维持性血液透析患者营养不良风险列线图模型及在线计算器的构建与验证研究  

Construction and validation of risk prediction model and online calculator for malnutrition in maintenance hemodialysis patients

作　　者：刘雪琴 刘晓辉[2] 平智广[3] LIU Xue-qin;LIU Xiao-hui;PING Zhi-guang(School of Nursing,Sanquan College of Xinxiang Medical University,Xinxiang 453513,China;Henan Hospital of Traditional Chinese Medicine,Zhengzhou 450003,China;School of Public Health,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]新乡医学院三全学院护理学院,河南新乡453513 [2]河南省中医院,河南郑州450002 [3]郑州大学公共卫生学院,河南郑州450001

出　　处：《护理学报》2023年第16期12-18,共7页Journal of Nursing（China）

基　　金：河南省教育厅高等学校重点科研项目(16A320073)。

摘　　要：目的 构建维持性血液透析患者营养不良可视化风险预测模型,个体化预测其发病风险。方法 选取河南省3所三级甲等医院2022年3—10月透析中心457例进行维持性血液透析治疗的患者,纳入前2所医院的患者为建模组(n=320),第3所医院的患者为验证组(n=137)。单因素、多因素Logistic回归分析构建模型。采用受试者工作特征曲线及Hosmer-Lemeshow校准曲线检验模型的区分度及校准度。利用R软件进行维持性血液透析患者营养不良风险在线计算器开发。结果 单因素及多因素Logistic回归分析结果显示年龄(≥60岁)(OR=2.550,95%CI:1.390~4.724)、透析月龄(OR=1.029,95%CI:1.016~1.043)、透析充分性(Kt/v<1.2)(OR=4.041,95%CI:2.226~7.519)、血清白蛋白(OR=0.860,95%CI:0.796~0.922)、血红蛋白(OR=0.979,95%CI:0.963~0.996)、抑郁评分(OR=1.101,95%CI:1.057~1.148)是维持性血液透析患者发生营养不良的影响因素。模型内部评价及外部验证结果显示,曲线下面积分别为0.881、0.875,Hosmer-Lemeshow拟合优度检验P值分别为0.687、0.621,平均绝对误差分别为0.019、0.012。结论 本研究构建的维持性血液透析患者营养不良风险列线图模型及在线计算器效能较好,使用方法简便,为维持性血液透析患者发生营养不良风险的早期筛查提供参考。Objective To construct a visual risk prediction model for malnutrition in maintenance hemodialysis(MHD)patients,and to predict the risk of malnutrition individually.Methods A total of 457 patients receiving MHD in dialysis center of three tertiary grade-A hospitals in Henan Province from March to October 2022 were selected.Patients from the first two hospitals were included as the modeling group(n=320),and those from the third hospital as the validation group(n=137).Univariate and multivariate logistic regression analysis was used to construct the model.ROC curve and Hosmer-Lemeshow calibration curve were used to test the differentiation and calibration degree of the prediction models.The software packages shiny,shinydashboard,survival and regplot in R software were used to develop an online calculation tool for risk prediction of malnutrition in MHD patients.Results Age(OR=2.550,95%CI:1.390~4.724),dialysis age(OR=1.029,95%CI:1.016~1.043),dialysis adequacy(OR=4.041,95%CI:2.226~7.519),serum albumin(OR=0.860,95%CI:0.796~0.922),hemoglobin(OR=0.979,95%CI:0.963~0.996),depression score(OR=1.101,95%CI:1.057~1.148)were finally included in this study.Internal evaluation and external verification of the model showed that the area under the curve was 0.881 and 0.875,the P-value of Hosmer-Lemeshow goodness of fit test was 0.687 and 0.621,and the average absolute error was 0.019 and 0.012,respectively.Conclusion The risk prediction model of malnutrition in MHD patients and the online calculator constructed in this study are effective and easy to use,providing reference for the early screening of malnutrition risk in MHD patients.

关 键 词：维持性血液透析 营养不良 预测模型 列线图 在线计算器 

分 类 号：R47[医药卫生—护理学] R473.5[医药卫生—临床医学]