尘肺病合并肺结核风险预测分析  

Predictive risk analysis for pneumoconiosis combined with tuberculosis

作　　者：刘梦婷 方朱雨冰 赵海莉 石卓跃 海荣 宁丽[1] Liu Mengting;Fang Zhuyubing;Zhao Haili;Shi Zhuoyue;Hai Rong;Ning Li(School of Public Health,Xinjiang Medical University,Urumqi 830000,China;Department of Cardiovascular Medicine,Kelamayi Central Hospital,Kelamayi 834000,China)

机构地区：[1]新疆医科大学公共卫生学院,乌鲁木齐8830000 [2]新疆克拉玛依市中心医院心血管内科,克拉玛依834000

出　　处：《中华劳动卫生职业病杂志》2025年第1期49-54,共6页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：新疆维吾尔自治区"十四五"高等学校特色学科-公共卫生与预防医学;新疆维吾尔自治区自然科学基金(YK2022-17)。

摘　　要：目的探索尘肺合并肺结核的危险因素,构建尘肺合并肺结核患者的临床预测模型,为预防尘肺合并肺结核提供科学依据。方法于2024年1月,简单随机抽取2022年1月至2023年1月在新疆维吾尔自治区第三人民医院(新疆维吾尔自治区职业病医院)呼吸与危重症医学科就诊的尘肺患者(包括煤工尘肺、矽肺)共232人作为研究对象。收集患者基本情况及诊断资料,用多因素logistic回归分析筛选尘肺合并肺结核的相关危险因素。根据多因素logistic回归分析结果建立列线图,利用受试者工作特征(ROC)曲线下面积(AUC),校准曲线和决策曲线分析(DCA)评估预测能力。结果232名尘肺患者中有73名合并肺结核,占比31.47%(73/232)。通过多因素logistic回归分析确定粉尘接触时间、工种、吸烟史、肺功能水平均为尘肺合并肺结核的危险因素(OR=10.33,95%CI=1.92~55.66,OR=5.43,95%CI=1.91~15.44,OR=3.10,95%CI=1.15~8.37,ORR=4.00,95%CI=1.62~9.87;P<0.05)。构建的列线图模型在受试者工作特征(ROC)曲线下面积为0.77[95%CI(0.69,0.73)],校准曲线接近理想对角线,模拟曲线和实际曲线绝对误差为0.03,DCA显示列线图模型概率阈值为1%~90%时具有良好的临床适用性。结论尘肺病合并肺结核的发病风险较高,粉尘接触时间、吸烟史、工种及肺功能水平是其危险因素。该列线图模型可用于预测尘肺患者合并肺结核的风险,有助于早期干预。Objective To explore the risk factors of pneumoconiosis complicated with pulmonary tuberculosis,to construct a clinical prediction model for patients with pneumoconiosis complicated with pulmonary tuberculosis,and to provide a scientific basis for the prevention of pneumoconiosis complicated with pulmonary tuberculosis.MethodsIn January 2024,a total of 232 patients with pneumoconiosis(including coal workers'pneumoconiosis and silicosis)who were treated in the Department of Respiratory and Critical Care Medicine of the Third People's Hospital of Xinjiang Uygur Autonomous Region(Xinjiang Uygur Autonomous Region Occupational Disease Hospital)from January 2022 to January 2023 were randomly selected as the study subjects.Collectted basic patient information and diagnostic data.Multivariate logistic regression analysis was used to screen the risk factors related to pneumoconiosis complicated with pulmonary tuberculosis.According to the results of multivariate logistic regression analysis,a nomogram was established,and the area under the receiver operating characteristic(ROC)curve(AUC),calibration curve and decision curve analysis(DCA)were used to evaluate the predictive ability.ResultsAmong the 232 patients with pneumoconiosis,73 were complicated with pulmonary tuberculosis,accounting for 31.47%(73/232).Multivariate logistic regression analysis determined that dust exposure time,type of work,smoking history,and lung function level were all risk factors for pneumoconiosis complicated with tuberculosis(OR=10.33,95%CI=1.92~55.66,OR=5.43,95%CI=1.91~15.44,OR=3.10,95%CI=1.15~8.37,OR=4.00,95%CI=1.62~9.87;P<0.05).The constructed nomogram model has good clinical applicability when the area under the receiver operating characteristic(ROC)curve is 0.77[95%CI(0.69,0.73)],the calibration curve is close to the ideal diagonal,the absolute error between the simulation curve and the actual curve is 0.03,and the DCA decision curve shows that the probability threshold of the nomogram model is 1%-90%.ConclusionThe risk of pneumoconiosis c

关 键 词：尘肺病 肺结核 危险因素 列线图 预测模型 流行病学特征 

分 类 号：R135.2[医药卫生—劳动卫生] R521[医药卫生—公共卫生与预防医学]