LASSO combined with logistic regression, and then included in weighted logistic regression to establish a prediction model. A nomogram was constructed, and the model was validated through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves. Results Among 2697 eligible children, 190 (7.0%) developed PB. Bootstrap aralysis of the weighted cogistic regression model identified nine independent predictors: asthma history (OR=1.67, 95% CI: 1.24-2.15, P<0.001), tachypnea (OR=2.01, 95% CI: 1.54-2.64, P<0.001), fever duration (OR=4.00, 95% CI: 3.24-5.83, P<0.001), pleural effusion (OR=1.53, 95% CI: 1.19-1.94, P<0.001), airway obstruction on CT reconstruction (OR=2.42, 95% CI: 1.77-3.87, P<0.001), neutrophil-to-lymphocyte ratio (NLR) (OR=1.63, 95% CI: 1.28-2.25, P<0.001), platelet count (OR=0.54, 95% CI: 0.33-0.72, P<0.001), fibrinogen (OR=1.48, 95% CI: 1.12-2.08, P=0.004), and D-dimer (OR=1.46, 95% CI: 1.20-1.80, P=0.006). The nomogram demonstrated good predictive performance in the test set with an AUC of =0.921,（95% CI: 0.88-0.96; P<0.05). Conclusion PB is a rare but severe complication of pediatric pneumonia, associated with distinct and quantifiable clinical and laboratory features. The validated nomogram provides a practical, interpretable, and statistically robust tool for early identification of high-risk children—enabling timely bronchoscopic evaluation and intervention.

Key words: plastic bronchitis, clinical characteristics, risk factor, prediction model, child

中图分类号:

罗自豪, 李少军, 任佩珍, 王艳红, 耿刚. 儿童肺炎并发塑型性支气管炎临床特征分析及风险预测模型建立与验证[J]. 临床儿科杂志, 2026, 44(6): 564-572.

LUO Zihao, LI Shaojun, REN Peizhen, WANG Yanhong, GENG Gang. Analysis of clinical characteristics of children with pneumonia complicated with plastic bronchitis and establishment and validation of risk prediction model[J]. Journal of Clinical Pediatrics, 2026, 44(6): 564-572.

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项目	总人数(n=1 887)	非PB组(n=1 754)	PB组(n=133)	P
发热时间[M(P₂₅~P₇₅)]/d	5.00(3.00~7.00)	5.00(3.00~7.00)	10.00(7.00~11.00)	<0.001
WBC[M(P₂₅~P₇₅]/×10⁹·L^-1	7.48(5.82~9.88)	7.59(5.89~10.07)	7.29(5.43~10.52)	0.694
NLR[M(P₂₅~P₇₅)]	1.52(0.85~3.00)	1.44(0.79~2.57)	3.45(2.20~5.60)	<0.001
PLT[M(P₂₅~P₇₅]/×10⁹·L^-1	346.50(264.00~444.00)	354.50(270.00~454.00)	262.00(205.00~341.00)	<0.001
CRP[M(P₂₅~P₇₅]/mg·L^-1	13.43(5.18~27.58)	12.93(5.16~26.36)	22.55(9.00~47.83)	<0.001
PCT[M(P₂₅~P₇₅]/ng·mL^-1	0.10(0.06~0.20)	0.09(0.06~0.19)	0.26(0.09~0.74)	0.023
纤维蛋白原[M(P₂₅~P₇₅]/g·L^-1	3.39(2.36~4.43)	3.29(2.31~4.32)	4.11(3.24~4.96)	<0.001
D-二聚体[M(P₂₅~P₇₅]/mg·L^-1	0.55(0.29~1.52)	0.53(0.28~1.28)	2.32(0.84~3.97)	<0.001
LDH[M(P₂₅~P₇₅]/U·L^-1	280.00(233.00~360.00)	276.00(232.00~352.00)	396.00(280.00~566.00)	<0.001
哮喘病史[n(%)]				<0.001
0	1 820(96.45)	1 708(97.38)	112(84.21)
1	67(3.55)	46(2.62)	21(15.79)
气促[n(%)]				<0.001
0	1 383(73.29)	1 334(76.05)	49(36.84)
1	504(26.71)	420(23.95)	84(63.16)
胸腔积液[n(%)]				<0.001
0	1 475(78.17)	1 419(80.90)	56(42.11)
1	412(21.83)	335(19.10)	77(57.89)
气道重建显示不通畅[n(%)]				<0.001
0	750(39.75)	734(41.85)	16(12.03)
1	1 137(60.25)	1 020(58.15)	117(87.97)

变量	Lasso系数	logistic回归系数	OR(95% CI)	P
发热时间	0.076	1.564	4.78（3.49~6.54）	<0.001
胸腔积液	0.0460	0.660	1.94（1.53~2.45）	<0.001
哮喘病史	0.034	0.425	1.53（1.29~1.82）	<0.001
气道重建显示不通畅	0.026	0.835	2.31（1.62~3.28）	<0.001
气促	0.037	0.563	1.76（1.38~2.23）	<0.001
PLT	-0.031	-0.792	0.45（0.32~0.63）	<0.001
NLR	0.046	0.409	1.51（1.23~1.84）	<0.001
D-二聚体	0.029	0.404	1.50（1.23~1.83）	<0.001
纤维蛋白原	0.018	0.426	1.53（1.170~2.01）	0.002
CRP	0.014	0.1745	1.19（0.93~1.53）	0.167
LDH	0.018	0.147	1.16（0.93~1.44）	0.189
PCT	0.003	0.033	1.03（0.81~1.32）	0.789
WBC	-0.002	-0.030	0.97（0.75~1.25）	0.813

变量	加权回归系数	加权OR(95% CI)	P
哮喘病史	0.510	1.67（1.24~2.15）	<0.001
气促	0.699	2.01（1.54~2.64）	<0.001
发热时间	1.385	4.00（3.24~5.83）	<0.001
胸腔积液	0.425	1.53（1.19~1.94）	<0.001
气道重建显示不通畅	0.884	2.42（1.77~3.87）	<0.001
NLR	0.487	1.63（1.28~2.25）	<0.001
PLT	-0.620	0.54（0.33~0.72）	<0.001
纤维蛋白原	0.394	1.48（1.12~2.08）	0.004
D-二聚体	0.381	1.46（1.20~1.80）	0.006

儿童肺炎并发塑型性支气管炎临床特征分析及风险预测模型建立与验证

Analysis of clinical characteristics of children with pneumonia complicated with plastic bronchitis and establishment and validation of risk prediction model

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