胡蜂蜇伤致急性呼吸窘迫综合征风险预测模型的构建  

Construction of a prediction model for risk of acute respiratory distress syndrome caused by wasp stings

作　　者：罗龚斌 陈玥璇 彭伟献[1] LUO Yanbin;CHEN Yuexuan;PENG Weixian(Department of Emergency,Hangzhou Municipal Hospital of Traditional Chinese Medicine,Hangzhou,Zhejiang 310007,China)

机构地区：[1]杭州市中医院急诊科,浙江杭州310007

出　　处：《中国工业医学杂志》2025年第1期10-13,共4页Chinese Journal of Industrial Medicine

摘　　要：目的 分析胡蜂蜇伤致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的危险因素并构建列线图风险预测模型。方法 收集2020—2023年杭州市中医院病房及重症监护室收治的胡蜂蜇伤患者,根据胡蜂蜇伤后是否发生ARDS分为ARDS组和非ARDS组,分别采用单因素和多因素logistic回归分析筛选ARDS发生的独立危险因素,构建列线图预测模型。结果 本研究共纳入符合入组标准的病例236例,其中ARDS组93例、非ARDS组143例,单因素及多因素logistic回归分析显示,蜂蜇伤≥20针、肉眼血尿或无尿、活化部分凝血活酶时间(APTT)增加以及天门冬氨酸氨基转移酶(AST)升高,为胡蜂蜇伤并发ARDS的独立危险因素(OR>1);基于此4项独立危险因素构建胡蜂蜇伤致ARDS的预测模型并绘制列线图。预测模型特征曲线下面积(area under the curve,AUC)为0.800(95%CI 0.742~0.858),提示模型有很好的区分度;采用Bootstrap法重复抽样1 000次对模型进行内部验证并绘制校准曲线,结果显示平均AUC为0.806(95%CI 0.746~0.859),校准曲线与理想曲线基本重合,Hosmer-Lemeshow检验示P>0.05,说明预测模型与理想模型有较好拟合度。结论 基于蜂蜇伤≥20针、肉眼血尿或无尿、APTT增加、AST升高4项危险因素构建的胡蜂蜇伤致ARDS风险预测模型具有良好的区分度、校准度和临床实用性,有助于临床早期评估ARDS的发生风险。Objective To analyze the risk factors of acute respiratory distress syndrome(ARDS)caused by wasp stings and construct a column chart risk prediction model.Methods Collect the data of patients with wasp stings admitted to the wards or ICU of Hangzhou Municipal Hospital of Traditional Chinese Medicine from 2020 to 2023,divided them into ARDS group and non-ARDS group based on whether ARDS occurred after wasp stings,then using single factor and multiple factor logistic regression analyses respectively to screen independent risk factors for ARDS occurrence and construct a column chart prediction model.Results A total of 236 cases that met the inclusion criteria were included,including 93 cases in the ARDS group and 143 cases in the non-ARDS group,univariate and multivariate logistic regression analysis suggested that stings ≥20 times,gross hematuria or anuria,prolonged activated partial thromboplastin time(APTT) prolonged,and elevated aspartate aminotransferase(AST) were the independent risk factors for ARDS caused by wasp stings(OR>1),based on these four independent risk factors,a prediction model for ARDS caused by wasp stings was constructed and the column chart was drawn as well.The area under the curve(AUC) was 0.800(95%CI 0.742~0.858),indicating that the model had good discriminability.The Bootstrap method was used for 1 000 times repeated sampling to internally validate the model and draw a calibration curve,the results showed that the average AUC verified by the Bootstrap method was 0.806(95%CI 0.746~0.859).The calibration curve basically coincident with the ideal curve,the Hosmer-Lemeshow test showed the P>0.05,indicating that the prediction model had a good fit with the ideal model.Conclusion The results suggested that the prediction model for ARDS caused by wasp stings based on four risk factors including ≥20 stings,gross hematuria or anuria,proloned APTT,and rised AST had good discrimination,calibration,and clinical practicality,which were helpful for early assessment of the risk of ARDS in clinical pr

关 键 词：胡蜂蜇伤 急性呼吸窘迫综合征(ARDS) 列线图 预测模型 

分 类 号：R595.8[医药卫生—内科学]