列线图模型对超重及肥胖儿童青少年高尿酸血症发生风险的预测与评估  

Prediction and evaluation of nomogram model on risk of hyperuricemia in overweight and obese children and adolescents

作　　者：敬剑英[1] 肖宁婷 郭雪梅[1] 敬雪明[1] 谢荣[1] 何泳龙 JING Jianying;XIAO Ningting;GUO Xuemei;JING Xueming;XIE Rong;HE Yonglong(Department of Nephrology,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China;Department of Rheumatology and Immunolgoy,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院附属医院肾病内科,四川南充637000 [2]川北医学院附属医院风湿免疫科,四川南充637000

出　　处：《重庆医学》2024年第2期220-225,共6页Chongqing medicine

基　　金：四川省南充市科技局市校科技战略合作项目(22SXQT0180)。

摘　　要：目的建立超重及肥胖儿童青少年高尿酸血症(HUA)发病风险列线图模型,为该人群HUA防治提供参考依据。方法回顾性分析2021年9月至2022年8月该院就诊的1410例6~17岁超重及肥胖儿童青少年临床资料。按照7∶3的比例随机抽取987例超重及肥胖儿童青少年建立模型,剩余423例进行内部验证。参照《诸福棠实用儿科学》高尿酸定义,将其分为HUA组和非HUA组,采用logistic回归分析超重及肥胖儿童青少年HUA的影响因素,R语言构建列线图模型,受试者工作特征(ROC)曲线下面积(AUC)、决策分析曲线(DCA)、临床影响曲线(CIC)及C-统计量(C-index)评估模型的预测能力,Bootstrap重复取样法(取样次数1000次)进行模型内部验证。结果多因素分析结果显示,年龄(OR=2.324,95%CI:1.155~4.672,P=0.018)、性别(OR=0.456,95%CI:0.256~0.810,P=0.007)、甘油三酯(TG)(OR=3.775,95%CI:2.321~6.138,P<0.001)、血钙(OR=26.986,95%CI:3.186~228.589,P=0.003)、血肌酐(OR=1.047,95%CI:1.026~1.070,P<0.001)为超重及肥胖儿童青少年HUA的影响因素。模型ROC的AUC为0.840,敏感度为0.786,特异度为0.762,Youden指数为0.548,C-index为0.840。DCA患病风险概率为0.1~0.8,两个模型的净受益率都>0,内部验证ROC的AUC为0.871。结论本研究构建的列线图对超重及肥胖儿童青少年HUA的发病风险具有良好的预测效能,可为该人群的早期诊疗提供参考。Objective To establish a nomogram prediction model of hyperuricemia(HUA)onset risk in overweight and obese children and adolescents in order to provide reference for the prevention and treatment of HUA in this population.Methods The clinical data of 1410 overweight and obese children and adolescents aged 6-17 years old visiting in this hospital from September 2021 to August 2022 were retrospectively analyzed.A total of 987 overweight and obese children and adolescents were randomly extracted according to a ratio of 7∶3 to establish the model,and the remaining 423 cases were validated internally.Referring to the definition of high uric acid in“Zhufutang Practical Pediatrics”,the subjects were divided into high uric acid group and non-high uric acid group.The logistic regression analysis was used to analyze the influencing factors of HUA in overweight and obese children and adolescents.The nomogram model was constructed by using the R language.The area under the receiver operating characteristic(ROC)curve(AUC),decision analysis curve(DIC),clinical impact curve(CIC)and C-index were used to evaluate the predictive ability of the model,and the Bootstrap repeated sampling method(taking samples for 1000 times)was used for internal validation of the model.Results The results of multivariate analysis showed that the age(OR=2.324,95%CI:1.155-4.672,P=0.018),gender(OR=0.456,95%CI:0.256-0.810,P=0.007),triglycerides(OR=3.775,95%CI:2.321-6.138,P<0.001),blood calcium(OR=26.986,95%CI:3.186-228.589,P=0.003)and blood creatinine(OR=1.047,95%CI:1.026-1.070,P<0.001)were the influencing factors of HUA in overweight and obese children and adolescents.AUC of the ROC curve of the model was 0.840,the sensitivity was 0.786,the specificity was 0.762,the Youden index was 0.548,and the C-index was 0.840.The risk probability of DCA was 0.1-0.8,the net benefit rate of both models was>0,AUC of ROC curve in the internal verification was 0.871.Conclusion The constructed nomogram in this study has a good predictive efficiency for the onset ris

关 键 词：超重及肥胖 儿童 青少年 高尿酸血症 危险因素 列线图 预测模型 

分 类 号：R589[医药卫生—内分泌]