重症结核病风险预测模型的构建与评价  

Construction and evaluation of a risk prediction model for severe tuberculosis

作　　者：戎卓宏 林珣 黄林喜[1] RONG Zhuohong;LIN Xun;HUANG Linxi(Department of Critical Care Medicine,The First Affiliated Hospital of Shantou University Medical College,Shantou 515041,China;Department of Critical Care Medicine,Shantou Third People's Hospital,Shantou 515073,China;Department of Infection Management,Shantou Third People's Hospital,Shantou 515073,China)

机构地区：[1]汕头大学医学院第一附属医院重症医学科,广东汕头515041 [2]汕头市第三人民医院重症医学科,广东汕头515073 [3]汕头市第三人民医院感染管理科,广东汕头515073

出　　处：《汕头大学医学院学报》2024年第3期136-141,146,共7页Journal of Shantou University Medical College

摘　　要：目的:探讨重症结核病的相关因素并构建风险预测模型,为重症结核病的早期预测提供依据。方法:回顾性选取2017年6月—2023年6月汕头市第三人民医院重症监护室的495例重症结核病患者与同期住院的493例普通结核病患者为研究对象,按7∶3比例随机分为模型组(n=692)和验证组(n=296)。通过logistic回归分析筛选重症结核病的相关因素,构建列线图预测模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)评估预测模型的区分度。采用Hosmer-Lemeshow检验及校准曲线评估预测模型的校准度。结果:模型组692例,男性525例,女性167例,年龄62 (52,69)岁。验证组296例,男性230例,女性66例,年龄64 (52,71)岁。两组基线资料差异无统计学意义(P>0.05)。多因素logistic回归分析显示白细胞(OR=1.099,95% CI:1.013~1.193)、血红蛋白(OR=0.832,95% CI:0.799~0.865)、白蛋白(OR=0.869,95% CI:0.778~0.971)、血尿素氮(OR=1.117,95% CI:1.045~1.194)、降钙素原(OR=1.846,95% CI:1.326~2.569)、血乳酸(OR=1.384,95%CI:1.100~1.742)、氧合指数(OR=0.989,95%CI:0.986~0.993)、慢性阻塞性肺病(OR=2.242,95% CI:1.120~4.488)、双侧肺段受累(OR=5.051,95% CI:1.323~19.286)、毁损肺(OR=6.241,95% CI:1.329~29.305)、心律失常(OR=2.275,95% CI:1.186~4.363)是重症结核病的相关因素。ROC曲线显示该列线图模型预测模型组和验证组重症结核病风险的AUC值分别为0.963 (95% CI:0.952~0.976)和0.968 (95% CI:0.952~0.984),表明该模型的区分度良好。经Hosmer-Lemeshow检验,模型组和验证组的P值分别为0.237和0.526 (P值均>0.05),校准曲线与理想曲线接近,表明在模型组及验证组中与实际结果具有较好的一致性。结论:构建的预测模型对重症结核病的发生风险有较好的预测能力。Objective:To investigate the factors associated with severe tuberculosis and construct a risk prediction model to provide a basis for early prediction of severe tuberculosis.Methods:495 patients with severe tuberculosis in the intensive care unit of Shantou Third People's Hospital,and 493 patients with common tuberculosis hospitalized during the same period were retrospectively selected as the study subjects,and were randomly divided into the model group(n=692)and the validation group(n=296)according to the ratio of 7:3.Factors associated with severe tuberculosis were screened by logistic regression analysis,and a nomogram prediction model was constructed.The area under curve(AUC)of the receiver operating characteristic(ROC)was used to assess the discrimination of the prediction model.Hosmer-Lemeshow test and calibration curve were used to assess the calibration of the prediction model.Results:There were 692 cases in the model group,525 males and 167 females,aged 62(52,69)years.There were 296 cases in the validation group,230 males and 66 females,aged 64(52,71)years.The difference in baseline data between the two groups was not statistically significant(P>0.05).Multivariate logistic regression analysis showed that leukocytes(OR=1.099,95%CI:1.013-1.193),hemoglobin(OR=0.832,95%CI:0.799-0.865),albumin(OR=0.869,95%CI:0.778-0.971),and blood urea nitrogen(OR=1.117.95%CI:1.045-1.194),calcitoninogen(OR=1.846,95%CI:1.326-2.569),blood lactate(OR=1.384,95%CI:1.100-1.742),oxygenation index(OR=0.989,95%CI:0.986-0.993),chronic obstructive pulmonary disease(OR=2.242,95%CI:1.120-4.488),bilateral lung segmental involvement(OR=5.051,95%CI:1.323-19.286),destroyed lungs(OR=6.241,95%CI:1.329-29.305),and cardiac arrhythmia(OR=2.275,95%CI:1.186-4.363)were associated with the severe tuberculosis.The ROC curves showed that the AUC values of this nomogram model for predicting the risk of severe tuberculosis in the model and validation groups were 0.963(95%CI:0.952-0.976)and 0.968(95%CI:0.952-0.984),respectively,which indicated that the mo

关 键 词：重症结核病 列线图 预测模型 

分 类 号：R52[医药卫生—内科学]