急诊肺结核患者死亡的危险因素及风险模型建立  

Analysis of risk factors for death in emergency pulmonary tuberculosis patients and risk model construction

作　　者：薛玉[1] 杨新婷[2] 王桂荣[3] 柳芳超 雷轩 张静[1] 李亮[5] Xue Yu;Yang Xinting;Wang Guirong;Liu Fangchao;Lei Xuan;Zhang Jing;Li Liang(Department of Emergency,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;The Second Department of Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;Department of Clinical Laboratory,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;Department of Science and Technology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;General Administration Office,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院急诊科,北京101149 [2]首都医科大学附属北京胸科医院结核二科,北京101149 [3]首都医科大学附属北京胸科医院检验科,北京101149 [4]首都医科大学附属北京胸科医院科技处,北京101149 [5]首都医科大学附属北京胸科医院,北京101149

出　　处：《中国防痨杂志》2025年第2期189-194,共6页Chinese Journal of Antituberculosis

基　　金：国家重点研发计划(2022YFC2304800)。

摘　　要：目的:分析急诊肺结核患者死亡的危险因素并建立风险预警模型。方法:采用回顾性分析方法,连续纳入2024年1—6月首都医科大学附属北京胸科医院237例急诊肺结核患者作为研究对象。收集研究对象一般人口学信息、临床症状、急诊实验室检查结果、影像分级、细菌学检测结果等资料。根据研究对象是否死亡分为存活组和死亡组,比较两组间各项指标的差异,采用多因素logistic回归模型分析影响急诊肺结核患者发生死亡的危险因素,明确独立危险因素并建立死亡风险模型,绘制受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)分析此模型对急诊肺结核患者死亡的预测价值。结果:237例研究对象中,存活189例,死亡48例,病亡率为20.3%。多因素logistic回归分析显示,血尿素氮>8.3 mmol/L、影像分级为重度、发生呼吸窘迫、呼吸衰竭、意识障碍为急诊肺结核患者死亡的独立危险因素[OR(95%CI)值分别为:4.550(1.761~11.758)、4.429(1.443~13.588)、27.507(3.985~189.847)、2.687(1.042~6.926)、27.184(6.926~106.699)]。多因素logistic回归方程为:logit P=In [P/(1-P)]=-1.433+1.515×(血尿素氮>8.3 mmol/L)+1.488×(影像分级重度)+3.314×(呼吸窘迫)+0.988×(呼吸衰竭)+3.303×(意识障碍)。ROC曲线分析显示,5种危险因素联合检测时曲线下面积为0.8968,预测急诊肺结核患者死亡的敏感度和特异度分别为87.50%和74.60%。结论:综合考虑急诊肺结核患者的血尿素氮水平、影像分级程度,以及是否出现呼吸窘迫、呼吸衰竭、意识障碍等症状可较好地预测其预后情况。Objective:To identify the risk factors associated with mortality in patients with pulmonary tuberculosis admitted to the emergency department and to develop a predictive risk model to assist clinical decision-making and improve patient outcomes.Methods:A retrospective analysis was conducted on 237 patients with pulmonary tuberculosis who were treated in the emergency department of Beijing Chest Hospital,Capital Medical University,between January 2024 and June 2024.Data collected included baseline demographic characteristics,clinical symptoms,laboratory findings,radiographic severity,and bacteriological evidence.Patients were categorized into two groups—the survival group and the mortality group—based on their clinical outcomes.Comparative analyses of clinical data between the two groups were performed.Multivariate logistic regression was employed to identify independent risk factors associated with mortality in the emergency setting.A predictive risk model was subsequently developed,and its performance in forecasting poor outcomes was evaluated using the receiver operating characteristic(ROC)curve.Results:Of the 237 patients included in the study,189 survived and 48 succumbed,resulting in an overall mortality rate of 20.3%.Multivariate logistic regression analysis identified five independent risk factors associated with mortality in the emergency department:elevated blood urea nitrogen(BUN)levels(>8.3 mmol/L),advanced radiographic lesions,respiratory distress,respiratory failure,and consciousness disorders.The respective odds ratios(ORs)and 95%CIs for these factors were 4.550(1.761-11.758),4.429(1.443-13.588),27.507(3.985-189.847),2.687(1.042-6.926),and 27.184(6.926-106.699).The predictive risk model was expressed as:logit P=ln(P/(1-P))=-1.433+1.515×(BUN>8.3 mmol/L)+1.488×(advanced radiographic lesions)+3.314×(respiratory distress)+0.988×(respiratory failure)+3.303×(consciousness disorder).ROC curve analysis demonstrated that the area under the curve(AUC)was 0.8968 when the five risk factors were combine

关 键 词：结核 肺 急诊处理 死亡 因素分析 统计学 

分 类 号：R521[医药卫生—内科学]