第三代头孢菌素治疗社区获得性自发性细菌性腹膜炎的疗效预测模型  

Establishment of a model for predicting the efficacy of third-generation cephalosporin in treatment of community-acquired spontaneous bacterial peritonitis

作　　者：朱龙川[1] 吴蔚[3] 邹波[1] 甘达凯 林学[1] 周炜 熊墨龙[1] ZHU Longchuan;WU Wei;ZOU Bo;GAN Dakai;LIN Xue;ZHOU Wei;XIONG Molong(Department of Liver Disease,The Ninth Hospital of Nanchang,Nanchang 330002,China;Department of Information Technology,The Ninth Hospital of Nanchang,Nanchang 330002,China;Department of Digestion,Children’s Hospital of Jiangxi Province,Nanchang 330000,China)

机构地区：[1]南昌市第九医院肝病科,南昌330002 [2]南昌市第九医院信息科,南昌330002 [3]江西省儿童医院消化科,南昌330000

出　　处：《临床肝胆病杂志》2022年第11期2499-2504,共6页Journal of Clinical Hepatology

基　　金：江西省重点研发计划项目(20181BBG78010)。

摘　　要：目的探讨第三代头孢菌素(3^(rd) GC)治疗社区获得性自发性细菌性腹膜炎(CASBP)疗效的预测因素,构建并验证3^(rd) GC治疗CASBP的疗效预测模型。方法回顾性收集南昌市第九医院的肝硬化伴CASBP患者,均单用3^(rd) GC进行初始治疗,依据疗效分为无效组与有效组。2013年—2018年住院的纳入建模库(无效组55例和有效组110例),2019年—2020年住院的纳入验证库(无效组17例和有效组43例)。在建模库中比较两组的一般资料、基础病、既往史、临床表现和实验室检查等指标,采用单因素分析(符合正态分布的计量资料组间比较采用t检验;不符合正态分布的计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ2检验或Fisher精确概率法)和二元Logistic回归分析识别疗效预测因素,根据Logistic回归方程构建疗效预测模型。采用受试者工作特征(ROC)曲线分别在建模库和验证库中对模型行内部验证和外部验证。结果全组以男性为主(占80.0%),平均(51.6±12.0)岁,肝硬化病因以乙型肝炎为主(66.7%),3^(rd) GC总有效率为68.0%。建模库中,无效组的SBP首次发病占比、腹水多形核细胞(PMN)计数及腹水白细胞计数明显低于有效组(P值均<0.05),而无效组的广谱抗生素暴露占比与血小板均显著高于有效组(P值均<0.05);Logistic回归分析显示,SBP首次发病[比值比(OR)=0.158,95%置信区间(CI):0.064~0.392,P<0.001]、腹水PMN计数(OR=0.728,95%CI:0.530~0.998,P=0.046)、广谱抗生素暴露(OR=9.152,95%CI:1.513~55.351,P=0.016)及血小板(OR=1.012,95%CI:1.006~1.019,P<0.001)是3^(rd) GC治疗无效的独立预测因素;疗效预测模型的ROC曲线下面积为0.840,依据约登指数最大原则,预测评分≥0.207是预测治疗无效的最佳界值,对应的约登指数为0.536,敏感度89.1%,特异度63.6%,阳性预测值55.1%,阴性预测值92.1%。验证库中,该模型的ROC曲线下面积为0.837。结论SBP首次发病和更高的腹水PMNObjective To investigate the factors for predicting the efficacy of third-generation cephalosporin(3^(rd) GC)in the treatment of community-acquired spontaneous bacterial peritonitis(CASBP),and to establish and validate an efficacy predictive model for 3^(rd) GC in the treatment of CASBP.Methods A retrospective analysis was performed for the clinical data of the patients with liver cirrhosis and CASBP who received 3^(rd) GC monotherapy for initial treatment in The Ninth Hospital of Nanchang,and according to their treatment outcome,they were divided into non-response group and response group.The patients hospitalized from 2013 to 2018 were included in the modeling cohort(55 patients the non-response group and 110 in the response group),and those hospitalized from 2019 to 2020 were included in the validation cohort(17 patients in the non-response group and 43 in the response group).In the modeling cohort,the two groups were compared in terms of the indices including general information,underlying diseases,past history,clinical manifestation,and laboratory test results.Univariate analyses(the t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups)and a binary Logistic regression analysis were used to identify efficacy predictors,and an efficacy predictive model was established based on the logistic regression equation.The receiver operating characteristic(ROC)curve was plotted to perform internal and external validations of the model in the modeling cohort and the validation cohort,respectively.Results The study population had a mean age of 51.6±12.0 years,and male patients accounted for 80.0%;hepatitis B was the main cause of liver cirrhosis(66.7%),and 3^(rd) GC had an overall response rate of 68.0%.In the modeling cohort,compared with the response group,the non-respons

关 键 词：肝硬化 腹膜炎 社区获得性感染 头孢菌素类 Logistic模型 

分 类 号：R572.2[医药卫生—消化系统]