移居高原男性青年慢性高山病的诊断模型构建  

Construction of a diagnostic model for chronic mountain sickness among young male migrants to high-altitude areas

作　　者：张权 陈建[1] 刘宝[1] 高志奇 赵文琦 张二龙[1] 徐刚[1] 陈德伟[2] 高钰琪[1] ZHANG Quan;CHEN Jian;LIU Bao;GAO Zhiqi;ZHAO Wenqi;ZHANG Erlong;XU Gang;CHEN Dewei;GAO Yuqi(Department of Medicine and Hygienic Equipment for High Altitude Region,Chongqing,China;Department of High Altitude Physiology and Pathology,Faculty of High Altitude Military Medicine,Army Medical University(Third Military Medical University),Chongqing,China)

机构地区：[1]陆军军医大学(第三军医大学)高原军事医学系高原特需药品与器材研究室,重庆 [2]陆军军医大学(第三军医大学)高原军事医学系高原生理学与病理学教研室,重庆

出　　处：《陆军军医大学学报》2025年第1期10-19,共10页Journal of Army Medical University

基　　金：重庆英才-重庆市自然科学基金重点项目(CQYC20200101163)。

摘　　要：目的分析移居高原男性青年慢性高山病(chronic mountain sickness,CMS)发生的危险因素,并构建诊断模型及评估诊断效能。方法本研究采用横断面研究设计方案,于2023年6月10日至12月29日以方便抽样方法选取移居到高原(海拔4500~5000 m地区)半年及以上的男性青年作为被试者,收集其人口学资料并采集血液样本进行实验室检测。以“慢性高山病青海标准”将被试者分为CMS组和非CMS组。按照8∶2的比例随机抽样将被试者分为训练集和测试集。通过随机森林变量重要性排序、单因素和多因素Logistic回归分析,筛选出CMS发生的独立危险因素并构建诊断模型;采用受试者工作特征曲线、校准曲线、临床决策曲线和影响曲线分析,全面评估模型的诊断效能。结果376名抽样被试者经纳入排除后,共308人纳入数据分析,其中CMS患病率为17.53%。呼吸困难或心悸(79.63%)和睡眠障碍(85.19%)是CMS患者的主要临床表现。进一步分析发现,肌酸激酶同工酶MB/肌酸激酶(creatine kinase-MB/creatine kinase,CK-MB/CK,OR=2.17,95%CI:1.43~3.28)、高原居住时间(OR=2.44,95%CI:1.08~5.54)和体质指数(body mass index,BMI,OR=1.62,95%CI:1.05~2.50)是CMS发生的三大独立危险因素。训练集和测试集的CMS诊断模型曲线下面积[0.821(95%CI:0.756~0.886)vs 0.822(95%CI:0.700~0.944)]、特异度(66.30%vs 73.90%)、敏感度(89.50%vs 81.20%),提示其区分度较好。通过Hosmer-Lemeshow拟合优度检验评估模型拟合度(χ^(2)=10.029,P=0.263)和(χ^(2)=4.477,P=0.812),说明模型预测与实际观察结果一致性较好。临床决策曲线分析表明,在阈值概率为0.1~0.7内,模型的净收益优于全干预和无干预策略。临床影响曲线分析显示,当阈值概率>0.4时,模型的预测和实际发病情况高度一致。这2项分析结果共同证实了模型的临床应用价值。结论CK-MB/CK、高原居住时间和BMI是CMS的独立危险因素,其构建的诊断模型有助于识�Objective To analyze the risk factors for chronic mountain sickness(CMS)in young male migrants living in high-altitude areas and to construct a diagnostic model and evaluate its diagnostic efficacy.Methods From June 10 to December 29,2023,a cross-sectional study was conducted on young male migrants subjected with convenience sampling who had been living in high-altitude areas(4500~5000 m)for 6 months or longer.Their demographic data were collected and blood samples were collected for laboratory test.According to the Qinghai Score for Chronic Mountain Sickness,they were divided into CMS group and non-CMS group.Then the participants were randomly divided into a training set and a test set in a ratio of 8∶2.Independent risk factors for CMS occurrence were screened out,through random forest variable importance ranking,univariate and multivariable logistic regression analysis,and a diagnostic model was constructed based on these factors.Receiver operating characteristic(ROC)curve analysis,calibration curve analysis,clinical decision curve analysis,and influence curve analysis were used to comprehensively evaluate the diagnostic performance of the model.Results According to the inclusion and exclusion criteria,308 out of 376 participants were finally subjected,and 17.53%of them were diagnosed with CMS.The major clinical symptoms of the CMS patients were dyspnea or palpitations(79.63%)and sleep disorders(85.19%).Further analysis revealed that creatine kinase-MB/creatine kinase(CK-MB/CK,OR=2.17,95%CI:1.43~3.28),high-altitude residence time(OR=2.44,95%CI:1.08~5.54),and body mass index(BMI,OR=1.62,95%CI:1.05~2.50)were 3 major independent risk factors for CMS.The area under the curve(AUC)value of the CMS diagnostic model in the training set and test set was 0.821(95%CI:0.756~0.886)and 0.821(95%CI:0.700~0.944),the specificity was 66.30%and 73.90%,the sensitivity was 89.50%and 81.20%,respectively,indicating good discrimination ability.Hosmer-Lemeshow goodness-of-fit test showed consistency between predicted results and actu

关 键 词：移居高原 高原病 慢性高山病 诊断 男性青年 

分 类 号：R195.4[医药卫生—卫生统计学] R446.112[医药卫生—卫生事业管理] R594.3[医药卫生—公共卫生与预防医学]