创伤性蛛网膜下腔出血患者并发神经源性肺水肿的危险因素及其风险预测列线图模型构建研究  

Risk factors and construction of risk prediction nomogram model for neurogenic pulmonary edema in patients with traumatic subarachnoid hemorrhage

作　　者：刘晓琳 王纯强[1] 邓媚艳 袁涛 LIU Xiaolin;WANG Chunqiang;DENG Meiyan;YUAN Tao(Department of Rehabilitation,Chenzhou No.1 People's Hospital,Chenzhou 423000,China;不详)

机构地区：[1]湖南省郴州市第一人民医院康复科,423000 [2]湖南省郴州市第一人民医院ICU,423000

出　　处：《临床合理用药杂志》2022年第27期15-19,共5页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的分析创伤性蛛网膜下腔出血(TSH)患者并发神经源性肺水肿(NPE)的危险因素,并构建列线图模型。方法选取2018年1月—2020年1月郴州市第一人民医院收治的175例TSH患者作为研究对象,记录患者的临床资料。采用多因素Logistic回归分析探讨TSH患者并发NPE的危险因素;应用rms程序包和R语言(R 3.5.3)软件包绘制TSH患者并发NPE的风险预测列线图模型,采用一致性指数、校正曲线、受试者工作特征(ROC)曲线评价该列线图模型对TSH患者并发NPE的预测价值。结果175例TSH患者中,发生NPE 24例,NPE发生率为13.71%,纳入NPE组;未并发NPE患者151例纳入非NPE组。2组疾病严重程度、糖尿病发生率、Hunt-Hess分级、Fisher分级及脑电图(EEG)异常发生率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,中晚期TSH、合并糖尿病、Hunt-HessⅢ~Ⅴ级、Fisher分级Ⅲ~Ⅳ级及EEG异常是TSH患者并发NPE的独立危险因素(P<0.05)。基于TSH患者并发NPE的危险因素构建TSH患者并发NPE的风险预测列线图模型,该列线图模型预测TSH患者并发NPE的校正曲线趋近于理想曲线;内部验证结果显示,一致性指数为0.811[95%CI(0.792,0.834)];列线图模型预测TSH患者并发NPE的ROC曲线下面积为0.811。结论中晚期TSH、合并糖尿病、HuntHessⅢ~Ⅴ级、Fisher分级Ⅲ~Ⅳ级及EEG异常是TSH患者并发NPE的独立危险因素,据此建立的列线图模型对TSH患者NPE发生风险具有良好的预测效能。Objective To analyze the risk factors of neurogenic pulmonary edema(NPE)in patients with traumatic subarachnoid hemorrhage(TSH),and establish the risk prediction nomogram model.Methods A total of 175 cases of TSH patients in Chenzhou No.1 People′s Hospital from January 2018 to January 2020 were retrospectively analyzed,clinical data of patients were recorded.Multivariate Logistic regression analysis was used to evaluate the risk factors of NPE in patients with TSH.rms package and R language(R 3.5.3)software package were used to draw the risk prediction nomogram model of TSH patients complicated with NPE,theCI,calibration curve,ROC curve were drawn to evaluate the prediction value of the nomogram model.Results In 175 cases of TSH patients,NPE was for 24 cases,with incidence of 13.71%,which was included NPE group;and 151 cases without NPE were non-NPE group.There were significant difference of severity of disease,incidence of diabetes,Hunt-Hess grade,Fisher grade and incidence of abnormal EEG between the two groups(P<0.05).Multivariate Logistic regression analysis results showed that,middle and late TSH,complicated with diabetes,Hunt-Hess grade withⅢ-Ⅴ,Fisher grade withⅢ-Ⅳand abnormal EEG were risk factors of NPE in patients with TSH(P<0.05).A nomogram model of TSH patients complicated with NPE were constructed based on those risk factors,calibration curve of the nomogram model in predicting TSH patients complicated with NPE was closed to the ideal curve;internal verification results showed that,CIwas 0.811[95%CI(0.792,0.834)];the area of ROC curve of the nomogram model in predicting TSH patients complicated with NPE was 0.811.Conclusion Middle and late TSH,complicated with diabetes,Hunt-Hess grade withⅢ-Ⅴ,Fisher grade withⅢ-Ⅳand abnormal EEG were risk factors of NPE in patients with TSH,and the nomogram model based on above risk factors has higher prediction efficiency in TSH complicated with NPE patients.

关 键 词：创伤性蛛网膜下腔出血 神经源性肺水肿 危险因素 列线图 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R563[医药卫生—临床医学]