肾综合征出血热患者实验室指标对重症患者的预警价值及模型构建  

Early warning value and model construction of laboratory indexes of patients with hemorrhagic fever with renal syndrome to severe patients

作　　者：段小霞 刘军芳 杨琴琴 刘杰 武波 马志琴 符浩雪 王琦 Duan Xiaoxia;Liu Junfang;Yang Qinqin;Liu Jie;Wu Bo;Ma Zhiqin;Fu Haoxue;Wang Qi(Department of Emergency,Tangdu Hospital of Air Force Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学唐都医院急诊科,西安710038

出　　处：《中华急诊医学杂志》2024年第7期1006-1010,共5页Chinese Journal of Emergency Medicine

摘　　要：目的分析肾综合征出血热患者急诊入院时实验室指标对临床危重患者的预警价值。方法本研究采用回顾性病例对照研究,分析空军军医大学唐都医院急诊科2021年1月至2022年1月收治的肾综合征出血热患者临床资料和实验室检查结果,根据患者实验室指标及临床症状分为轻、中、重、危重组,将轻、中组纳入轻症组,重、危重组纳入重症组,并进行回顾性分析。比较两组一般资料和实验室指标,进一步对有统计学意义的指标进行多因素分析,采用多因素Logistic回归分析筛选出重症患者的独立危险因素,绘制受试者工作特征ROC曲线评估模型的预测价值。结果164例HFRS患者中重症组50例,轻症组114例。重症组血清WBC、AST、ALT、Cr、BUN、DD、PCT水平均高于轻症组,血清PLT、ALB、PTA水平均低于轻症组,差异均有统计学意义(均P<0.05)。进行二元多因素logistic回归分析筛选出WBC、PLT、PCT是患者进展为危重症的独立影响因子(均P<0.05)。并建立重症HFRS的预测模型:logit(P)=-0.321+0.040 WBC(×109/L)-0.045 PLT(×109/L)+0.086 PCT(ng/mL)。进一步分析WBC、PLT、PCT对重症HFRS预警效能,计算ROC曲线下面积(area under curve,AUC)分别为0.779,0.842,0.862,最佳阈值分别为10.435×109/L、41.5×109/L、2.97ng/mL。联合检测AUC为0.900,敏感度为88.0%,特异度为82.5%,特异度优于单个实验室检查指标的检测。结论HFRS实验室指标对重症患者识别有一定临床意义,其中的指标血清WBC、PLT、PCT指标是重症HFRS的危险因素,为重症HFRS患者临床诊治及预后提供理论依据。Objective To analyze the early warning value of laboratory examination on admission of patients with hemorrhagic fever with renal syndrome to critically ill patients.Meetods In this study,a retrospective case-control study was used to analyze the clinical data and laboratory examination results of patients with hemorrhagic fever with renal syndrome admitted to the emergency department of Tangdu Hospital of Air Force Medical University from January 2021 to January 2022.According to the patient's laboratory indexes and clinical symptoms,the patients were divided into mild,moderate,severe and critical groups.The general data of the two groups were compared,and the independent risk factors of critically ill patients were screened by multi-factor logistic regression analysis,the predictive model of severe HFRS patients was constructed,and the ROC curve was drawn..Results Of the 164 patients with HFRS,50 were in the severe group and 114 in the mild group.The serum levels of WBC,AST,ALT,Cr,BUN,DD and PCT in the severe group were higher than those in the mild group,while the levels of PLT,ALB and PTA in the severe group were lower than those in the mild group.Multiple logistic regression analysis showed that WBC,PLT and PCT were independent influencing factors for the progression of critically ill patients.The predictive model of severe HFRS was established as follows:logit(P)=-0.321+0.040 WBC(×109/L)-0.045 PLT(×109/L)+0.086 PCT(ng/mL).The early warning efficacy of WBC,PLT,And PCT for severe HFRS was further analyzed.The area under the ROC curve(area under curve,AUC)was 0.779,0.842,0.862,and the optimal threshold was 10.435×109/L,41.5×109/Land 2.97 ng/mL,respectively.The AUC of joint detection is 0.900,the sensitivity is 88.0%,and the specificity is 82.5%,which is better than that of a single laboratory..Conclusions HFRS laboratory indexes have certain clinical significance for the identification of critically ill patients,in which serum WBC,PLT and PCT indexes are the risk factors of severe HFRS,which provides a

关 键 词：肾综合征出血热 实验室指标 预警价值 

分 类 号：R512.8[医药卫生—内科学]