基于骨髓淋巴细胞比例构建预测免疫性血小板减少症预后的Nomogram模型

Construction of a Nomogram model to predict prognosis of immune thrombocytopenia based on bone marrow lymphocyte ratio

目的 探讨骨髓淋巴细胞比例对免疫性血小板减少症(ITP)预后的影响,并构建影响ITP预后的Nomogram模型。方法 选取2018年1月至2023年1月收治于浙江省医疗健康集团衢州医院的200例ITP患者作为研究对象,根据预后情况分为观察组(预后差)和对照组(预后好)。记录两组患者的基线资料,分析影响预后的危险因素,并据此建立Nomogram模型;采用校准曲线以及内部数据验证模型临床效能。结果 与对照组比较,观察组抗核抗体阳性者、年龄较大、出血评分>2分者较多,病程较长,血小板计数(PLT)较高,骨髓淋巴细胞比例较低,差异均有统计学意义(χ~2=77.74,t分别=5.49、40.69、2.44、3.69、-6.48,P均<0.05);年龄、病程、PLT、骨髓淋巴细胞比例的AUC分别为0.73、0.59、0.64、0.71;年龄(>39岁)、抗核抗体(阳性)、病程(>25个月)、PLT(>29.04×10~9/L)、出血评分(>2分)、骨髓淋巴细胞比例(≤17.50%)是影响ITP患者预后的危险因素(OR分别=1.98、2.11、1.69、1.77、1.89、2.38,P均<0.05);内部验证结果显示,Nomogram模型预测ITP患者预后的风险C-index为0.74(95%CI 0.65~0.83);Nomogram模型的风险阈值>0.12,Nomogram模型提供临床净收益。结论 骨髓淋巴细胞比例可以预测ITP患者预后,年龄(>39岁)、抗核抗体(阳性)、病程(>25个月)、PLT(>29.04×10~9/L)、出血评分(>2分)、骨髓淋巴细胞比例(≤17.5%)是影响ITP患者预后的危险因素,且基于变量构建的Nomogram模型对ITP患者预后有较好的预测。

Objective To investigate the effect of bone marrow lymphocyte ratio on the prognosis of immune thrombo-cytopenia(ITP),and to construct a Nomogram model affecting the prognosis of ITP.Methods Two hundred ITP pa-tients admitted to Quzhou Hospital of Zhejiang Medical and Healthcare Group from January 2018 to January 2023 were selected as the study subjects,and the baseline data of the patients were recorded to analyze the risk factors affecting the prognosis,and the Nomogram model was established accordingly.Calibration curves and internal data were used to validate the model's clinical efficacy.Results Compared with the control group,the observation group had a higher per-centage of positive antinuclear antibodies,older age,and bleeding score>2,longer disease duration,higher PLT,and lower bone marrow lymphocyte proportion(χ2=77.74,t=5.49,40.69,2.44,3.69,-6.48,P<0.05).The AUCs of age,dis-ease duration,PLT,and bone marrow lymphocyte proportion were 0.73,0.59,0.64,and 0.71.The age(>39 years),antinuclear antibodies(positive),disease duration(>25 months),PLT(>29.04×109/L),hemorrhage score(>2),and bone marrow lymphocyte proportion(≤17.50%)were risk factors affecting ITP patients'prognosis(OR=1.98,2.11,1.69,1.77,1.89,2.38,P<0.05).Internal validation showed that the Nomogram model predicted patients'prognosis with a risk C-index of 0.74(95%CI 0.65-0.83).The risk threshold for the Nomogram model was>0.12,and the Nomogram model provided a net clinical benefit.Conclusion The bone marrow lymphocyte ratio predicted patient prognosis,and age(>39 years),antinuclear antibody(positive),disease duration(>25 months),PLT(>29.04×109/L),bleeding score(>2 points),and bone marrow lymphocyte ratio(≤17.5%)were risk fac-tors affecting patient prognosis,and the Nomogram model constructed based on the variables had a better prediction of pa-tient prognosis.