强直性脊柱炎脊柱结构损伤肾虚瘀阻证和湿热瘀阻证临床特征分析及判别模型构建  

Clinical characteristic analysis and discriminative model construction of kidney deficiency and blood stasis blocking syndrome and stagnant dampness-heat syndrome of spinal structural damage in ankylosing spondylitis

作　　者：陈悦宁 刘宏潇[1] 王宇[2] 耿昭阳 CHEN Yuening;LIU Hongxiao;WANG Yu;GENG Zhaoyang(Department of Rheumatology,Guanganmen Hospital,China Academy of Chinese Medical Science,Beijing100053,China;Department of Spine Surgery,Peking University First Hospital,Beijing100034,China)

机构地区：[1]中国中医科学院广安门医院风湿病科,北京100053 [2]北京大学第一医院脊柱外科,北京100034

出　　处：《中国医药导报》2024年第32期155-160,共6页China Medical Herald

基　　金：北京市中医药科技发展资金重点项目(BJZYZD-2023-02);中国中医科学院科技创新工程重点协同攻关项目(CI2023C072YLL);中国中医科学院科技创新工程重大攻关项目(CI2021A01506);中国中医科学院拔尖创新博士研究生支持计划项目。

摘　　要：目的探讨强直性脊柱炎(AS)脊柱结构损伤肾虚瘀阻证和湿热瘀阻证的临床特征,分析影响因素并构建判别模型,为临床诊治提供依据。方法选取2023年6月至2024年6月于中国中医科学院广安门医院风湿病科和北京大学第一医院脊柱外科住院及门诊就诊的232例AS严重脊柱结构损伤患者,最终纳入208例,肾虚瘀阻证124例,湿热瘀阻证84例。分析肾虚瘀阻证和湿热瘀阻证的临床特征,采用logistic回归构建列线图判别模型,采用受试者操作特征(ROC)曲线、校准曲线、临床决策曲线和混淆矩阵评估模型效能。结果湿热瘀阻证与肾虚瘀阻证吸烟史比较,差异有统计学意义(P<0.05)。湿热瘀阻证与肾虚瘀阻证AS疾病活动度评分-C反应蛋白(CRP)评分、Bath强直性脊柱炎功能指数(BASFI)评分、国际脊柱关节炎评估协会(ASAS)HI评分、抑郁评分、焦虑评分、压力评分、夜间痛视觉模拟评分法评分、患者整体评估评分、CRP水平、红细胞沉降率比较,差异有统计学意义(P<0.05)。多因素分析显示,BASFI评分、ASAS HI评分和CRP是判别脊柱结构损伤肾虚瘀阻证的影响因素(P<0.05)。模型效能评估显示,ROC曲线下面积为0.98(95%CI:0.97~1.00),校准曲线接近理想曲线,临床决策曲线表现良好,模型准确度、灵敏度、特异度、阳性判别值和阴性判别值均>0.90,说明模型效能良好。结论AS严重脊柱结构损伤湿热瘀阻证患者存在高疾病活动状态、脊柱活动度和身体功能差、更易患不良心理状况、整体评估欠佳;开发了一种可通过临床特征判别AS严重脊柱结构损伤肾虚瘀阻证的列线图模型,BASFI评分、ASAS HI评分和CRP是判别因素。Objective To investigate clinical characteristic of kidney deficiency and blood stasis blocking syndrome and stagnant dampness-heat syndrome of spinal structural damage in ankylosing spondylitis(AS),analyze the influencing factors and construct discriminative model,so as to provide a basis for clinical diagnosis and treatment.Methods A total of 232 patients with severe spinal structural damage caused by AS admitted to Department of Rheumatology,Guanganmen Hospital,China Academy of Chinese Medical Science,and Department of Spine Surgery,Peking University First Hospital from June 2023 to June 2024 were selected.A total of 208 patients were included,included 124 with kidney deficiency and blood stasis blocking syndrome and 84 with stagnant dampness-heat syndrome.Clinical characteristics of kidney deficiency and blood stasis blocking syndrome and stagnant dampness-heat syndrome were analyzed.Nomograms discriminative model was constructed by using logistic regression.The model efficacy was evaluated by using receiver operator characteristic(ROC)curve,calibration curve,clinical decision curve,and confusion matrix.Results There was statistically significant difference in smoking history between kidney deficiency and blood stasis blocking syndrome and stagnant dampness-heat syndrome(P<0.05).There were statistically significant differences in AS disease activity score-C-reactive protein(CRP)score,Bath ankylosing spondylitis functional index(BASFI)score,Assessment of SpondyloArthritis International Society(ASAS)HI score,depression score,anxiety score,stress score,nocturnal pain visual analog scale score,patient global assessment score,CRP level,erythrocyte sedimentation rate(P<0.05).Multivariate analysis showed that BASFI score,ASAS HI score,and CRP were the influencing factors for distinguishing kidney deficiency and blood stasis blocking syndrome in spinal structural damage.The model efficacy evaluation showed that area under the curve of ROC curve was 0.98(95%CI:0.97-1.00),the calibration curve was close to the ideal cu

关 键 词：强直性脊柱炎 脊柱结构损伤 肾虚瘀阻证 判别模型 

分 类 号：R681.51[医药卫生—骨科学]