慢性荨麻疹病人生活质量的影响因素分析及Nomogram预测模型构建

Impact of quality of life in patients with chronic urticaria:analysis of factors and construction of a Nomogram prediction model

目的 探讨影响慢性荨麻疹病人生活质量的因素并构建Nomogram预测模型。方法 回顾性分析2019年6月至2021年12月于张家港第一人民医院和合作医院就诊的符合纳入、排除标准的631例慢性荨麻疹病人的临床资料,根据WHOQOLBREF问卷评分分为低生活质量组(n=188)和高生活质量组(n=443)。收集并分析病人的临床资料,探索影响慢性荨麻疹病人生活质量的相关因素;绘制受试者操作特征曲线(ROC曲线),分析各影响因素预测慢性荨麻疹病人生活质量的曲线下面积和最佳截断值;采用logistic多元回归模型分析影响慢性荨麻疹病人生活质量的独立危险因素;采用R语言软件4.0“rms”包构建预测慢性荨麻疹病人生活质量的Nomogram模型,校正曲线对Nomogram模型进行内部验证,决策曲线对Nomogram模型的预测效能进行评估。结果 低生活质量组在医疗费用负担形式、皮肤划痕症、血管性水肿、发作频率、病程、风团持续时间、视觉模拟评分(VAS)方面与高生活质量组差异有统计学意义(P<0.05)。发作频率、病程、风团持续时间、VAS评分的AUC分别为0.76、0.71、0.69、0.68,最佳截断值分别为6次、47月、13 h、6分。皮肤划痕症(是)、血管性水肿(是)、发作频率(>6次)、病程(>47月)、风团持续时间(>13 h)、VAS评分(>6分)是影响慢性荨麻疹病人生活质量的独立危险因素。内部验证结果显示,Nomogram模型预测影响慢性荨麻疹病人生活质量的C-index为0.72,95%CI:(0.64,0.77),校准曲线显示观测值与预测值之间保持较好一致性。Nomogram模型预测影响慢性荨麻疹病人生活质量的阈值>0.21,Nomogram模型提供临床净收益;此外,Nomogram模型临床净收益均高于皮肤划痕症、血管性水肿、发作频率、病程、风团持续时间、VAS评分。结论 该研究基于皮肤划痕症、血管性水肿、发作频率、病程、风团持续时间、VAS评分构建了预测慢性荨麻疹病人生活质量的Nomogram模型,该模型可探查影响慢性荨麻疹病人生活质量的相关因素,有助于早期干预,改善病人生活质量。

Objective To explore the factors affecting the quality of life in patients with chronic urticaria and to construct a nomogram prediction model.Methods The clinical data of 631 chronic urticaria patients who met the inclusion and exclusion criteria and were divided into low quality of life(n=188)and high quality of life(n=443)groups according to the WHOQOL-BREF questionnaire scores between June,2019 and December,2021 in the First People's Hospital of Jiagang and collaborating hospitals were retrospective‐ly reviewed.The clinical data of the patients were collected and analyzed to explore the related factors affecting the quality of life in pa‐tients with chronic urticaria;Receiver operating characteristic(ROC)curves were drawn to analyze the area under the curve and opti‐mal cutoff values for each influencing factor in predicting QOL in chronic urticaria patients;Logistic multiple regression models were used to analyze independent risk factors affecting the quality of life of patients with chronic urticaria;The R language software 4.0"RMS"package was used to construct the nomogram model to predict the quality of life of patients with chronic urticaria,the calibra‐tion curve to perform internal validation of the nomogram model,and the decision curve to evaluate the predictive efficacy of the nomo‐gram model.Results The low QOL group differed significantly(P<0.05)from the high QoL group in the form of healthcare cost bur‐den,skin scratch,angioedema,attack frequency,disease duration,wheal duration,VAS score.The AUCs of seizure frequency,disease duration,wheal duration,and VAS score were 0.76,0.71,0.69,0.68 and the optimal cutoff values were 6 times,47 months,13 hours,and 6 points,respectively.Scratch skin(yes),angioedema(yes),frequency of attacks(>6 episodes),disease duration(>47 months),du‐ration of wheal(>13 h),and VAS score(>6 points)were independent risk factors affecting the quality of life of patients with chronic urti‐caria.Internal validation results showed that the nomogram model predicted a c-index of 0.72,95%CI:(0.64,0.77)affecting quality of life in patients with chronic urticaria,and the calibration curve showed good agreement between observed and predicted values.The no‐mogram model predicted a threshold of>0.21 for influencing QOL in patients with chronic urticaria,and the nomogram model provided a net clinical benefit;In addition,the nomogram model clinical net benefit was higher than that of skin scratch,angioedema,seizure fre‐quency,disease duration,wheal duration,and VAS score.Conclusion In the study,a nomogram model for predicting QOL in patients with chronic urticaria was constructed based on skin scarification,angioedema,attack frequency,disease duration,wheal duration,and VAS score,and this model can explore the factors related to the QOL of patients with chronic urticaria,which may facilitate early clini‐cal intervention and improve the QOL of patients.