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

Abstract

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

CLC Number:

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.

Figures/Tables 7

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References 36

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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

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

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