基于检验指标构建多参数模型在特发性肺纤维化临床评估中的应用  

Application of multi-parameter model based on test indicators in clinical evaluation of idiopathic pulmonary fibrosis

作　　者：胡莉娟 刘若雨 周允[2] 曹永彤[2] Hu Lijuan;Liu Ruoyu;Zhou Yun;Cao Yongtong(Graduate School of Chinese Academy of Medical Sciences,Beijing 100730 China;Clinical Laboratory,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京协和医学院研究生院,北京100730 [2]中日友好医院检验科,北京100029

出　　处：《中华检验医学杂志》2024年第10期1139-1151,共13页Chinese Journal of Laboratory Medicine

基　　金：中央高水平医院临床科研业务费资助(2023-NHLHCRF-YYPPLC-TJ-27);国家自然科学基金项目(82272407,82072337)。

摘　　要：目的利用检验指标构建联合诊断模型,并评估其在间质性肺病患者临床评估中的应用价值。方法方法学建立及验证。收集2022—2023年中日友好医院收治的特发性肺纤维化(IPF)患者101例,非IPF间质性肺病患者107例,并收集同时期健康人群98名。将各组人群通过完全随机化分组分为建模组(180例)和验证组(126例),收集患者的血清标本和临床检验指标检测结果[白细胞总数、淋巴细胞计数、单核细胞计数、血红蛋白浓度、高敏C反应蛋白、涎液化糖链抗原6、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、腺苷脱氨酶、神经元特异烯醇化酶、甲胎蛋白、癌胚抗原、细胞角蛋白19片段、糖类抗原15-3、胃泌素释放肽前体和鳞状细胞癌抗原及白介素1(IL-1)、IL2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12p70、IL-17、肿瘤坏死因子-α、干扰素-α、干扰素-γ],分别对各组纳入的检验指标进行多重共线性检验、单因素和多因素Logistic回归模型,建立列线图并通过受试者工作特征(ROC)曲线、校准曲线和临床决策曲线对模型进行验证。结果糖类抗原15-3(OR=1.285,95%CI 1.178~1.402)、白介素6(OR=1.128,95%CI 1.011~1.258)、腺苷脱氨酶(OR=1.465,95%CI 1.261~1.702)、涎液化糖链抗原6(OR=1.013,95%CI 1.008~1.017)是间质性肺病的独立危险因素,基于此4项指标构建列线图风险模型。构建的联合诊断模型AUC为0.967(95%CI 0.941~0.993),在验证组中联合诊断模型AUC为0.948(95%CI 0.911~0.984),决策曲线分析显示联合诊断模型诊断IPF的净获益在阈值0.01-1范围内均高于单个指标;甲胎蛋白(OR=1.403,95%CI 0.975~2.019)和鳞状细胞癌抗原(OR=0.531,95%CI 0.321~0.878)是IPF的独立危险因素,构建的联合诊断模型AUC为0.703(95%CI 0.597~0.810),联合诊断模型在验证组AUC为0.642(95%CI 0.528~0.757),通过校准曲线和临床决策曲线验证发现其在IPF鉴别诊断中具有一定价值�ObjectiveThe combined diagnosis models was constructed with the test indicators and its application value in the clinical evaluation of patients with interstitial lung disease was evaluated.MethodsMethodology development and validation.A total of 101 patients with idiopathic pulmonary fibrosis(IPF)and 107 patients with non-IPF interstitial lung disease admitted to China-Japan Friendship Hospital from 2022 to 2023 were collected,and 98 healthy people were collected during the same period.The population in each group was divided into modeling group(180 cases)and validation group(126 cases)by complete randomization.Serum samples and clinical test results were collected.The test indicators included white blood cell count,lymphocyte count,monocyte count,hemoglobin concentration,highly sensitive C-reactive protein,Krebs von den Lungen 6,total cholesterol,triglycerides,high density lipoprotein cholesterol,low density lipoprotein cholesterol,adenosine deaminase,neuron-specific enolase,alpha-fetoprotein,carcinoembryonic antigen,cytokeratin 19 fragment,carbohydrate antigen 15-3,gastrin releasing peptide precursor,squamous cell carcinoma antigen and interleukin 1(IL-1),IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,tumor necrosis factor-α,interferon-α,interferon-γ.Multiple collinearity test,univariate and multivariate logistic regression were performed for the included test indicators in each group,and nomograms were established and validated by receiver operating characteristic(ROC)curves,calibration curves and clinical decision curves.ResultsBy comparing interstitial lung disease to healthy people,carbohydrate antigen 15-3(OR=1.285,95%CI 1.178-1.402),IL-6(OR=1.128,95%CI 1.011-1.258),adenosine deaminase(OR=1.465,95%CI 1.261-1.702),and Krebs von den Lungen-6(OR=1.013,95%CI 1.008-1.017)were independent risk factors for interstitial lung disease.Based on these four indexes,the nomogram model was constructed.The AUCs of the combined diagnosis model in the modeling group and validation group were 0.967(95%CI 0.941-0.993)and 0

关 键 词：肺纤维化 特发性肺纤维化 生物标志物 联合诊断模型 

分 类 号：R563[医药卫生—呼吸系统]