| 金宇欣,洪波,王润秀,等.腹膜透析相关性腹膜炎危险因素及风险预测模型的构建[J].安徽医药,2026,30(1):149-154. |
| 腹膜透析相关性腹膜炎危险因素及风险预测模型的构建 |
| Risk factors and prediction model for peritoneal dialysis-associated peritonitis |
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| DOI：10.3969/j.issn.1009-6469.2026.01.030 |
| 中文关键词: 腹膜透析 腹膜炎 危险因素 预测模型 列线图 |
| 英文关键词: Peritoneal dialysis Peritonitis Risk factor Forecasting model Nomogram |
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| 中文摘要: |
| 目的探讨腹膜透析相关性腹膜炎的危险因素，并建立风险预测列线图模型。方法收集 2018年 1月至 2022年 12月于赣南医学院第一附属医院首次行腹膜透析置管的 531例透析病人临床资料。根据病人随访期间是否发生腹膜透析相关性腹膜炎分为非腹膜炎组( 400例)和腹膜炎组( 131例)。采用单因素分析两组一般资料及实验室检查结果，将差异有统计学意义的变量纳入多因素 logistic回归模型，根据结果构建可视化的列线图模型并评估模型的效能。结果与非腹膜透析相关性腹膜炎组病人相比，腹膜透析相关性腹膜炎组病人血红细胞计数［(3.45±0.82)×109/L比( 3.65±0.74)×109/L］、血红蛋白［(95.35±19.06)g/L比(103.16±20.11)g/L］明显降低(P<0.05)，血白蛋白、甘油三酯及血钙降低，而血白细胞计数、中性粒细胞与淋巴细胞比值、血尿酸、血磷及 C反应蛋白明显升高( P<0.05)。多因素分析显示腹膜透析龄、中性粒细胞与淋巴细胞比值及 C反应蛋白是腹膜透析相关性腹膜炎发生的独立危险因素，而血红蛋白是其保护性因素( P<0.05)。风险预测列线图模型曲线下面积为 0.77；Hosmer-Lemeshow检验结果显示 χ2=3.90(P=0.866)；校准曲线与理想曲线相接近，模型准确性较高；决策曲线分析显示模型预测概率阈值为 0.09~0.78时临床获益较好。结论基于腹膜透析龄、中性粒细胞与淋巴细胞比值、血红蛋白、 C反应蛋白构建的风险预测列线图模型有较好的预测效能，可为临床尽早识别腹膜透析病人发生腹膜透析相关性腹膜炎提供理论依据。 |
| 英文摘要: |
| Objective To explore the risk factors for peritoneal dialysis-associated peritonitis (PDAP) and to establish a risk prediction nomogram model.Methods The clinical data of 531 dialysis patients, who underwent their first peritoneal dialysis catheterization at Af-filiated Hospital of Gannan Medical University from January 2018 to December 2022, were collected. Based on whether PDAP occurredduring the follow-up period, the patients were assigned to non-peritoneal dialysis-associated peritonitis group (n=400) or peritoneal dialy-sis-associated peritonitis group (n=131). Univariate analysis was performed to analyze the clinical data and laboratory results of the twogroups before statistically significant variables were included in the multivariate logistic regression model. According to the results, a vi-sual nomogram model was constructed and the effectiveness of the model was evaluated.Results Compared with non-peritoneal dialysis-associated peritonitis group, red blood cell count [(3.45±0.82)×109/L vs. (3.65±0.74)×109/L], hemoglobin [(95.35±19.06) g/L vs. (103.16± 20.11) g/L], serum albumin, triglyceride and serum calcium in peritoneal dialysis-associated peritonitis group were significantly de-creased, while white blood cell count, neutrophil-to-lymphocyte ratio, serum uric acid, serum phosphorus and C-reactive protein were sig-nificantly increased ( P < 0.05 ). Multivariate analysis results showed that peritoneal dialysis age, neutrophil-to-lymphocyte ratio, and C-reactive protein were independent risk factors for PDAP, and hemoglobin was a protective factor (P<0.05). The area under the ROC curve of risk prediction nomogram model was 0.77. The results of Hosmer-Lemeshow test indicated that χ2=3.90 (P=0.866); the calibrationcurve was close to the ideal curve, and the accuracy of the model was high. The decision curve analysis showed that the clinical benefitwas better when the predictive probability threshold of the model was set between 0.09 and 0.78.Conclusion The risk prediction nomo-gram model based on PD age, neutrophil-to-lymphocyte ratio, hemoglobin and C-reactive protein has good predictive efficacy, which can provide a theoretical basis for early identification of peritoneal dialysis-associated peritonitis in peritoneal dialysis patients. |
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