头孢哌酮钠/舒巴坦钠相关凝血障碍风险的列线图预测模型构建与验证  

Construction and validation of a column chart prediction model for the risk of cefoperazone sodium/sulbactam sodium-related coagulation disorders

作　　者：刘冬芳 王航 胡学锋 LIU Dongfang;WANG Hang;HU Xuefeng(Department of Pharmacy,Hefei Eighth People's Hospital,Hefei 238000,China;Department of Respiratory Medicine,Hefei Eighth People's Hospital,Hefei 238000,China)

机构地区：[1]合肥市第八人民医院药剂科,合肥238000 [2]合肥市第八人民医院呼吸内科,合肥238000

出　　处：《临床药物治疗杂志》2025年第1期55-60,共6页Clinical Medication Journal

基　　金：合肥市卫生健康委应用医学研究项目(Hwk2020yb0020)。

摘　　要：目的构建并验证住院患者头孢哌酮钠/舒巴坦钠相关凝血障碍的列线图预测模型。方法纳入2022年7月至2024年7月接受头孢哌酮钠/舒巴坦钠治疗的患者,分为凝血障碍组和对照组,收集临床资料,确定危险因素并构建列线图模型,H-L拟合优度检验、受试者工作特征曲线(ROC)、决策曲线以及临床影响曲线对预测模型进行验证。结果共纳入266例患者,其中凝血障碍组52例,占19.55%,对照组214例。研究发现,营养不良、近期出血史、头孢哌酮钠/舒巴坦钠治疗时间延长、与碳青霉烯类药物联合使用、以及血清肌酐升高是发生头孢哌酮钠/舒巴坦钠相关凝血障碍的独立危险因素。以此构建列线图,模型的AUC为0.840,具有较好的标定能力(χ^(2)=2.157,P=0.867),在预测头孢哌酮钠/舒巴坦钠相关凝血障碍发生率方面提供了中等净获益。模型在预测1000人口规模概率分层方面的预测概率与实际概率吻合良好。结论头孢哌酮钠/舒巴坦钠相关凝血障碍风险的列线图预测模型,有助于风险较高患者的早期识别。营养不良、近期出血史、头孢哌酮钠/舒巴坦钠治疗时间延长、与碳青霉烯类药物联合使用、以及血清肌酐升高患者使用头孢哌酮钠/舒巴坦钠时应注意发生凝血障碍的风险。Objective To construct and validate a nomogram prediction model for the risk of cefoperazone sodium/sulbactam sodium(CPZ/SAM)-related coagulation disorders in hospitalized patients.Methods Patients treated with CPZ/SAM from July 2022 to July 2024 were enrolled and divided into a coagulation disorder group and a control group.Clinical data were collected,risk factors were identified,and a nomogram model was constructed.The model was validated using the Hosmer-Lemeshow(H-L)goodness-of-fit test,receiver operating characteristic(ROC)curve,decision curve analysis,and clinical impact curve.Results A total of 266 patients were enrolled,Among them,52(19.55%)were in the coagulation disorder group,and 214 were in the control group.The study identified malnutrition,recent bleeding history,prolonged treatment duration with CPZ/SAM,combination use with carbapenems,and elevated serum creatinine as independent risk factors for coagulation disorders associated with CPZ/SAM.A nomogram was constructed based on these factors,with an AUCof 0.840,demonstrating good calibration(χ^(2)=2.157,P=0.867).The model provided moderate net benefit in predicting the incidence of coagulation disorders associated with CPZ/SAM.The predicted probabilities aligned well with the actual probabilities in a probability stratification of 1000 individuals.Conclusion In this study,a nomogram prediction model for the risk of CPZ/SAM-related coagulation disorders was constructed,which is helpful for the early identification of patients with high risk.Patients with malnutrition,a history of recent bleeding,prolonged treatment with CPZ/SAM,combination with carbapenems,and elevated serum creatinine should be aware of the risk of coagulation disorders when using CPZ/SAM.

关 键 词：头孢哌酮钠/舒巴坦钠 凝血障碍 预测模型 列线图 抗菌药物管理 

分 类 号：R969.3[医药卫生—药理学] R978.11[医药卫生—药学]