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肾移植受者术后肺部感染风险预测模型的构建及效果评价

宫晶, 窦晓庆, 丁良成, 等. 肾移植受者术后肺部感染风险预测模型的构建及效果评价[J]. 器官移植, 2022, 13(3): 385-392. doi: 10.3969/j.issn.1674-7445.2022.03.016
引用本文: 宫晶, 窦晓庆, 丁良成, 等. 肾移植受者术后肺部感染风险预测模型的构建及效果评价[J]. 器官移植, 2022, 13(3): 385-392. doi: 10.3969/j.issn.1674-7445.2022.03.016
Gong Jing, Dou Xiaoqing, Ding Liangcheng, et al. Establishment and effect evaluation of risk prediction model for lung infection after kidney transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(3): 385-392. doi: 10.3969/j.issn.1674-7445.2022.03.016
Citation: Gong Jing, Dou Xiaoqing, Ding Liangcheng, et al. Establishment and effect evaluation of risk prediction model for lung infection after kidney transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(3): 385-392. doi: 10.3969/j.issn.1674-7445.2022.03.016

肾移植受者术后肺部感染风险预测模型的构建及效果评价

doi: 10.3969/j.issn.1674-7445.2022.03.016
基金项目: 

山东省自然科学基金 ZR2020MH128

潍坊医学院教育教学改革研究项目 2019YB010

潍坊医学院博士启动基金 2017BSQD58

详细信息
    作者简介:
    通讯作者:

    孟庆慧,女,1966年生,博士,教授,研究方向为临床护理、老年护理,Email:hui_m12@163.com

  • 中图分类号: R617, R619+.3

Establishment and effect evaluation of risk prediction model for lung infection after kidney transplantation

More Information
  • 摘要:   目的  探讨肾移植受者术后1年内发生肺部感染风险预测模型的构建及其预测价值。  方法  回顾性分析197例肾移植受者的临床资料,根据术后1年内是否发生肺部感染分为感染组(42例)和非感染组(155例)。分析肾移植术后肺部感染的发生情况及危险因素,利用多元logistic回归分析建立风险预测模型。选取符合标准的45例肾移植受者进行验证,其中感染组8例,非感染组37例,验证模型的预测效果。  结果  肾移植术后1年内肺部感染的发生率为21.3%(42例),其中肺炎严重指数(PSI)评级Ⅰ级38例(90%),Ⅲ级1例(2%),Ⅴ级3例(8%)。13例发生于术后1个月内,22例发生于术后2~6个月,7例发生于术后6个月后。细菌感染19例、真菌感染7例、病毒感染10例、混合感染6例。存在吸烟史、糖尿病史、肺部疾病史及白蛋白 < 35 g/L是肾移植受者术后发生肺部感染的独立危险因素(均为P < 0.05)。肾移植受者术后肺部感染风险预测模型方程为logit(肾移植受者术后1年内肺部感染)=-1.891+1.063×吸烟史(有=1,无=0)+1.398×糖尿病史(有=1,无=0)+1.732×肺部疾病史(有=1,无=0)+1.269×白蛋白(< 35 g/L=1,≥35 g/L=0),受试者工作特征(ROC)曲线下面积(AUC)为0.788,灵敏度为0.786,特异度为0.645,约登指数为0.431。Hosmer-Lemeshow拟合优度检验结果显示模型预测值和实际观测值间的一致度较好。验证组AUC为0.834,Hosmer-Lemeshow拟合优度检验结果显示模型校准度较好。  结论  以吸烟史、糖尿病史、肺部疾病史、白蛋白为预测因子构建的模型可有效预测肾移植受者术后1年内肺部感染的发生。

     

  • 图  1  模型组和验证组肾移植受者术后发生肺部感染的ROC曲线

    注:A图为模型组ROC曲线;B图为验证组ROC曲线。

    Figure  1.  ROC curves of postoperative pulmonary infection in kidney transplant recipients in model group and validation group

    表  1  肾移植术后发生肺部感染危险因素的单因素分析

    Table  1.   Univariate analysis of risk factors for pulmonary infection after kidney transplantation

    变量 感染组(n=42) 非感染组(n=155) 统计值 P 变量 感染组(n=42) 非感染组(n=155) 统计值 P
    年龄[M(P25P75),岁] 43(34,51) 42(34,48) 0.232 0.871 术前透析[n(%)] 0.000 1.000
    性别[n(%)] 0.287 0.592   有 41(98) 151(97)
      男 30(71) 117(75)   无 1(2) 4(3)
      女 12(29) 38(25) 术前诱导方案[n(%)] 0.436 0.509
    BMI[n(%)] 0.660 0.509   巴利昔单抗 8(19) 37(24)
       < 18 kg/m2 13(31) 54(35)   抗人T淋巴细胞球蛋白 34(81) 118(76)
      18~24 kg/m2 24(57) 88(57) 围手术期误吸[n(%)] 7.987 0.005
       > 24 kg/m2 5(12) 13(8)   有 5(12) 2(1)
    吸烟史[n(%)] 14.272 < 0.001   无 37(88) 153(99)
      有 22(52) 35(23) 术前使用抗菌药物[n(%)] 0.000 1.000
      无 20(48) 120(77)   有 42(100) 154(99)
    酗酒史[n(%)] 2.139 0.343   无 0 1(1)
      有 2(5) 19(12) 白细胞[n(%)] 1.048 0.295
      无 40(95) 136(88)    < 4×109/L 1(2) 3(2)
    原发疾病病程[n(%)] 1.183 0.237   4~10×109/L 21(50) 64(41)
       < 1年 3(7) 27(17)    > 10×109/L 20(48) 88(57)
      2~5年 21(50) 70(45) 淋巴细胞绝对值[n(%)] 0.714 0.475
       > 5年 18(43) 58(37)    < 0.8×109/L 39(93) 148(95)
    供者来源[n(%)] 0.436 0.509   0.8~3.5×109/L 2(5) 7(5)
      亲属活体 8(19) 37(24)    > 3.5×109/L 1(2) 0
      脑死亡供者 34(81) 118(76) 白蛋白[n(%)] 13.391 < 0.001
    高血压史[n(%)] 4.265 0.039    < 35 g/L 24(57) 42(27)
      有 33(79) 140(90)   ≥35 g/L 18(43) 113(73)
      无 9(21) 15(10) 血清肌酐[n(%)] 1.527 0.217
    糖尿病史[n(%)] 18.891 < 0.001   ≤110 μmoI/L 3(7) 3(2)
      有 14(33) 12(8)    > 110 μmoI/L 39(93) 152(98)
      无 28(67) 143(92) 供肾脓液培养病原菌[n(%)] 0.614 0.433
    肺部疾病史[n(%)] 10.311 0.001   有 21(50) 67(43)
      有 10(24) 9(6)   无 21(50) 88(57)
      无 32(76) 146(94)
    注:白细胞、淋巴细胞绝对值、白蛋白、血清肌酐均为肾移植术后第1次测量结果。
    下载: 导出CSV

    表  2  肾移植术后发生肺部感染危险因素的多因素分析

    Table  2.   Multivariate analysis of risk factors for pulmonary infection after kidney transplantation

    危险因素 偏回归系数 标准误 Wald χ2 P OR 95%CI
    常数项 -1.891 0.585 10.459 0.001 0.151 -
    吸烟史 1.063 0.423 6.329 0.012 2.896 1.265~6.633
    高血压史 -1.050 0.596 3.109 0.078 0.350 0.109~1.124
    糖尿病史 1.398 0.522 7.183 0.007 4.407 1.456~11.250
    肺部疾病史 1.732 0.567 9.342 0.002 6.121 1.861~17.156
    围手术期误吸 2.061 1.122 3.372 0.066 7.851 0.871~70.813
    白蛋白 < 35 g/L 1.269 0.425 8.917 0.003 3.566 1.546~8.178
    注:①OR为比值比。
          ②CI为可信区间。
          ③-为无数据。
    下载: 导出CSV

    表  3  模型组和验证组危险因素比较

    Table  3.   Comparison of risk factors between model group and validation group

    变量 模型组(n=197) 验证组(n=45) 统计值 P
    吸烟史[n(%)] 0.245 0.283
      有 57(29) 17(38)
      无 140(71) 28(62)
    糖尿病史[n(%)] 0.626 0.616
      有 26(13) 4(9)
      无 171(87) 41(91)
    肺部疾病史[n(%)] 0.596 0.687
      有 42(21) 8(18)
      无 155(79) 37(82)
    白蛋白[n(%)] 0.586 0.604
       < 35 g/L 66(34) 17(38)
      ≥35 g/L 131(66) 28(62)
    下载: 导出CSV
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  • 收稿日期:  2022-02-26
  • 网络出版日期:  2022-04-29
  • 刊出日期:  2022-05-15

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