系统性红斑狼疮病人免疫抑制治疗期间发生感染的风险预警模型构建与验证  

Construction and validation of a risk warning model for infection in patients with systemic lupus erythematosus during immunosuppressive therapy

作　　者：尹娟 孙苏 YIN Juan;SUN Su(Suqian Hospital,Nanjing Drum Tower Hospital Group,Jiangsu 223800 China)

机构地区：[1]南京鼓楼医院集团宿迁医院(徐州医科大学附属宿迁医院),223800

出　　处：《全科护理》2024年第23期4370-4374,共5页Chinese General Practice Nursing

摘　　要：目的:探讨系统性红斑狼疮(SLE)病人免疫抑制治疗期间发生感染的相关危险因素,构建并验证该风险预测模型。方法:回顾性分析2022年1月—2023年1月医院收治127例接受免疫抑制治疗的SLE病人相关资料,按照7∶3分为建模集(n=89)和验证集(n=38),并根据治疗期间是否发生感染分为感染组与非感染组。收集SLE病人资料,以单因素分析和多因素Logistic回归分析筛选病人免疫抑制治疗期间发生感染的独立影响因素。使用R软件绘制列线图和校准图,将模型可视化和评估一致性;受试者工作特征(ROC)评估风险预测模型的预测价值;并采用H-L检验判断模型的拟合优度。结果:建模集89例病人中有24例发生感染(感染组,n=24;未感染组,n=65),感染率为26.97%。进一步多因素分析结果提示,病程、系统性红斑狼疮的病情活动程度评分(SLEDAI)、免疫抑制剂使用种类以及年龄均为SLE病人免疫抑制治疗期间发生感染的独立影响因素(P<0.05)。风险预测模型为:Logit(P)=14.928-0.193×(年龄)-1.265×(病程)-1.761×(免疫抑制剂使用种类)-0.273×(SLEDAI评分)。建模集ROC曲线下面积(AUC)为0.913[95%CI(0.847,0.979)],其敏感度为87.5%,特异度为87.7%,绘制建模集的预测模型校准图当中校准曲线贴近于标准曲线,提示该模型一致性较好;H-L拟合优度检验结果显示χ~2=8.791,P=0.360;外部验证AUC为0.916[95%CI(0.848,0.984)],其敏感度为87.5%,特异度为90.8%。结论:年龄、病程、SLEDAI评分、免疫抑制剂使用种类均为SLE病人免疫抑制治疗期间发生感染的独立影响因素,以此构建出的风险预测模型具有较好的临床预测价值。Objective:To explore the risk factors for infection during immunosuppressive therapy in patients with systemic lupus erythematosus(SLE),and to construct and validate the risk prediction model.Methods:The relevant data of 127 SLE patients who received immunosuppressive therapy admitted to the hospital from January 2022 to January 2023 were retrospectively analyzed.They were divided into modeling set(n=89)and validation set(n=38)according to 7∶3,and divided into infected group and non-infected group according to whether infection occurred during treatment.Data of SLE patients were collected.Univariate analysis and multivariate Logistic regression analysis were used to screen for independent influencing factors of infection during immunosuppressive therapy.R software was used to draw a nomogram and calibration diagram to visualize the model and evaluate consistency;ROC was used to evaluate the predictive value of risk prediction model;H-L test was used to judge the goodness of fit of the model.Results:24 of 89 patients in the modeling set developed infection(infection group,n=24;In the uninfected group,n=65),the infection rate was 26.97%.Further multivariate analysis suggested that the course of disease,SLEDAI,type of immunosuppressant and age were independent factors for infection during immunosuppressive therapy in SLE patients(P<0.05).The risk prediction model was as follows:Logit(P)=14.928-0.193×(age)-1.265×(course of disease)-1.761×(type of immunosuppressant used)-0.273×(SLEDAI score).The AUC in the ROC of the modelin g set was 0.913(95%CI:0.847,0.979),the sensitivity was 87.5%,and the specificity was 87.7%.In the calibration diagram of the predictive model of the modeling set,the calibration curve was close to the standard curve,indicating that the model had good consistency.H-L goodness of fit test results showed that(χ^(2)=8.791,P=0.360);The external validation AUC was 0.916(95%CI:0.848,0.984),the sensitivity was 87.5%,and the specificity was 90.8%.Conclusions:Age,course of disease,SLEDAI score and ty

关 键 词：系统性红斑狼疮 免疫抑制 感染 预测模型 影响因素 

分 类 号：R473.5[医药卫生—护理学]