基于肾小球滤过率的肾上腺醛固酮瘤列线图预测模型的建立与验证研究  

Construction and Verification the Nomogram Prediction Model for Primary Aldosteronism Based on Glomerular Filtration Rate

作　　者：常钰朋 耿茜茜 火睿[1] 孙侃[1] 常向云[1] 李军[1] 朱凌云[1] 董玉洁 罗丽娜 CHANG Yupeng;GENG Xixi;HUO Rui;SUN Kan;CHANG Xiangyun;LI Jun;ZHU Lingyun;DONG Yujie;LUO Lina(Department of Endocrinology,First Affiliated Hospital,Shihezi University,Shihezi 832000,China;The School of Medicine,Shihezi University,Shihezi 832000,China)

机构地区：[1]石河子大学第一附属医院内分泌科,新疆维吾尔自治区石河子市832000 [2]石河子大学医学院,新疆维吾尔自治区石河子市832000

出　　处：《中国全科医学》2024年第12期1480-1486,共7页Chinese General Practice

基　　金：兵团指导性科技计划项目(2022ZD038);石河子大学高层次人才科研启动项目(RCZX201536);石河子大学科技计划项目(ZZZC201820A);八师石河子市社会发展科技攻关与成果转化项目(2018YL03)。

摘　　要：背景醛固酮瘤(APA)是原发性醛固酮增多症的常见类型。对于单侧肾上腺腺瘤者,虽然共识推荐血浆醛固酮与肾素比值(ARR)作为APA的筛查指标,由于缺乏统一的检测方法和诊断流程,ARR切点值范围变化大。因此临床需要一种可靠、快捷的预测模型协助鉴别APA。目的探讨肾小球滤过率(GFR)与APA的相关性,基于此构建APA的列线图预测模型并验证。方法收集2012—2022年石河子大学第一附属医院经肾上腺内分泌激素评估后行手术治疗病理回报为单侧肾上腺肿物患者493例,根据APA和肾上腺无功能腺瘤的诊断标准,最终纳入APA组155例,无功能腺瘤合并原发性高血压组113例。收集患者的病史资料、生化资料等。按照GFR四分位数水平将患者分组,分析GFR与APA的相关性。通过多因素Logistic回归分析筛选APA的危险因素并构建列线图预测模型。采用受试者工作特征(ROC)曲线分析预测模型的区分度,一致性指数(C-index)评价模型的预测精准度,Hosmer-Lemeshow检测模型的拟合度,运用决策曲线与临床获益曲线评价模型的诊断效能。结果按照GFR四分位数进行分组(Q1~Q4组),Q1组:≥107.4 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),Q2组:99.7~107.3 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),Q3组:88.6~99.6 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),Q4组:≤88.5 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),各组APA发生率分别为47.8%(32/67)、53.7%(36/67)、58.2%(39/67)、71.6%(48/67)。Logistic回归趋势性检验提示随着GFR水平降低,APA患病风险呈趋势性升高(P<0.05)。多因素Logistic回归分析结果显示:收缩压>160mmHg(OR=5.209,95%CI=2.531~10.720)、高血压病程≥59个月(OR=4.326,95%CI=1.950~9.595)、血钾<3.25 mmol/L(OR=4.714,95%CI=2.046~10.860)、GFR[Q4组:≤88.5 mL·min^(-1)·(1.73 m^(2))^(-1)](OR=4.106,95%CI=1.492~11.300)、基础血浆醛固酮>13.42 ng/dL(OR=8.756,95%CI=4.320~17.749)为APA发生的独立危险因素(P<0.050)。根据多因素筛选的变量构建�Background Aldosterone-producing adenoma(APA)is a common type of primary aldosteronism.For those with unilateral adrenocortical adenoma,although expert consensus recommends plasma aldosterone-to-renin ratio(ARR)as a screening indicator for APA,the range of ARR cut-off values varies widely due to the lack of unified detection method and diagnostic process.Therefore,there is a clinical need for a reliable and rapid predictive model to assist in identifying APA.Objective To explore the correlation between glomerular filtration rate(GFR)and APA,construct and validate the nomogram prediction model of APA.Methods A total of 493 patients with with pathologic results of unilateral adrenal mass who underwent surgical treatment after evaluation of adrenal endocrine hormones in the first affiliated hospital of Shihezi University from 2012 to 2022 were collected,155 patients were ultimately included in the APA group and 113 patients in nonfunctioning adrenal adenoma combined with essential hypertension group according to the diagnostic criteria of APA and nonfunctioning adrenal adenoma.The patients'clinical data and biochemical data were collected.The patients were grouped according to GFR quartiles,and the correlation between GFR and APA was analyzed.The risk factors for APA were screened by multivariate Logistic regression analysis and a nomogram prediction model was constructed.Receiver operating characteristic(ROC)curve was used to analyze the discrimination of the prediction model,a consistency index(C-index)was used to evaluate the predictive accuracy of the model,Hosmer Lemeshow test was used to verify the fit of model,and the diagnostic efficacy of the model was evaluated using decision curve and clinical benefit curve.Results The patients were grouped according to GFR quartiles(Q1 to Q4 groups),Q1 group:≥107.4 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),Q2 group:99.7-107.3 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),Q3 group:88.6-99.6 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67)and Q4 group:≤88.5 mL·min^(-1)·(1.73 m^(2))^(-1)(n=

关 键 词：原发性醛固酮增多症 醛固酮瘤 肾小球滤过率 列线图 预测模型 

分 类 号：R586.24[医药卫生—内分泌]