系统性红斑狼疮并发股骨头坏死危险因素列线图预测模型的建立和验证  

Establishment and validation of a Nomogram prediction model for risk factors of osteonecrosis of the femoral head in systemic lupus erythematosus

作　　者：徐文博[1] 汪利合[2] 李松伟[2,3] 史鹏博 Xu Wenbo;Wang Lihe;Li Songwei;Shi Pengbo(Henan University of Chinese Medicine,Zhengzhou 450046,Henan Province,China;First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan Province,China;Henan Provincial Hospital of TCM,Zhengzhou 450002,Henan Province,China)

机构地区：[1]河南中医药大学,河南省郑州市450046 [2]河南中医药大学第一附属医院,河南省郑州市450000 [3]河南省中医院,河南省郑州市450002

出　　处：《中国组织工程研究》2025年第15期3215-3226,共12页Chinese Journal of Tissue Engineering Research

基　　金：河南省中医药拔尖人才培养项目(豫中医科教[2018]35号),项目负责人:汪利合;中国博士后科学基金面上项目(2022M721066),项目负责人:史鹏博;河南省重点研发与推广专项(232102310474),项目负责人:史鹏博。

摘　　要：背景:股骨头坏死是系统性红斑狼疮患者常见的并发症,若能早期对其发生风险进行预测与验证,将有助于避免或延缓股骨头坏死的发展。目的:分析系统性红斑狼疮患者并发股骨头坏死的危险因素,构建系统性红斑狼疮患者并发股骨头坏死的列线图预测模型并进行验证。方法:回顾性分析2013年1月至2022年12月首次就诊于河南中医药大学第一附属医院的914例系统性红斑狼疮患者的病历资料,根据是否发生股骨头坏死分为发生股骨头坏死组(n=100)和未发生股骨头坏死组(n=814)。采用单因素、LASSO回归和多因素Logistic回归分析筛选和确定系统性红斑狼疮并发股骨头坏死的危险因素。同时将数据集按照7∶3的比例随机分为训练集和测试集,并基于多因素Logistic回归分析结果,构建系统性红斑狼疮并发股骨头坏死的列线图预测模型。同时,使用受试者工作特征曲线、Hosmer-Lemeshow校准曲线和决策曲线对列线图的性能进行评估。结果与结论:①股骨头坏死组与未发生股骨头坏死组患者在系统性红斑狼疮病程、系统性红斑狼疮疾病活动度评分、狼疮性肾炎、呼吸系统受累、胃肠道受累、干燥综合征、骨质疏松、抗核糖核蛋白抗体阳性、补体C3降低、环磷酰胺、吗替麦考酚酯、生物抑制剂、糖皮质激素最大日剂量、糖皮质激素冲击治疗方面差异有显著性意义(P<0.05);②采用LASSO回归分析方法筛选出10个与系统性红斑狼疮并发股骨头坏死风险相关的预测变量,将其纳入多因素Logistic回归分析,结果显示系统性红斑狼疮病程、呼吸系统受累、干燥综合征、骨质疏松、抗核糖核蛋白抗体阳性、环磷酰胺、吗替麦考酚酯、生物抑制剂、糖皮质激素最大日剂量是系统性红斑狼疮患者发生股骨头坏死的独立危险因素(P<0.05);③训练集中预测发生风险的受试者工作特征曲线下面积为0.802(95%CIBACKGROUND:Osteonecrosis of the femoral head is a common complication in patients with systemic lupus erythematosus.The prediction and validation of the risk in advance will help to avoid or delay the progression of osteonecrosis of the femoral head.OBJECTIVE:To analyze risk factors for the occurrence of osteonecrosis of the femoral head in systemic lupus erythematosus patients and to construct and validate a nomogram prediction model of systemic lupus erythematosus patients with osteonecrosis of the femoral head.METHODS:A retrospective study was conducted to analyze the medical records of 914 systemic lupus erythematosus patients who first visited First Affiliated Hospital of Henan University of Chinese Medicine between January 2013 and December 2022.All patients were divided into osteonecrosis of the femoral head(n=100)and non-osteonecrosis of the femoral head(n=814)groups according to whether they had suffered from osteonecrosis of the femoral head or not.Univariate,LASSO regression,and multifactorial logistic regression analyses were used to screen and identify the risk factors for systemic lupus erythematosus complicating osteonecrosis of the femoral head.The dataset was also randomly divided into training and test sets in a ratio of 7:3.A nomogram prediction model of the risk of systemic lupus erythematosus complicating osteonecrosis of the femoral head was constructed based on the results of the multifactorial logistic regression analysis.The performance of the nomogram was evaluated using the receiver operating characteristic curve,Hosmer-Lemeshow calibration curve,and decision curve analysis.RESULTS AND CONCLUSION:(1)There were significant differences in disease duration of systemic lupus erythematosus,systemic lupus erythematosus disease activity,lupus nephritis,respiratory involvement,gastrointestinal involvement,Sjögren's syndrome,osteoporosis,anti-ribonucleoprotein,complement C3 decrease,cyclophosphamide,mycophenolate mofetil,biologics,maximum daily dose of glucocorticosteroids,and pulses of intrave

关 键 词：系统性红斑狼疮 股骨头坏死 危险因素 列线图 预测模型 月经异常 LASSO回归 多因素Logistic回归 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R593.241