摘要
目的分析中青年维持性血液透析(MHD)患者发生肌少症的危险因素,建立风险预测模型并进行验证。方法选取2020年9—12月连云港市第一人民医院收治的中青年MHD患者339例,采用简单随机法,并按7∶3的比例分为建模组(n=237)和验证组(n=102)。采用多因素Logistic回归模型分析建模组数据,筛选中青年MHD患者肌少症的独立危险因素并建立风险预测模型。应用Hosmer-Lemeshow检验评价该模型的拟合程度,应用受试者工作特征(ROC)曲线评估模型的鉴别力。选取验证组患者资料,应用ROC曲线检验模型预测效果。结果本研究最终纳入体质量指数(BMI)(OR=0.742,95%CI=0.612~0.899)、上臂肌围(OR=0.767,95%CI=0.595~0.988)和血红蛋白(OR=0.975,95%CI=0.951~0.999)3个危险因素构建风险预测模型,模型方程为:Z=-0.298×BMI-0.265×上臂肌围-0.025×血红蛋白。建模组Hosmer-Lemeshow卡方检验结果显示模型有较好的拟合程度(χ^(2)=14.954,P=0.060),ROC曲线的曲线下面积为0.862(95%CI=0.792~0.932)。验证组ROC曲线的曲线下面积为0.866(95%CI=0.788~0.943),灵敏度、特异度分别为89.5%、74.7%,约登指数为0.642。结论本研究基于BMI、上臂肌围和血红蛋白3个指标构建的中青年MHD患者肌少症预测模型具有较高的预测价值,所需指标获取简单、方便,可为临床评估提供可靠依据。
Objective To analyze the risk factors of sarcopenia in young and middle-aged patients with maintenance hemodialysis(MHD),and to establish and verify the risk prediction model.Methods A total of 339 young and middle-aged MHD patients in the First People′s Hospital of Lianyungang City from September to December 2020 were selected,and were divided into modeling group(n=237)and verification group(n=102)in a ratio of 7∶3 by the simple random method.Multivariate Logistic regression model was used to analyze the data of the modeling group,the independent risk factors of sarcopenia in young and middle-aged MHD patients were screened,and a risk prediction model was established.The Hosmer-Lemeshow test was used to evaluate the fitting degree of the model,and the receiver operating characteristics(ROC)curve was used to evaluate the identification ability of the model.The data of the patients in the validation group were selected,and the ROC curve was used to test the prediction effect of the model.Results In this study,the body mass index(BMI)(OR=0.742,95%CI,0.612~0.899),upper arm muscle circumference(OR=0.767,95%CI,0.595~0.988)and hemoglobin(OR=0.975,95%CI,0.951~0.999)were included to construct a risk prediction model finally,and the model equation was:Z=-0.298×BMI-0.265×upper arm muscle circumference-0.025×hemoglobin.The Hosmer-Lemeshow chi square test result of the modeling group showed that the model had a good fitting degree(χ^(2)=14.954,P=0.060),and the area under the curve of ROC curve was 0.862(95%CI,0.792~0.932).The area under the curve of ROC curve in the verification group was 0.866(95%CI,0.788~0.943),the sensitivity and specificity were 89.5%and 74.7%respectively,and the Youden index was0.642.Conclusion In this study,the prediction model of sarcopenia for young and middle-aged MHD patients based on BMI,upper arm muscle circumference and hemoglobin has high prediction value,and the required indicators are easy and convenient to obtain,which can provide a reliable basis for clinical evaluation.
作者
周起帆
尹丽霞
张海林
鲍凤香
ZHOU Qifan;YIN Lixia;ZHANG Hailin;BAO Fengxiang(Center of Blood Purification,Lianyungang Clinical Medical College of Nanjing Medical University,Lianyungang,Jiangsu,222000;Department of Nursing,Lianyungang Clinical Medical College of Nanjing Medical University,Lianyungang,Jiangsu,222000)
出处
《实用临床医药杂志》
CAS
2022年第5期44-47,53,共5页
Journal of Clinical Medicine in Practice
基金
2020年度江苏省第五期“333工程”科研资助项目(BRA2020258)
2020年度连云港市妇幼健康科研项目(F202001)。
关键词
维持性血液透析
肌少症
体质量指数
上臂肌围
血红蛋白
预测模型
maintenance hemodialysis
sarcopenia
body mass index
upper arm muscle circumference
hemoglobin
prediction model