基于列线图的类风湿关节炎相关肺间质病变影响因素分析  

Analysis of influencing factors of rheumatoid arthritis related interstitial lung disease based on nomogram

作　　者：海环玥 戚燕 龙武彬[2] 王胜岚 朱静[2] HAI Huan-yue;QI Yan;LONG Wu-bin;WANG Sheng-lan;ZHU Jing(School of Medicine,University of Electronic Science and Technology of China,Chengdu 610072,China;Department of Rheumatology,Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital(Affiliated Hospital of University of Electronic Science and Technology of China),Chengdu 610072,China)

机构地区：[1]电子科技大学医学院,四川成都610054 [2]四川省医学科学院·四川省人民医院(电子科技大学附属医院)风湿内科,四川成都610072

出　　处：《实用医院临床杂志》2025年第1期139-143,共5页Practical Journal of Clinical Medicine

基　　金：四川省科技厅科研基金资助项目(编号:2021YFS0165)。

摘　　要：目的探讨类风湿关节炎(RA)发生肺间质病变(ILD)的危险因素。方法选取2017年5月至2020年12月我院收治的432例RA患者,分为RA合并ILD与不合并ILD两组。收集患者临床特点、常规实验室检查及免疫学指标。候选变量的筛选通过单因素分析,将得到的变量纳入多因素Logistic回归分析RA发生ILD的独立危险因素。调整纳入最终模型的变量因子后将建立的临床预测模型以可视化的列线图展示。两组队列中,区分度评价采用ROC曲线下面积,校准度评价采用bootscrap方法并绘制校准曲线,有效性评价采用临床决策曲线与临床影响曲线。结果性别、年龄、合并关节损害、红细胞沉降率、血小板计数、抗核抗体阳性以及低密度脂蛋白与RA患者发生ILD具有相关性(P<0.05)。男性、抗核抗体是ILD的独立影响因素(P<0.05)。所建立的临床预测模型通过内部验证后可以被认为区分度良好(AUC 0.786,95%CI 0.7389-0.8334)。结论通过采用列线图可视化构建的临床风险预测模型可能有助于预测RA患者发生ILD的风险。Objective To explore the risk factors for interstitial lung disease(ILD)in rheumatoid arthritis(RA).Methods Four hundred and thirty-two RA patients admitted to our hospital from May 2017 to December 2020 were selected.The patients were divided into a RA group and a RA combine ILD group.The clinical characteristics,routine laboratory tests and immunological indica-tors of the patients were collected.Candidate variables were firstly screened by univariate analysis,and further screened by multivariate logistic regression analysis to identify the independent risk factors for the occurrence of ILD in patients with RA.The clinical prediction model presented in a visual column charts was constructed after adjusting the variable factors included in the final model.In both co-horts,the area under the ROC curve was used for differentiation.The bootcrap method was used for calibration and calibration curves were plotted.The clinical decision curve and clinical impact curve were used for validity.Results Gender,age,comorbid joint dam-age,erythrocyte sedimentation rate,platelet count,antinuclear antibody positivity,and low-density lipoprotein were correlated with the development of ILD in RA patients(P<0.0).Male and antinuclear antibody were independent influencing factors for ILD(P<0.05).The clinical prediction model was considered to have good discriminability after internal verification(AUC=0.786,95%CI:0.7389~0.8334).Conclusion The clinical risk prediction model constructed by using nomogram visualization may be useful for predicting the risk of ILD in RA patients.

关 键 词：列线图 类风湿关节炎 肺间质病变 

分 类 号：R593.22[医药卫生—内科学]