维持性血液透析患者的生存预后及其风险预测模型的构建  

Survival analysis and risk predictive model of maintenance hemodialysis patients

作　　者：黄国海 许少英[1] 李绪城[1] Huang Guo-hai;Xu Shao-ying;Li Xu-cheng(Blood Purification Center of Shantou central hospital,Shantou 515041,China)

机构地区：[1]汕头市中心医院血液净化中心,汕头515041

出　　处：《临床肾脏病杂志》2023年第4期320-325,共6页Journal Of Clinical Nephrology

基　　金：汕头市科技计划项目(211116146491392)。

摘　　要：目的了解维持性血液透析(maintenance hemodialysis,MHD)患者的生存状况,分析影响其生存预后的危险因素,构建并验证生存预测模型。方法选择2018年12月至2019年5月在汕头市中心医院血液净化中心接受治疗的MHD患者,记录患者的临床资料及转归,多因素Cox回归分析患者生存预后的影响因素。应用R语言的survminer、survival、rms、survival ROC数据包构建并检验患者预后的预测模型,DynNom数据包及DNbuilder函数生成在线动态列线图。结果共纳入370例MHD患者,多因素Cox回归分析结果显示影响患者生存预后的危险因素包括:年龄、糖尿病、血管通路、粒细胞与淋巴细胞比值(neutrophils lymphocytes ratio,NLR)、血清白蛋白。据Cox回归分析结果构建MHD患者的生存预后风险预测模型,一致性指数为0.703(95%CI:0.6589~0.7471),1年、2年、3年生存率的受试者工作特征曲线的曲线下面积分别是0.742、0.734、0.737。结论基于年龄、糖尿病、血管通路、NLR、血清白蛋白五个变量构建在线动态列线图,可较准确预测MHD患者1~3年生存率。Objective To explore the survival rate of maintenance hemodialysis(MHD)patients and construct an survival prediction.Methods From December 2018 to May 2019,370 cases of MHD patients were recruited.Clinical data and outcomes were recorded.Cox regression was employed for examining the influencing factors of survival prognosis.And survminer,survival,rms and survival receiver operating characteristic(ROC)data packets of R were utilized for constructing and validating the survival predictive model.DynNom data packet and DNbuilder function were employed for constructing online dynamic nomogram.Results A total of 370 cases of MHD patients were included.Multivariate Cox regression analysis indicated that the risk factors for survival prognosis included age,diabetes mellitus(DM),vascular access,ratio of neutrophil-to-lymphocyte and serum albumin.According to the results of Cox regression analysis,a survival predictive nomogram was constructed with a C-index of 0.703(95%CI:0.6589-0.7471).And the areas under ROC of 1/2/3-year survival were 0.742,0.734 and 0.737 respectively.Conclusion Based upon age,DM,vascular access,ratio of neutrophil-to-lymphocyte and serum albumin,online dynamic nomogram helps to predict 1/2/3-year survival rates of MHD patients.

关 键 词：血液透析 生存分析 列线图 

分 类 号：R692.5[医药卫生—泌尿科学]