腹膜透析相关性腹膜炎发生的影响因素及列线图预测模型建立  

Influencing factors of peritoneal dialysis-associated peritonitis and nomogram prediction modeling

作　　者：狄亚妮 杨靖倩 吕玉敏[1] 刘云[1] 郭明好[1] 马东红[1] Di Ya-ni;Yang Jing-qian;Lyu Yu-min;Liu Yun;Guo Ming-hao;Ma Dong-hong(Department of Nephrology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,China)

机构地区：[1]新乡医学院第一附属医院肾内科,卫辉453100

出　　处：《临床肾脏病杂志》2023年第7期569-574,共6页Journal Of Clinical Nephrology

基　　金：河南省医学科技攻关计划联合共建立项项目(LHGJ20200491)。

摘　　要：目的分析腹膜透析相关性腹膜炎发生的影响因素,建立预测腹膜透析相关性腹膜炎发生风险的列线图模型。方法收集2016年1月至2021年12月在新乡医学院第一附属医院肾内科规律随访的253例腹膜透析患者的资料。根据是否发生腹膜炎分为非腹膜炎组(170例)和腹膜炎组(83例,发生腹膜炎97次)。采用logistic回归分析比较两组的临床资料,将单因素分析结果中差异有统计学意义的变量纳入多因素logistic回归模型,应用逐步回归法分析腹膜透析相关性腹膜炎发生的影响因素,应用R语言绘制预测腹膜透析相关性腹膜炎发生风险的列线图模型。采用受试者工作特征曲线(receiver operator characteristic curve,ROC)和Hosmer-Lemeshow拟合优度检验P值分别评估模型的区分度和校准度。结果多因素logistic回归分析结果显示,碱性磷酸酶升高(OR=1.006,95%CI:1.001~1.011,P<0.05)、白蛋白降低(OR=0.907,95%CI:0.847~0.972,P<0.01)、中性粒细胞/淋巴细胞比值升高(OR=1.327,95%CI:1.162~1.515,P<0.001)、铁蛋白升高(OR=1.003,95%CI:1.001~1.004,P<0.001)是腹膜透析患者发生腹膜透析相关性腹膜炎的独立危险因素。ROC分析显示,风险预测模型的曲线下面积为0.811(95%CI:0.755~0.867,P<0.001)。Hosmer-Lemeshow拟合优度检验结果为χ^(2)=2.336,P=0.969。结论基于碱性磷酸酶、白蛋白、中性粒细胞/淋巴细胞比值、铁蛋白这4项影响因素建立的列线图预测模型具有较好的区分度和校准度,可以有效评估腹膜透析患者发生腹膜炎的风险程度。Objective To explore the influencing factors of peritoneal dialysis-associated peritonitis(PDAP)and establish a nomogram model for predicting the risks of PDAP.Methods From January 2016 to December 2021,clinical data were retrospectively reviewed for 297 peritoneal dialysis(PD)patients followed up regularly.According to whether or not PDAP occurred after PD,they were assigned into non-peritonitis group(n=170)and peritonitis group(n=82,97 bouts of peritonitis).Logistic regression analysis was utilized for comparing the clinical data of two groups.Univariate variables with statistically significant differences were included into multivariate Logistic regression model.And stepwise regression analysis was utilized for examining the influencing factors of PDAP.R language was employed for establishing a nomogram model to predict the risks of PDAP.The area under the receiver operating characteristic(ROC)curve and P value of Hosmer-Lemeshow test were utilized for evaluating the discrimination and calibration of the model.Results Multivariate Logistic regression analysis indicated that higher alkaline phosphatase(OR=1.006,95% CI:1.001-1.011,P<0.05),lower albumin(OR=0.907,95% CI:0.847-0.972,P<0.01),higher neutrophil-to-lymphocyte ratio(OR=1.327,95% CI:1.162-1.515,P<0.001)and higher ferritin(OR=1.003,95% CI:1.001-1.004,P<0.001)were independent risk factors for PDAP.The area under the ROC curve(AUC)of risk prediction model was 0.811(95%CI:0.755-0.867,P<0.001).The result of Hosmer-Lemeshow test was χ^(2)=2.336(P=0.969).Conclusions The prediction model of PDAP has been established based upon alkaline phosphatase,albumin,neutrophil-to-lymphocyte ratio and ferritin.It has satisfactory discrimination accuracy.Such a model may effectively evaluate the risks of peritonitis in PD patients.

关 键 词：腹膜透析 腹膜炎 影响因素 预测模型 

分 类 号：R692.5[医药卫生—泌尿科学] R572.2[医药卫生—外科学]