预测腹膜透析患者预后模型的构建与验证  

Development and validation of a prognostic model for survival in peritoneal dialysis patients

作　　者：陈婷[1] 龙海波[1] 黄千殷 周伟东[1] 朱艳[1] 李沛霖[1] 陈毅华[1] 罗丛伟 彭芬芬[1] Chen Ting;Long Haibo;Huang Qianyin;Zhou Weidong;Zhu Yan;Li Peilin;Chen Yihua;Luo Congwei;Peng Fenfen(Department of Nephrology,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学珠江医院肾内科,广州510280

出　　处：《中华肾脏病杂志》2020年第9期680-687,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81673792、81873346、81900607);广东省自然科学基金(2019A1515011083)。

摘　　要：目的构建与验证腹膜透析(PD)患者1年和3年生存率的预测模型。方法入选2010年1月1日至2017年12月31日在南方医科大学珠江医院首次接受腹膜透析置管术的患者为研究对象。其中2014年1月1日至2017年12月31日接受腹膜透析置管术的患者作为建模队列。收集入选者基线临床资料,主要研究终点事件为患者全因死亡。采用Cox比例风险回归模型筛选影响患者预后的危险因素,用R语言的rms包构建预测预后的模型;用一致性指数、ROC曲线和校准曲线评估模型的区分度和准确性。以2010年1月1日至2013年12月31日接受腹膜透析置管术的患者作为验证队列的研究对象,对模型的预测准确性进行验证。结果建模队列纳入患者457例,中位随访时间为27.67月(18.37,39.22),64例患者死亡(14.0%),患者1年、3年累积生存率分别为96.4%、83.0%。多因素Cox分析结果显示,高龄(每增加1岁,HR=1.07,95%CI 1.04~1.09,P<0.001)、有卒中史(HR=3.63,95%CI 1.93~6.85,P<0.001)、外周血中性粒细胞/淋巴细胞比值(NLR)高(每增加1,HR=1.12,95%CI 1.05~1.20,P=0.001)、低血浆白蛋白(每增加1 g/L,HR=0.89,95%CI 0.82~0.95,P=0.001)和高总胆固醇(每增加1 mmol/L,HR=1.51,95%CI 1.20~1.89,P<0.001)水平是PD患者预后的独立危险因素。预测模型在建模队列和验证队列的一致性指数分别为0.815(95%CI 0.765~0.865)和0.804(95%CI 0.744~0.864),校正曲线均接近斜率为1的直线。结论基于年龄、血总胆固醇水平、卒中史和NLR,用列线图建立的腹膜透析患者预后的预测模型可辅助预测PD患者1年和3年生存率。Objective To develop and validate a nomogram for predicting the 1-and 3-year survival rates of patients receiving peritoneal dialysis.Methods Patients who underwent peritoneal dialysis for the first time in Zhujiang hospital from January 1,2010 to December 31,2017 were enrolled.The patients from January 1,2014 to December 31,2017 were enrolled in a training dataset.Baseline clinical data were collected and the primary endpoint was all-cause death.Cox proportional hazard regression models were used to analyze risk factors affecting the survival rates.Nomograms were generated using the R rms package.The Harrell'concordance index(C-index),receiver operating characteristic curve and calibration curve were used to verify the performance of the model.Patients who underwent peritoneal dialysis from January 1,2010 to December 31,2013 were then selected to validate the external predictive accuracy of the prediction models.Results The prediction cohort enrolled 457 patients,with a median follow-up time of 27.67(18.37,39.22)months,and 64 patients(14.00%)died during follow-up.The 1-and 3-year cumulative survival rates were 96.4%and 83.0%.Multivariate analysis showed that aging(every 1 year old increase,HR=1.07,95%CI 1.04-1.09,P<0.001),stroke(HR=3.63,95%CI 1.93-6.85,P<0.001),higher cholesterol(every 1 mmol/L increase,HR=1.51,95%CI 1.20-1.89,P<0.001),higher neutrophil-to-lymphocyte ratio(every 1 increase,HR=1.12,95%CI 1.05-1.20,P=0.001),and lower albumin(HR=0.89,95%CI 0.82-0.95,P=0.001)were independent risk factors affecting the survival rates of PD patients.The C-index of the prediction cohort and the validation cohort were 0.815(95%CI 0.765-0.865)and 0.804(95%CI 0.744-0.864,respectively).Both internally and externally verified calibration curves showed that the predicted results were close to the actual survival rates.Conclusion Based on age,blood total cholesterol level,stroke history,and NLR,the prognosis prediction model of peritoneal dialysis patients established with nomogram can help predict the 1-year and 3-year survi

关 键 词：腹膜透析 预后 列线图 预测模型 

分 类 号：R692.5[医药卫生—泌尿科学]