补肾生血法与益气养血法为主治疗再生障碍性贫血的T淋巴细胞亚群变化及疗效的临床预测模型构建  

Construction of clinical prediction model for the changes of T lymphocyte subsets and efficacy in the treatment of aplastic anemia with the method of nourishing kidney and engendering blood and the method of boosting qi and nourishing blood

作　　者：蒋佩珍 丁宇斌 李芮 王金环[3] 徐瑞荣[4] 刘奇峰[5] 王海霞[6] 孙岸弢[7] 唐旭东[1] JIANG Peizhen;DING Yubin;LI Rui;WANG Jinhuan;XU Ruirong;LIU Qifeng;WANG Haixia;SUN Antao;TANG Xudong(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,China;First Affiliated Hospital,Heilongjiang University of Chinese Medicine,Harbin 150040,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250011,China;Jilin Province People's Hospital,Changchun 130021,China;Weifang Medical University Hospital,Weifang 261035,China;Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]深圳市中医院,深圳518033 [3]黑龙江中医药大学附属第一医院,哈尔滨150040 [4]山东中医药大学附属医院,济南250011 [5]吉林省人民医院,长春130021 [6]潍坊医学院附属医院,潍坊261035 [7]中国中医科学院广安门医院,北京100053

出　　处：《中华中医药杂志》2024年第3期1209-1215,共7页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家中医药管理局中医药行业科研专项(No.201507001-13)。

摘　　要：目的:探讨经补肾生血法与益气养血法为主治疗的再生障碍性贫血(AA)患者T淋巴细胞亚群变化特点,构建疗效预测的多因素评估模型。方法:回顾性收集一项前瞻、多中心、随机对照试验中患者的临床资料,包括治疗分组、性别、合并症、年龄、病程、HGB、PLT、WBC、ANC和各项T淋巴细胞亚群等指标。根据《血液病诊断及疗效标准》对治疗6个月后的AA患者进行疗效评价,以“有效”“无效”作为因变量,通过单因素、多因素Logistic回归分析筛选出影响治疗有效率的指标,根据回归方程结果构建预测模型,并分析其预测效能。结果:共纳入277例AA患者临床资料进行分析,其中补肾生血组136例,益气养血组141例,治疗6个月后疗效评价治疗有效共219例,无效共58例。将18个相关指标纳入单因素分析后,P<0.1的自变量则进入多因素Logistic分析,治疗分组中设置益气养血组为哑变量,补肾生血组(P<0.001,OR=2.88,95%CI[1.50,5.74]),PLT(P=0.03,OR=1.01,95%CI[1.00,1.02]),CD_(3)^(+)CD_(8)^(+)(P=0.04,OR=1.02,95%CI[1.00,1.05]),提示治疗分组、PLT、CD_(3)^(+)CD_(8)^(+)是预测AA中西医结合治疗效果的保护性因素,根据结果使用R4.1.3软件生成疗效预测列线图,列线图模型ROC的AUC为0.71,95%CI[0.63,0.78],模型内部验证校准曲线和标准曲线较为贴近,重合度较高,拟合度良好,Hosmer-Lemeshow拟合优度检验为模型一致性良好(x^(2)=4.02,P=0.86)。结论:T淋巴细胞亚群CD_(3)^(+)CD_(8)^(+)中是AA疗效的重要影响因素,结合中医治疗分组、PLT建立的列线图模型可以用于中西医结合治疗AA患者的疗效预测。Objective:To investigate the characteristics of T lymphocyte subpopulation changes in patients with aplastic anemia(AA)treated mainly by the method of nourishing kidney and engendering blood and the method of boosting qi and nourishing blood and to construct a multifactorial assessment model for efficacy prediction.Methods:Clinical data of patients in a prospective,multicenter,randomized controlled trial were retrospectively collected,including treatment subgroups,gender,comorbidities,age,disease age,HGB,PLT,WBC,ANC,and various T lymphocyte subsets.According to the Diagnostic and Eficacy Criteria for Hematological Diseases,the efficacy of AA patients after 6 months of treatment was evaluated,'effective'and ineffective'were used as the dependent varivables,and the indexes affecting treatment efficiency were screened out by univariate and multivariate Logistic regression analysis,and prediction models were constructed according to the results of regression equations and their predictive efficacy was analyzed.Results:A total of 277 AA patients'clinical data were included for analysis,including 136 cases in the group of nourishing kidney and engendering blood,141 cases in the group of boosting qi and nourishing blood,and a total of 219 cases were evaluated as effective and 58 cases were ineffective in treatment after 6 months of treatment.After including 18 relevant indexes in the univariate analysis,the independent variables with P<0.1 were then entered into the multivariate Logistic analysis,and the treatment grouping was set as dummy variables for the group of boosting qi and nourishing blood,the group of nourishing kidney and engendering blood(P<0.001,OR=2.88,95%CI[1.50,5.74],PLT(P=0.03,OR=1.01,95%CI[1.00-1.02],CD_(3)^(+)CD_(8)^(+)(P=0.04,OR=1.02,95%CI[1.00,1.05])were protective factors for predicting efficacy.Based on the results,the nomogram model of efficacy prediction was generated using R 4.1.3 sofeware.The AUC of the ROC of the nomogram model was 0.71,95%CI[0.63,0.78],the calibration curve and the standard

关 键 词：再生障碍性贫血 T淋巴细胞 补肾生血法 益气养血法 中西医结合 临床预测模型 列线图 

分 类 号：R259[医药卫生—中西医结合]