蜂蜇伤溶血患者的临床特征与危险因素及其列线图预测模型  

Clinical characteristics and risk factors of patients with wasp sting hemolysis and its nomogram prediction model

作　　者：李文来 钟威 李玥 李轩维 马聪媛 朱平[1,4] LI Wenlai;ZHONG Wei;LI Yue;LI Xuanwei;MA Congyuan;ZHU Ping(The First College of Clinical Medical Science of China Three Gorges University/Yichang Central People's Hospital,Yichang,Hubei 443002,China;不详)

机构地区：[1]三峡大学第一临床医学院/宜昌市中心人民医院,湖北宜昌443002 [2]华南理工大学医学院 [3]三峡大学第二临床学院/三峡大学仁和医院 [4]三峡大学风湿免疫疾病研究所

出　　处：《中国工业医学杂志》2023年第1期11-15,共5页Chinese Journal of Industrial Medicine

基　　金：湖北省教育厅自然科学研究计划项目(B2017024);宜昌市医疗卫生研究项目(A20-2-002)。

摘　　要：目的探讨蜂蜇伤所致溶血患者的临床特征与危险因素,并构建预测蜂蜇伤患者发生溶血的列线图模型。方法回顾性分析三峡大学第一临床医学院2004年1月至2020年12月收治的365例蜂蜇伤患者的临床资料,归纳溶血组(97例)和未溶血组(268例)两组患者的临床特征,采用多因素Logistic回归法分析蜂蜇伤所致溶血的危险因素;利用Rstudio软件构建预测蜂蜇伤患者发生溶血的列线图模型,并使用工作特征曲线(ROC)及校准图验证列线图模型的区分度和校准度,最后利用决策曲线分析(decision curve analysis,DCA)评价该模型在临床上的应用价值。结果溶血组较非溶血组更易发生呕吐、皮肤过敏、横纹肌溶解、急性肾损伤(P<0.05);多因素Logistic分析显示,女性、年龄≥45岁、未处理伤口、活化凝血酶原时间(APTT)为蜂蜇伤患者发生溶血的独立危险因素(P<0.05),血浆白蛋白(ALB)为蜂蜇伤患者发生溶血的保护因素(P<0.05);所构建的列线图模型具有良好的区分度和校准度。结论女性、年龄≥45岁、未处理伤口、APTT延长有助于为临床早期发现蜂蜇伤溶血提供一定预测作用,ALB在蜂蜇伤患者发生溶血中起保护作用;基于上述独立危险因素所构建的列线图可有效地预测蜂蜇伤后患者发生溶血的概率,为临床早期干预提供依据。Objective To investigate the clinical characteristics and risk factors of patients with hemolysis due to wasp stings,and construct a nomogram model to predict the occurrence of hemolysis in patients with wasp stings.Methods The clini cal data of 365 patients with wasp stings admitted to the First Clinical School of Three Gorges University from January 2004 to December 2020 were retrospectively analyzed,the clinical characteristics of patients both in hemolyzed group(97 cases)or non hemolyzed group(268 cases)were summarized and the risk factors of hemolysis caused by wasp sting were screened by multi variate Logistic regression method.Then,theRstudio software is used to build a nomogram model for predicting the occurrence of hemolysis in patients with bee sting,and theROC curves and calibration chart were used to verify the differentiation and calibration of the nomograms model,and finally decision curve analysis(DCA)was used to evaluate the clinical application value of the model.Results The results showed that the patients in hemolytic group were more prone to vomiting,skin sensibility,rhabdomyolysis,and acute renal than those in non-hemolytic group(P<0.05);the multifactorial Logistic analysis showed that gender(female),age(≥45 years),untreated wounds and APTT(activated partial prothrombin time)were the independent risk factors for hemolysis in wasp sting patients(P<0.05),and plasma albumin(ALB)was the protective factor for hemolysis in wasp sting patients(P<0.05).Additionally,the nomogram model constructed in this investigation had good discrimination and calibration.Conclusion The results suggested that female patients,age≥45 years,untreated wounds,and prolonged APTT could be helpful to provide a certain predictive role for the early clinical detection of wasp sting hemolysis,while ALB played a protective role in the occurrence of hemolysis in wasp sting patients.The nomogram constructed based on the independent risk factors mentioned above could effectively predict the probability of hemolysis in patients

关 键 词：蜂蜇伤 溶血 危险因素 列线图 

分 类 号：R595.8[医药卫生—内科学]