类风湿关节炎患者预后的影响因素分析及列线图预测模型构建  

Analysis of influencing factors on prognosis of patients with rheumatoid arthritis and construction of Nomogram prediction model

作　　者：桂菲 潘京[1] 薛国辉[1] 楚金申[1] 王路 刘晓峰[1] GUI Fei;PAN Jing;XUE Guohui;CHU Jinshen;WANG Lu;LIU Xiaofeng(Department of Laboratory,Jiu Jiang NO.1 People's Hospital,Jiangxi Province,Jiujiang332000,China)

机构地区：[1]江西省九江市第一人民医院检验科,江西九江332000

出　　处：《中国当代医药》2024年第7期18-21,28,共5页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202140262)。

摘　　要：目的分析类风湿关节炎患者预后的影响因素并构建列线图(Nomogram)预测模型。方法选取2020年6月至2022年12月九江市第一人民医院收治的213例类风湿关节炎患者作为研究对象,根据患者预后情况分为预后良好组(n=135)和预后不良组(n=78)。比较两组患者的临床资料,采用多因素logistic分析影响类风湿关节炎患者预后的独立风险因素,R软件“rms”包构建Nomogram预测模型。结果单因素分析结果显示,预后不良组患者血清红细胞沉降率(ESR)、白细胞介素-6(IL-6)、白细胞介素-32(IL-32)、肿瘤坏死因子-α(TNF-α)水平高于预后良好组,差异有统计学意义(P<0.05)。logistic回归模型进行多因素分析结果显示,ESR(β=0.048,OR=1.049,95%CI:1.019~1.080)、IL-6(β=0.339,OR=1.404,95%CI:1.219~1.617)、IL-32(β=0.042,OR=1.042,95%CI:1.018~1.068)、TNF-α(β=0.046,OR=1.047,95%CI:1.027~1.067)是类风湿关节炎患者预后的独立危险因素(P<0.05)。决策曲线结果显示,风险阈值>0.13时,此预测模型可以提供额外的临床净收益。结论ESR、IL-6、IL-32、TNF-α是类风湿关节炎患者预后的独立危险因素,基于此构建的Nomogram预测模型为类风湿关节炎患者预后的防治提供重要的策略指导。Objective To analyze the factors influencing the prognosis of patients with rheumatoid arthritis patients and construct a nomogram prediction model.Methods A total of 213 patients with rheumatoid arthritis admitted to Jiu Jiang NO.1 People's Hospital from June 2020 to December 2022 were selected as the research subjects.They were divided into a good prognosis group(n=135)and a poor prognosis group(n=78)based on their prognosis.The clinical data of two groups of patients were compared.Multivariate logistic analysis was used to analyze the independent risk factors affecting the prognosis of patients with rheumatoid arthritis,and the R software"rms"package was used to construct a Nomogram prediction model.Results The results of univariate analysis showed that serum erythrocyte sedimentation rate(ESR),IL-6,IL-32 and tumor necrosis factor-α(TNF-α)levels in the poor prognosis group were higher than those in the good prognosis group,and the differences were statistically significant(P<0.05).Multivariate analysis of logistic regression model showed that ESR(β=0.048,OR=1.049,95%CI:1.019-1.080),IL-6(β=0.339,OR=1.404,95%CI:1.219-1.617),IL-32(β=0.042,OR=1.042,95%CI:1.018-1.068)and TNF-α(β=0.046,OR=1.047,95%CI:1.027-1.067)were independent risk factors for prognosis in patients with rheumatoid arthritis(P<0.05).The results of the decision curve show that this predictive model can provide additional clinical net benefit when the risk threshold is>0.13.Conclusion ESR,IL-6,IL-32,TNF-αare independent risk factor for the prognosis of rheumatoid arthritis patients,and the Nomogram prediction model constructed based on this provides important strategic guidance for the prevention and treatment of the prognosis of rheumatoid arthritis patients.

关 键 词：类风湿关节炎 白细胞介素-6 白细胞介素-32 影响因素 列线图 

分 类 号：R684.3[医药卫生—骨科学]