结核性腹膜炎患者肝被膜结核风险诺莫图模型建立与验证

Establishment and verification of the Nomogram model for the risk of hepatic capsule tuberculosis in patients with tuberculous peritonitis

  • 摘要: 目的:探讨结核性腹膜炎(TBP)患者肝被膜结核发生影响因素,以期确定合理防治措施,降低肝被膜结核发生率。方法:选取2018 年1 月至2023 年1 月黑龙江省传染病防治院收治的202 例TBP 并发肝被膜结核患者作为研究组,同期按照性别、年龄、体重指数1∶1匹配202例TBP患者作为对照组。对比两组一般资料、实验室指标、超声表现等,采用Lasso回归筛选变量,以筛选出的变量建立logistic回归模型,绘制诺莫图模型,采用受试者工作特征曲线(ROC)、校准曲线评价诺莫图模型的区分能力和准确性。结果:两组病程、天冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)比值、红细胞沉降率(ESR)、总胆红素(TBIL)、总蛋白(TP)、白蛋白(ALB)、腺苷脱氨酶(ADA)、糖链抗原125(CA125)、腹水、腹水内回声特点、腹膜壁层增厚呈片状、肠壁增厚黏连比较,差异均有统计学意义(均P< 0.05)。Lasso-logistic 回归方程显示,CA125、ADA、AST/ALT、腹水、腹膜壁层增厚呈片状、肠壁增厚黏连是TBP 并发肝被膜结核影响因素(P< 0.05)。基于Lasso-logistic 回归方程筛选影响因素构建TBP并发肝被膜结核诺莫图模型,预测灵敏度、特异度分别为82.67%、74.25%,且该模型预测结果与实际观察结果之间有较好的相关性。结论:CA125、ADA、AST/ALT、腹水、腹膜壁层增厚呈片状、肠壁增厚黏连均为TBP 患者肝被膜结核的影响因素,基于上述影响构建的诺莫图模型具有良好的预测效能。

     

    Abstract: Objective: To investigate the influencing factors of hepatic capsule tuberculosis in patients with tuber-culous peritonitis (TBP), so as to determine reasonable prevention and treatment measures and reduce the inci-dence of hepatic capsule tuberculosis.Methods: A total of 202 patients with TBP complicated with hepatic hepat-ic tuberculosis admitted to Heilongjiang Institute of Infectious Diseases Prevention and Control from January 2018 to January 2023 were taken as the study group, while 202 patients with TBP were matched 1∶1 according to gender, age and body mass index as the control group.The general data, laboratory indicators and ultrasonic mani-festations of the two groups were compared, variables were screened by Lasso regression, and a logistic regres-sion model was established based on the selected variables.The Nomogram model was drawn, and the distinction ability and accuracy of Nomogram model were evaluated by receiver operating characteristic (ROC) curve and calibration curve.Results: There were significant differences in the course of desease, aspartate aminotransferase(AST)/alanine aminotransferase (ALT) ratio, erythrocyte sedimentation rate (ESR), total bilirubin (TBIL), total protein (TP), albumin (ALB), adenosine deaminase (ADA), carbohydrate antigen 125 (CA125), ascites, echo characteristics in ascites, lamina-like thickening of peritoneum, and thickening and adhesion of intestinal wall be-tween the two groups (all P< 0.05).Lasso-logistic regression equation showed that CA125, ADA, AST/ALT, ascites, lamina-like thickening of peritoneum, and thickening and adhesion of intestinal wall were the influencing factors of TBP complicated with hepatic capsule tuberculosis(P< 0.05).Based on the Lasso-logis-tic regression equation, the Nomogram model of TBP complicated with hepatic capsule tuberculosis was con-structed.The prediction sensitivity and specificity were 82.67% and 74.25%, respectively, and there was a good correlation between the prediction results of this model and the actual observation results.Conclusion: CA125, ADA, AST/ALT, ascites, lamina-like thickening of peritoneum, and thickening and adhesion of intestinal wall are the influencing factors of hepatic capsule tuberculosis in TBP patients.The Nomograph model built based on the above influences has good predictive efficacy.

     

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