急性胰腺炎患者发生全身炎症反应综合征的危险因素分析及预测列线图构建  

Risk factors for SIRS in patients with acute pancreatitis and construction of a predictive nomogram

作　　者：澹会芳 樊冰雨 王勇[1] 高晓 郑研艳 樊智辉 冯军安[1] 杨丽[1] TAN Huifang;FAN Bingyu;WANG Yong;GAO Xiao;ZHENG Yanyan;FAN Zhihui;FENG Jun'an;YANG Li(The Fifth Clinical Medical College,Henan University of Chinese Medicine(Zhengzhou People's Hospital),Zhengzhou 450000,China;不详)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)消化内科,河南郑州450000 [2]郑州大学附属郑州中心医院消化内科,河南郑州450000 [3]河南科技大学数学与统计学院信息与计算科学系,河南洛阳471000

出　　处：《山东医药》2025年第3期69-73,共5页Shandong Medical Journal

基　　金：河南省科技攻关项目(242102310103);河南省高等学校重点科研项目(25B110011)。

摘　　要：目的分析急性胰腺炎(AP)患者发生全身炎症反应综合征(SIRS)的危险因素,并构建AP患者发生SIRS的预测列线图。方法AP患者112例,根据患者是否发生SIRS分为非SIRS组92例和SIRS组20例。收集两组患者的性别、年龄、体质量、合并症、吸烟史、饮酒史、既往病史、C反应蛋白、降钙素原(PCT)、血清淀粉酶、血清脂肪酶、D二聚体、预后营养指数、系统免疫炎症指数(SII)等资料。以单因素分析有统计学差异的指标为自变量,以AP患者发生SIRS为因变量,构建二元Logistic回归模型,分析AP患者发生SIRS的危险因素。采用R软件中的rms程序包建立列线图预测模型,绘制AP患者发生SIRS预测列线图的受试者工作特征(ROC)曲线及Hosmer-Lemeshow检验评估模型的预测性能,绘制校准曲线评估列线图的校准度。结果非SIRS组年龄、合并高脂血症者、PCT水平、D二聚体水平、SII与SIRS组相比,P均<0.05。Logistic多因素回归分析结果显示,年龄高、SII高、PCT水平高、D二聚体水平高是AP患者发生SIRS的独立危险因素(P均<0.05),据此构建了AP患者发生SIRS的预测列线图,预测列线图的ROC曲线下面积为0.832(95%CI:0.739~0.927),灵敏度为80.0%、特异度为73.9%。结论年龄高、SII高、PCT水平高、D二聚体水平高是AP患者发生SIRS的独立危险因素,基于上述危险因素构建的预测列线图对AP患者发生SIRS具有较高的预测价值。Objective To analyze the risk factors for the occurrence of systemic inflammatory response syndrome(SIRS)in patients with acute pancreatitis(AP)and to construct a prediction nomogram for SIRS in AP patients.Methods Totally 112 AP patients were divided into the non-SIRS group(92 cases)and SIRS group(20 cases)based on whether they developed SIRS.Data on gender,age,body mass index(BMI),comorbidities,smoking history,alcohol history,past medical history,C-reactive protein,procalcitonin(PCT),serum amylase,serum lipase,D-dimer,prognostic nutritional index,and systemic immune-inflammation index(SII)were collected from patients of both groups.Statistical analysis was performed using univariate analysis to identify variables with significant differences;with SIRS occurrence in AP patients as the dependent variable and the identified variables as independent variables,a binary Logistic regression model was constructed to analyze the risk factors for SIRS in AP patients.The rms package in R software was used to establish the nomogram prediction model.The receiver operating characteristic(ROC)curve and Hosmer-Lemeshow test were used to evaluate the predictive performance of the model,and a calibration curve was generated to assess the calibration of the nomogram.Results Compared with the SIRS group,the non-SIRS group had younger age,fewer cases of hyperlipidemia,lower PCT levels,lower D-dimer levels,and lower SII(all P<0.05).Logistic multivariate regression analysis showed that advanced age,higher SII,higher PCT levels,and higher D-dimer levels were independent risk factors for SIRS in AP patients(all P<0.05).Based on these risk factors,a prediction nomogram for SIRS in AP patients was constructed,with an area under the ROC curve of 0.832(95%CI:0.739-0.927),sensitivity of 80.0%,and specificity of 73.9%.Conclusions Advanced age,higher SII,higher PCT levels,and higher D-dimer levels are independent risk factors for SIRS in AP patients.The prediction nomogram constructed based on these risk factors has high predictive value for

关 键 词：胰腺炎 急性胰腺炎 全身炎症反应综合征 预测列线图 

分 类 号：R576[医药卫生—消化系统]