儿童耐多药结核病发生的相关影响因素及其预测模型的建立  

Establishment of related influencing factors and prediction model of multidrug-resistant tuberculosis in children

作　　者：罗季 陈永刚 马雅妮[2] 李娜 喻明丽 陈洁 彭江丽 刘梦醒 LUO Ji;CHEN Yonggang;MA Yani;LI Na;YU Mingli;CHEN Jie;PENG Jiangli;LIU Mengxing(Department of Pharmacy,Kunming Third People's Hospital,Kunming,Yunnan 650000,China;Department of Pharmacy,The First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650000,China)

机构地区：[1]昆明市第三人民医院药学部,云南昆明650000 [2]昆明医科大学第一附属医院药剂科,云南昆明650000

出　　处：《安徽医药》2024年第3期592-596,共5页Anhui Medical and Pharmaceutical Journal

基　　金：昆明市卫健委卫生科研课题项目(2020-13-01-001);云南省孔令义专家工作站项目(2019IC047)。

摘　　要：目的 探究儿童耐多药结核病(MDR-TB)发生的相关影响因素及其预测模型的建立。方法 回顾性选取2010年3月1日至2022年2月28日昆明市第三人民医院结核病病儿,统计MDR-TB发生情况,比较MDR-TB病儿与非MDR-TB病儿临床资料,通过logistic多因素回归模型分析儿童MDR-TB发生的相关影响因素,采用R语言构建儿童MDR-TB发生的列线图预测模型,并进行一致性检验。结果 共纳入850例结核病病儿,其中初治MDR-TB病儿占5.65%,复治MDR-TB病儿占24.88%,总MDR-TB病儿占10.47%;logistic多因素回归模型分析显示,年龄、吸烟史、治疗情况、感染播散性、与结核病病人接触、合并人类免疫缺陷病毒(HIV)感染、合并乙型肝炎病毒(HBV)感染是儿童MDR-TB发生的独立危险因素,规范用药是独立保护因素(P<0.05);根据影响因素构建儿童MDR-TB发生的列线图预测模型,通过Bootstrap自抽样法验证显示该预测模型预测值与实际观测值基本一致,一致性指数(C-index)为0.960,具有良好的区分度;预测模型ROC曲线的曲线下面积(AUC)为0.96[95%CI:(0.94,0.98)],预测效能较高。结论 病儿年龄、吸烟史、治疗情况、感染播散性、与结核病病人接触、合并HIV感染、合并HBV感染等均为MDR-TB发生的影响因素,根据影响因素构建的列线图预测模型可较好预测结核病病儿发生MDR-TB的风险。Objective To explore the related influencing factors of multidrug-resistant tuberculosis(MDR-TB) in children and the establishment of a predictive model.Methods Children with tuberculosis in Kunming Third People's Hospital from March 1,2010 to February 28,2022 were retrospectively selected,the incidence of MDR-TB was counted,and the clinical data of children with MDRTB and those without MDR-TB were compared,the relevant influencing factors of the occurrence of MDR-TB in children by logistic multifactorial regression model were analyzed,a column-line graph prediction model of the occurrence of MDR-TB in children was constructed by using the R language,and the consistency test was performed.Results A total of 850 children with tuberculosis were included in this study,of which 5.65% were initially treated with MDR-TB,24.88% were retreated with MDR-TB,and 10.47% were in total MDR-TB.Logistic multivariate regression model analysis showed that age,smoking history,treatment status,dissemination of infection,contact with tuberculosis patients,HIV infection,and hepatitis B virus(HBV) infection were independent risk factors for the occurrence of MDR-TB in children,and standardized medication was an independent protective factor(P<0.05);According to the influencing factors,a nomogram prediction model for the occurrence of MDR-TB in children was constructed.The Bootstrap self-sampling method showed that the prediction value of the prediction model was basically consistent with the actual observation value,and the C-index was 0.960,which had a good degree of discrimination;the prediction model ROC The area under the curve(AUC) of the curve was 0.96[95%CI:(0.94,0.98)],indicating high predictive power.Conclusions Children's age,smoking history,treatment,infection spread,contact with tuberculosis patients,combined HIV infection,combined HBV infection,etc.are all influencing factors of MDR-TB.The nomogram prediction model based on the influencing factors can better predict the risk of MDR-TB in children with tuberculosis.

关 键 词：广泛耐药结核 儿童 影响因素 列线图 预测模型 

分 类 号：R529.9[医药卫生—内科学]