【摘要】 目的：探讨学龄期哮喘患儿接受屋尘螨皮下特异性免疫治疗（SCIT）效果的影响因素，并建立风险预测模型以供临床参考。方法：选取2018年5月至2021年5月我院收治的160例接受标准屋尘螨SCIT的学龄期哮喘患儿，其中154例完成3年治疗。回顾性收集临床资料，根据患儿3年后是否能完全停用吸入性糖皮质激素（ICS）分为ICS停药组（治疗成功，99例）和ICS持续组（ICS未停药，55例）。采用多因素Logistic回归模型分析治疗效果的影响因素，并构建预测模型，利用受试者工作特征（ROC）曲线下面积（AUC）评估其预测价值。结果：两组患儿治疗期间丙酸氟替卡松（FP）使用剂量均逐渐下降，且在治疗12、24、36个月时剂量差异有统计学意义（P<0.05）;ICS停药组超重、哮喘重度持续、合并变应性鼻炎、过敏原种类多、被动吸烟的比例均高于ICS持续组（P<0.05）；多因素Logistic回归分析显示，哮喘重度持续、过敏原种类多、被动吸烟是治疗后ICS无法完全停药的独立危险因素（OR>1）(P<0.05);Logistic回归预测模型验证结果显示模型有效且拟合良好（P<0.05）;ROC曲线分析显示AUC为0.829，当cut-off值为0.650时，预测敏感度为0.707，特异度为0.855(P<0.05)。结论：哮喘重度持续、过敏原种类多、被动吸烟是影响学龄期哮喘患儿屋尘螨SCIT治疗效果的重要因素，据此建立的预测模型具有一定的预测价值。更多还原

【Abstract】 Objective: To investigate the determinants influencing the efficacy of house dust mite subcutaneous specific immunotherapy(SCIT) in school-age children with asthma and to develop a risk prediction model for clinical reference.Methods: A total of 160 school-age asthmatic children who received standard house dust mite SCIT at our hospital between May 2018 and May 2021 were retrospectively reviewed, of whom 154 completed the 3-year treatment. Based on whether inhaled corticosteroids(ICS) could be completely withdrawn after 3 years, patients were categorized into the ICS withdrawal group(n=99) and the ICS continuation group(n=55). Clinical data were collected retrospectively. Multivariate logistic regression was used to identify independent factors associated with treatment efficacy and to construct a predictive model. The discriminative ability of the model was evaluated by the area under the receiver operating characteristic(ROC) curve(AUC).Results: The dosage of fluticasone propionate(FP) gradually decreased in both groups during the treatment, with statistically significant differences between the two groups at 12, 24, and 36 months(P<0. 05). Compared to the ICS continuation group, the ICS withdrawal group had significantly higher proportions of overweight, severe persistent asthma, comorbid allergic rhinitis, multiple allergen sensitizations, and exposure to passive smoking(P<0. 05). Multivariate logistic regression analysis identified severe persistent asthma(OR>1), multiple allergen sensitizations(OR>1), and passive smoking exposure(OR>1) as independent risk factors for failure to discontinue ICS after treatment(all P<0. 05). The logistic regression prediction model showed a good fit(P<0. 05). ROC curve analysis revealed an AUC of 0. 829(P<0. 05). At an optimal cut-off value of 0. 650, the model demonstrated a sensitivity of 0. 707 and a specificity of 0. 855(P<0. 05).Conclusion: Severe persistent asthma, multiple allergen sensitizations, and passive smoking exposure are significant determinants affecting the efficacy of house dust mite SCIT in school-age asthmatic children. The prediction model based on these factors shows acceptable discriminative ability.更多还原