基于Nomogram的酒精性肝硬化合并自发性细菌性腹膜炎诊断模型  

Nomogram to diagnose alcoholic cirrhosis complicated with spontaneous bacterial peritonitis

作　　者：张琴[1] 江宇泳 熊飞翔 姜艳丹 姜婷婷 于浩 ZHANG Qin;JIANG Yuyong;XIONG Feixiang;JIANG Yandan;JIANG Tingting;YU Hao(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]首都医科大学附属北京地坛医院中西医结合二科,北京100015

出　　处：《中国临床医生杂志》2025年第3期296-300,共5页Chinese Journal For Clinicians

基　　金：北京市高层次公共卫生技术人才建设(学科带头人-03-04);研究型病房卓越临床研究计划(BRWEP2024W102170110)。

摘　　要：目的本研究旨在通过Nomogram构建诊断酒精性肝硬化(ALC)患者合并自发性细菌性腹膜炎(SBP)的模型,帮助临床医生尽早诊断并干预,改善预后。方法回顾性收集2020年8月至2023年6月在首都医科大学附属北京地坛医院住院的532例ALC患者的数据资料,根据入院时是否合并SBP,分为合并SBP组(n=143)和未合并SBP组(n=389)。基于夏普利解释模型(SHAP)可视化筛选变量,构建Nomogram诊断模型,采用受试者操作特征(ROC)曲线下面积(AUC)及校准曲线进行模型性能的评估。结果通过SHAP筛选出白细胞计数、中性粒细胞/淋巴细胞比值、C反应蛋白、白蛋白、高密度脂蛋白胆固醇作为重要特征,以此构建Nomogram模型,AUC为0.812(95%CI:0.768~0.856);当模型的截断值为0.300时,模型诊断的敏感度为0.946,特异度为0.420,具有较好的诊断效能,但误诊率偏高。结论基于Nomogram建立ALC合并SBP诊断模型具有较高诊断效能,可为临床诊断SBP提供参考。Objective To construct a model for diagnosing spontaneous bacterial peritonitis(SBP)in alcoholic liver cirrhosisl(ALC)patients through Nomogram,to assist clinicians in early diagnosis and intervention,and improve the prognosis.Method Data of ALC patients hospitalized in Beijing Ditan Hospital Affiliated to Capital Medical University from August 2020 to June 2023 were collected retrospectively.A total of 532 patients were divided into the SBP group(n=143)and the non-SBP group(n=389)according to whether they had SBP at admission.Variables were screened based on shapley additive explanation(SHAP)visualization,and a Nomogram diagnostic model was constructed,and the receiver operating characteristic(ROC)curve area(AUC)and calibration curve were used to evaluate the model performance.Result White blood cell count,neutrophil-to-lymphocyte ratio,C-reactive protein,albumin,and high-density lipoprotein cholesterol were selected as important features through SHAP.A Nomogram model was constructed based on these features,with an AUC of 0.812(95%CI:0.768-0.856).When the cut-off value of the model was 0.300,the sensitivity of the model diagnosis was 0.946,specificity was 0.420,with good diagnostic results,but misdiagnosis rate.Conclusion The diagnostic model for ALC complicated with SBP established based on Nomogram had high diagnostic efficiency and could provide a reference for the clinical diagnosis of SBP.

关 键 词：酒精性肝硬化 自发性细菌性腹膜炎 列线图 诊断模型 

分 类 号：R657.31[医药卫生—外科学]