解毒复胰汤治疗瘀毒互结型重症急性胰腺炎患者的临床预测模型构建  

Establishing a Clinical Prediction Model for Jiedu Fuyi Decoction in Treating Patients with Severe Acute Pancreatitis and Syndrome of Intermingled Poisonous Damp-heat and Static Blood

作　　者：姚逸阳 董绮 杨冰倩 陈乾 赵哲 胡仕祥[2] Yao Yiyang;Dong Qi;Yang Bingqian;Chen Qian;Zhao Zhe;Hu Shixiang(Henan University of Chinese Medicine,Henan,Zhengzhou 450008,China)

机构地区：[1]河南中医药大学,河南郑州450008 [2]河南省中医院,河南郑州450002

出　　处：《中国中医急症》2024年第5期753-756,780,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家自然科学基金项目(82104833);河南省中医药学科领军人才项目(豫卫中医函〔2021〕8号);河南省中医药科学研究专项课题(20-21ZY2049,2023ZY1014)。

摘　　要：目的建立解毒复胰汤治疗瘀毒互结型重症急性胰腺炎患者的临床预测模型。方法选取2018年1月至2022年12月在河南省中医院急诊科住院治疗的重症急性胰腺炎患者,回顾性收集解毒复胰汤治疗7 d的患者临床资料,包括性别、年龄、病因、白细胞计数(WBC)、血红蛋白(HGB)、C反应蛋白(CRP)、凝血酶原时间(PT)、血清钙离子(Ca^(2+))、肌酐(Cr)等。将患者分为治疗有效组和无效组,通过单因素回归分析、多因素Logis⁃tic回归分析、逐步回归法筛选独立影响因素建立模型。从拟合优度、区分度、校准度及内部验证来对构建的模型进行评估。结果在接受解毒复胰汤治疗的145例瘀毒互结型重症急性胰腺炎患者中,有效组107例,无效组38例。筛选出CRP、PT、Ca^(2+)、Cr为独立影响因素,构建临床预测模型,受试者工作特征(ROC)曲线下面积(AUC)为0.880,模型灵敏度为1.000,特异度为0.623,Hosmer-Lemeshow拟合优度检验显示χ^(2)=4.2989,P=0.8292(P>0.05)。结论临床预测模型提示解毒复胰汤更适合炎症指标较低、凝血功能及肾功能较好、电解质水平稳定的瘀毒互结型重症急性胰腺炎患者,应用时须关注CRP、PT、Cr、Ca^(2+)指标。Objective:To establish a clinical prediction model for Jiedu Fuyi Decoction in treating patients with severe acute pancreatitis(SAP)and syndrome of intermingled poisonous damp-heat and static blood.Methods:SAP patients who were hospitalized in the emergency department of Henan Provincial Hospital of Traditional Chi⁃nese Medicine from January 2018 to December 2022 were selected,and the clinical data of 7 days of treatment with Jiedu Fuyi Decoction for SAP patients with syndrome of intermingled poisonous damp-heat and static blood were collected,including gender,age,etiology,white blood cell count(WBC),hemoglobin(HGB),C-reactive protein(CRP),prothrombin time(PT),serum calcium ions(Ca^(2+)),and creatinine(Cr).Patients were divided into treatment effective group and ineffective group,and a model was established by screening independent influencing factors through uni-variate regression analysis,multivariate logistic regression analysis,and stepwise regression method.The constructed model was evaluated based on goodness of fit,discriminability,calibration,and internal validation.Results:Among the 145 patients with SAP who received the treatment of Jiedu Fuyi Decoction,there were 107 cases in the effective group and 38 cases in the ineffective group.CRP,PT,Ca^(2+),and Cr were selected as indepen⁃dent influencing factors,and a clinical prediction model was constructed.The area under the receiver operating characteristic(ROC)area under the curve(AUC)was 0.880,the model sensitivity was 1.000,and the specificity was 0.623.The Hosmer Lemeshow goodness of fit test showed thatχ^(2)=4.2989,P=0.8292(P>0.05).Conclusion:The clinical prediction model suggests that Jiedu Fuyi Decoction is more suitable for SAP patients with low⁃er inflammatory indicators,better coagulation function and renal function,and stable electrolyte levels.When apply⁃ing this treatment,special attention should be paid to CRP,PT,Cr and Ca^(2+)indicators.

关 键 词：重症急性胰腺炎 解毒复胰汤 瘀毒互结 临床预测模型 

分 类 号：R576[医药卫生—消化系统]