基于中医证型的慢性肾脏病患者高钾血症风险预测模型构建和验证  

Construction and Validation of a Hyperkalemia Risk Prediction Model for Chronic Kidney Disease Patients Based on Traditional Chinese Medicine Syndrome Types

作　　者：谷梦磊 孙海彤 孙伟[1] 何伟明 许陵冬 张露 GU Menglei;SUN Haitong;SUN Wei;HE Weiming;XU Lingdong;ZHANG Lu(Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院/江苏省中医院,南京210029

出　　处：《世界中医药》2025年第3期454-459,共6页World Chinese Medicine

基　　金：国家自然科学基金面上项目(82374373);江苏省“六大人才高峰”高层次人才项目(WSN-021);江苏省中医肾病医学创新中心项目(苏卫科教〔2022〕15号)。

摘　　要：目的:建立一个基于中医证型的慢性肾脏病(CKD)患者高钾血症风险评估模型。方法:回顾性分析2020年1月至2022年12月在江苏省中医院肾内科门诊就诊的CKD3~5期非透析患者386例作为研究对象,按7∶3的比例分为训练集(270例)和验证集(116例)。采用单因素和多因素logistic回归分析CKD并发高钾血症的影响因素,构建风险评估模型,并用受试者操作特征(ROC)曲线、校准曲线和决策曲线分析(DCA)评价模型的效能。结果:血红蛋白、CKD分期、是否有糖尿病、心力衰竭史、是否服用肾素-血管紧张素-醛固酮系统抑制剂(RAASI)、中医证型是高钾血症的危险因素(P<0.05),根据这些因素建立了一个简单易用的风险评估模型,该模型在训练集和验证集中均表现出良好的区分度(验证集ROC:0.847,95%CI为0.793~0.910;训练集ROC:0.813,95%CI为0.724~0.902)、校准度和临床获益。结论:基于上述6个影响因素构建的列线图能较为准确预测CKD3~5期非透析患者发生高钾血症的风险。Objective:To develop a risk assessment model for hyperkalemia in chronic kidney disease(CKD)patients based on traditional Chinese medicine(TCM)syndrome types.Methods:A retrospective study was conducted on 386 non-dialysis CKD stage 3 to 5 patients who visited the Nephrology Department of Jiangsu Province Hospital of Chinese Medicine from January 2020 to December 2022.Patients were randomly divided into a training set(n=270)and a validation set(n=116)in a 7∶3 ratio.Univariate and multivariate logistic regression analyses were performed to identify risk factors for hyperkalemia in CKD patients,and a risk assessment model was constructed.The performance of the model was evaluated using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results:Hemoglobin levels,CKD stage,presence of diabetes,history of heart failure,use of renin-angiotensin-aldosterone system inhibitors(RAASI),and TCM syndrome types were identified as significant risk factors for hyperkalemia(P<0.05).A simple and practical risk assessment model was developed based on these factors.The model demonstrated good discrimination in both the training set(ROC:0.813,95%CI 0.724 to 0.902)and the validation set(ROC:0.847,95%CI 0.793 to 0.910),along with good calibration and clinical benefit.Conclusion:The nomogram based on six key risk factors provides an accurate prediction of hyperkalemia risk in non-dialysis CKD stage 3 to 5 patients,offering a valuable tool for clinical risk stratification and management.

关 键 词：慢性肾脏病 高钾血症 中医证型 预测模型 列线图 临床研究 非透析 

分 类 号：R259[医药卫生—中西医结合]