肾移植受者术后肺部感染风险预测模型的构建及效果评价  

Establishment and effect evaluation of risk prediction model for lung infection after kidney transplantation

作　　者：宫晶 窦晓庆[2] 丁良成 孙亚楠 李景余 孟庆慧[1] Gong Jing;Dou Xiaoqing;Ding Liangcheng;Sun Ya′nan;Li Jingyu;Meng Qinghui(School of Nursing,Weifang Medical College,Weifang 261053,China;不详)

机构地区：[1]潍坊医学院护理学院,山东潍坊261053 [2]潍坊市人民医院泌尿外科

出　　处：《器官移植》2022年第3期385-392,共8页Organ Transplantation

基　　金：山东省自然科学基金(ZR2020MH128);潍坊医学院教育教学改革研究项目(2019YB010);潍坊医学院博士启动基金(2017BSQD58)。

摘　　要：目的探讨肾移植受者术后1年内发生肺部感染风险预测模型的构建及其预测价值。方法回顾性分析197例肾移植受者的临床资料,根据术后1年内是否发生肺部感染分为感染组(42例)和非感染组(155例)。分析肾移植术后肺部感染的发生情况及危险因素,利用多元logistic回归分析建立风险预测模型。选取符合标准的45例肾移植受者进行验证,其中感染组8例,非感染组37例,验证模型的预测效果。结果肾移植术后1年内肺部感染的发生率为21.3%(42例),其中肺炎严重指数(PSI)评级Ⅰ级38例(90%),Ⅲ级1例(2%),Ⅴ级3例(8%)。13例发生于术后1个月内,22例发生于术后2~6个月,7例发生于术后6个月后。细菌感染19例、真菌感染7例、病毒感染10例、混合感染6例。存在吸烟史、糖尿病史、肺部疾病史及白蛋白<35 g/L是肾移植受者术后发生肺部感染的独立危险因素(均为P<0.05)。肾移植受者术后肺部感染风险预测模型方程为logit(肾移植受者术后1年内肺部感染)=-1.891+1.063×吸烟史(有=1,无=0)+1.398×糖尿病史(有=1,无=0)+1.732×肺部疾病史(有=1,无=0)+1.269×白蛋白(<35 g/L=1,≥35 g/L=0),受试者工作特征(ROC)曲线下面积(AUC)为0.788,灵敏度为0.786,特异度为0.645,约登指数为0.431。Hosmer-Lemeshow拟合优度检验结果显示模型预测值和实际观测值间的一致度较好。验证组AUC为0.834,Hosmer-Lemeshow拟合优度检验结果显示模型校准度较好。结论以吸烟史、糖尿病史、肺部疾病史、白蛋白为预测因子构建的模型可有效预测肾移植受者术后1年内肺部感染的发生。Objective To establish and evaluate the predictive value of the risk prediction model for lung infection within postoperative 1 year in kidney transplant recipients.Methods Clinical data of 197 kidney transplant recipients were retrospectively analyzed.All recipients were divided into the infection group(n=42)and non-infection group(n=155)according to the incidence of lung infection within postoperative 1 year.The incidence and risk factors of lung infection after kidney transplantation were analyzed.Risk prediction model was established by multiple logistic regression analysis.Forty-five kidney transplant recipients who met the inclusion criteria,including 8 cases in the infection group and 37 cases in the non-infection group,were selected to verify the predictive effect of the established model.Results The incidence of lung infection within 1 year after kidney transplantation was 21.3%(n=42),including 38 cases(90%)of pneumonia severity index(PSI)classⅠ,1 case(2%)of PSI classⅢand 3 cases(8%)of PSI classⅤ.Lung infection occurred within 1 month after operation in 13 cases,within postoperative 2-6 months in 22 cases and after postoperative 6 months in 7 cases.Nineteen recipients were diagnosed with bacterial infection,7 cases of fungal infection,10 cases of viral infection and 6 cases of mixed infection.Smoking history,diabetes mellitus history,pulmonary disease history and albumin level of<35 g/L were the independent risk factors for lung infection after kidney transplantation(all P<0.05).The equation of risk prediction model for postoperative lung infection in kidney transplant recipients was logit(lung infection within postoperative 1 year in kidney transplant recipients)=-1.891+1.063×smoking history(yes=1,no=0)+1.398×diabetes mellitus history(yes=1,no=0)+1.732×pulmonary disease history(yes=1,no=0)+1.269×albumin level(<35 g/L=1,≥35 g/L=0).The area under the curve(AUC)of receiver operating characteristic(ROC)was 0.788,the sensitivity was 0.786,the specificity was 0.645,and the Youden index was 0.431,r

关 键 词：肺部感染 肾移植 风险预测模型 危险因素 肺部疾病 糖尿病 白蛋白 吸烟 

分 类 号：R617[医药卫生—外科学] R619.3[医药卫生—临床医学]