基于血小板和淋巴细胞计数比值的列线图模型预测腹膜透析相关腹膜炎患者治疗预后的价值  

Value of the nomogram model combined with the ratio of platelet and lymphocyte counts in predicting the treatment prognosis of patients with peritoneal dialysis associated peritonitis

作　　者：郑庆发[1] 白建祥 黄成文[1] Zheng Qingfa;Bai Jianxiang;Huang Chengwen(Department of Nephrology,Huizhou Central People’s Hospital,Huizhou 516000,China)

机构地区：[1]惠州市中心人民医院肾内科,惠州市516000

出　　处：《中华实验和临床感染病杂志（电子版）》2023年第2期117-124,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：惠州市科技计划项目(No.2021WC0106407)。

摘　　要：目的探讨血小板和淋巴细胞比值(PLR)预测腹膜透析相关腹膜炎(PDAP)患者治疗预后的价值,并建立相关列线图模型。方法纳入2019年1月至2021年6月于惠州市中心人民医院肾内科因PDAP而住院治疗的129例患者作为建模组,根据最终疗效,将患者分为治愈组(83例)和预后不良组(46例)。同期纳入惠州市第一人民医院因PDAP而住院治疗的113例患者作为验证组,比较两组患者一般临床资料、实验室指标以及病原菌组成的差异。多因素Logistic回归模型中获得PDAP患者治疗预后不良的独立预测因素,根据独立预测因素建立预测PDAP患者治疗预后不良风险的列线图模型,以Bootstrap法和校准曲线进行列线图模型的内外部验证,绘制决策曲线,分析独立预测指标以及联合预测模型预测PDAP患者治疗预后不良的净收益。结果预后不良组患者透析龄[11.23(8.44,14.57)月]显著高于治愈组[7.23(5.31,10.41)月],差异有统计学意义(Z=5.735、P<0.001);糖尿病肾病患者占比(69.57%)显著高于治愈组(30.12%)(χ^(2)=6.165、P=0.007),差异均有统计学意义。预后不良组患者血小板计数(t=5.687、P<0.001)、降钙素原(Z=6.945、P<0.001)、PLR(t=7.267、P<0.001)以及C-反应蛋白(CRP)(t=8.221、P<0.001)显著高于治愈组,而淋巴细胞计数[1.01(0.78,1.15)×109/L]显著低于治愈组[1.42(1.11,1.67)×109/L](Z=4.467、P<0.001),差异均有统计学意义。多因素Logistic回归分析显示,原发病(χ^(2)=7.564、P=0.014)、PLR(χ^(2)=9.786、P=0.005)及透析龄(χ^(2)=8.967、P=0.009)均为PDAP患者治疗预后不良的独立预测因素,其中PLR每增加1个单位,患者治疗预后不良的风险增加1.568倍(OR=2.568、95%CI:的3.265倍(OR=3.265、95%CI:2.196~6.457、P=0.014);透析龄每增加1个月,患者治疗预后不良的风险增加1.733倍(OR=2.733、95%CI:2.245~3.214、P=0.009)。基于多因素分析结果获得的3个独立预测因素,建立预测PDAP患者治疗预后不良风险的列线�Objective To investigate the value of platelet lymphocyte ratio(PLR)in predicting the prognosis of patients with peritoneal dialysis associated peritonitis(PDAP),and to establish a nomogram model.Methods Total of 129 hospitalized patients with the PDAP in the Department of Nephrology,Huizhou Central People’s Hospital from January 2019 to June 2021 were included as modeling group,the patients were divided into cured group(83 cases)and poor prognosis group(46 cases)according to the final treatment effect.There were 113 patients with PDAP admitted to Huizhou the First People’s Hospital in the same period served as the validation group.The differences in clinical data,laboratory indicators and pathogenic bacteria composition between the two groups were compared,respectively.The independent predictors of poor prognosis patients with PDAP were obtained by multivariate Logistic regression model.According to the independent predictors,the nomogram model for predicting the risk of poor prognosis of patients with PDAP was established.The Bootstrap method and calibration curve were used for the internal and external verification of the nomogram model.The decision curve was drawn,and the independent predictors and the combined prediction model were analyzed to predict the net return of poor prognosis of patients with PDAP.Results The dialysis period of patients[11.23(8.44,14.57)months vs.7.23(5.31,10.41)months]in poor prognosis group was significantly higher than that of the cure group(Z=5.735,P<0.001),and the proportion of diabetes nephropathy of patients in poor prognosis[69.57%vs.30.12%]was significantly higher than that of the cured group(χ^(2)=6.165,P=0.007),the platelet count(t=5.687,P<0.001),procalcitonin(Z=6.945,P<0.001),PLR(t=7.267,P<0.001)and C-reactive protein(CRP)(t=8.221,P<0.001)of patients in poor prognosis group were significantly higher than those of the cured group,and the lymphocyte count of patients[1.01(0.78,1.15)×109/L vs.1.42(1.11,1.67)×109/L]was significantly lower than that of patients in the c

关 键 词：血小板和淋巴细胞比值 腹膜透析相关腹膜炎 预后 列线图模型 

分 类 号：R563.1[医药卫生—呼吸系统]