中度重症/重症急性胰腺炎患者并发胰源性糖尿病的危险因素分析及预测模型构建  

Analysis of risk factors for pancreatogenic diabetes mellitus in patients with moderately severe and severe acute pancreatitis and construction of a predictive model

作　　者：周雪梅[1] 杨佳妮 张海蓉[1] ZHOU Xuemei;YANG Jiani;ZHANG Hairong(Department of Gastroenterology,The First Affiliated Hospital of Kunming Medical University,Yunnan Clinical Medical Research Center for Digestive Disease,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院消化内科、云南省消化系统疾病临床医学研究中心,云南昆明650032

出　　处：《山东医药》2025年第3期30-35,共6页Shandong Medical Journal

摘　　要：目的分析中度重症急性胰腺炎(MSAP)及重症急性胰腺炎(SAP)患者并发胰源性糖尿病(T3cDM)的危险因素,构建预测模型并进行验证。方法选择MSAP/SAP患者411例,AP发作后随访至少3个月,记录是否发生T3cDM。收集T3cDM及非T3cDM患者的一般资料、入院后24 h内首次实验室检查指标、疾病相关评分、并发症情况。将T3cDM与非T3cDM患者之间有统计学差异的指标纳入LASSO和多因素Logistic回归分析,得到MSAP/SAP并发T3cDM的独立危险因素。构建包含独立危险因素的列线图预测模型,采用bootstrap法、受试者工作特征(ROC)曲线、校准曲线及Hosmer-Lemeshow拟合优度检验对该模型进行内部验证,临床决策曲线分析(DCA)评估模型的临床实用性。结果411例患者并发T3cDM 113例、非T3cDM 298例。T3cDM与非T3cDM患者之间差异有统计学意义的指标共31个,LASSO和多因素Logistic回归分析结果显示中性粒细胞百分比升高、甘油三酯升高、总胆固醇升高、胰腺坏死为MSAP/SAP并发T3cDM的独立危险因素(P均<0.05)。上述独立危险因素构建的列线图预测模型经bootstrap法1000次内部验证校准后显示仍具有较高的鉴别能力,ROC曲线分析结果提示具有良好的区分度,模型校准曲线可见校准曲线接近参考曲线,Hosmer-Lemeshow拟合优度检验结果显示具有良好的拟合度,DCA结果显示在较大风险阈值内具有较高净获益、有一定临床实用性。结论中性粒细胞百分比升高、甘油三酯升高、总胆固醇升高、胰腺坏死与MSAP/SAP并发T3cDM有关,上述危险因素构建的列线图预测模型具有良好的区分度、校准度和临床实用性。Objective To analyze the risk factors for the development of type 3c diabetes mellitus(T3cDM)in patients with moderately severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP),and to construct and validate a predictive model.Methods Totally 411 patients with MSAP/SAP were selected and followed up for at least 3 months after the onset of acute pancreatitis(AP)to record the occurrence of T3cDM.Data were collected on general characteristics,laboratory parameters within 24 hours of admission,disease-related scores,and complications.Indicators with statistically significant differences between T3cDM and non-T3cDM patients were included in LASSO and multivariate Logistic regression analyses to identify independent risk factors for T3cDM in MSAP/SAP patients.A nomogram prediction model incorporating these independent risk factors was constructed and validated internally using bootstrap methods,receiver operating characteristic(ROC)curves,calibration curves,and Hosmer-Lemeshow goodness-of-fit tests.The clinical utility of the model was assessed using decision curve analysis(DCA).Results Among the 411 patients,113 developed T3cDM and 298 did not.Thirty-one indicators showed statistically significant differences between T3cDM and non-T3cDM patients.LASSO and multivariate Logistic regression analyses revealed that elevated neutrophil percentage,elevated triglycerides,elevated total cholesterol,and pancreatic necrosis were independent risk factors for T3cDM in MSAP/SAP patients(all P<0.05).The nomogram prediction model demonstrated high discriminative ability after 1,000 bootstrap internal validations.ROC curve analysis indicated good discrimination,and the calibration curve was close to the reference line.The Hosmer-Lemeshow goodness-of-fit test showed good model fit.DCA revealed high net benefit and clinical utility across a wide range of risk thresholds.Conclusions Elevated neutrophil percentage,elevated triglycerides,elevated total cholesterol,and pancreatic necrosis are associated with the development of T3cD

关 键 词：中度重症急性胰腺炎 重症急性胰腺炎 胰源性糖尿病 危险因素 列线图 

分 类 号：R576[医药卫生—消化系统]