慢性阻塞性肺疾病急性加重期合并II型呼吸衰竭列线图模型的构建及验证  

Development and validation of a nomogram for predicting the prognosis of acute exacerbation of chronic obstructive pulmonary disease combined with type II respiratory failure

作　　者：曾黎静 张嘉瑞 易群 ZENG Lijing;ZHANG Jiarui;YI Qun(School of Medicine,Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Department of Health Management Center,People’s Hosipital of Leshan,Leshan,Sichuan,614000,P.R.China;Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Sichuan Cancer Hospital,Chengdu,Sichuan 610042,P.R.China)

机构地区：[1]西南医科大学临床医学院,四川泸州646000 [2]乐山市人民医院健康管理中心,四川乐山614000 [3]四川大学华西医院呼吸与危重症医学科,四川成都610041 [4]四川省肿瘤医院,四川成都610042

出　　处：《中国呼吸与危重监护杂志》2024年第12期876-881,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的构建并验证慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD,简称慢阻肺)急性加重期合并II型呼吸衰竭的列线图模型。方法回顾性分析2016年8月—2021年12月乐山市人民医院收治的300名慢阻肺急性加重住院患者的临床资料。将患者以7∶3的比例分为训练集(n=210)和验证集(n=90)。对训练集的患者采用LASSO回归分析筛选变量,再进行多因素Logistic回归分析筛选出慢阻肺急性加重并发II型呼吸衰竭的独立危险因素,并绘制相关的列线图模型。在训练集和验证集分别绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线),计算曲线下面积(area under ROC curve,AUC),进行HosmerLemeshow检验,并绘制校准曲线和决策分析曲线(decision curve analysis,DCA)验证模型。结果心脏疾病、淋巴细胞百分比、红细胞分布宽度标准差(red cell distribution width-standard deviation,RDW-SD)是慢阻肺急性加重并发II型呼吸衰竭患者的独立危险因素(P<0.05)。训练集和验证集的AUC分别为0.742(95%CI:0.672-0.812)和0.793(95%CI:0.699-0.888)。两组的校准曲线贴近理想曲线。两组的Hosmer-Lemeshow检验P>0.05,有较好的临床实用性。DCA曲线提示模型具有较好的临床使用价值。结论基于心脏疾病、淋巴细胞百分比、RDW-SD等因素构建的临床预测模型对慢阻肺急性加重并发II型呼吸衰竭的患者有较好的预测价值。Objective To develop and validate a nomogram model that can be used to predict the prognosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients with type II respiratory failure.Methods A retrospective analysis was conducted on the clinical data of 300 hospitalized AECOPD patients in the People’s Hosipital of Leshan from August 2016 to December 2021.Patients were grouped into a training cohort(n=210)and a validation cohort(n=90)in a 7:3 ratio.The variables for the patients in the training cohort were selected using the least absolute shrinkage and selection operator(LASSO),followed by multivariate logistic regression analysis to identify independent risk factors of poor prognosis in AECOPD with type II respiratory failure,and a nomogram model was constructed.Receiver operating characteristic(ROC)curves were plotted for the training and validation cohorts,and the area under ROC curve(AUC)was calculated.The model was validated by conducting the Hosmer-Lemeshow test,drawing calibration curves,and performing decision curve analysis(DCA).Results Cardiovascular disease,lymphocyte percentage,and red cell distribution width-standard deviation(RDW-SD)were identified as independent risk factors of poor prognosis for AECOPD patients with type II respiratory failure(P<0.05).The AUC values for the training and validation cohorts were 0.742(95%CI:0.672-0.812)and 0.793(95%CI:0.699-0.888),respectively.The calibration curves of the two cohorts are close to the desirable curves.The Hosmer-Lemeshow test P-values were greater than 0.05,indicating good clinical practicality.The DCA curve indicates that the model has good clinical value.Conclusions The clinical prediction model,based on factors such as cardiovascular disease,lymphocyte percentage,and RDW-SD,showed good predictive value for AECOPD patients complicated by type II respiratory failure.

关 键 词：慢性阻塞性肺病 急性加重期 II型呼吸衰竭 列线图 

分 类 号：R563.8[医药卫生—呼吸系统] R563.9[医药卫生—内科学]