| 孙思雨,朱莹莹,张甜甜.老年肺部细菌感染合并真菌感染的危险因素及其风险预测模型构建[J].安徽医药,2026,30(4):704-711. |
| 老年肺部细菌感染合并真菌感染的危险因素及其风险预测模型构建 |
| Risk factors and risk prediction model construction for bacterial and fungal pulmonary infections in older adult patients |
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| DOI：10.3969/j.issn.1009-6469.2026.04.014 |
| 中文关键词: 呼吸道感染 重叠感染 肺部细菌感染 肺部真菌感染 列线图 预测模型 危险因素 |
| 英文关键词: Respiratory tract infections Superinfection Pulmonary bacterial infection Pulmonary fungal infection Nomo-gram Prediction model Risk factors |
| 基金项目:国家自然科学基金青年科学基金培育计划项目( 2019kj05) |
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| 中文摘要: |
| 目的探讨老年肺部细菌感染合并真菌感染的危险因素，建立预测模型为病人肺部真菌感染的预测提供参考。方法收集 2022年 11月 1日至 2024年 2月 20日于安徽医科大学第一附属医院的 415例老年肺部细菌感染病人的临床资料进行回顾分析，其中合并肺部真菌感染的病人纳入病例组( n=186)未合并肺部真菌感染的病人纳入对照组( n=229)分析病例组病人肺部真菌感染病原菌分布特征，采用 logistic回归分析探究病，人肺部真菌感染危险因素，采用 LASSO回归分析筛，选潜在影响因素；基于危险因素的回归系数构建风险预测模型，最后在训练集及验证集分别通过绘制受试者操作特征曲线( ROC曲线)、校准曲线、决策曲线评价模型的区分度、校准度及有效性进行内部验证与预测效能评估。结果将数据拆分为训练集( 70%)、验证集( 30%)。采用 LASSO回归模型筛选出潜在的影响因素:呼吸道慢性炎症、使用糖皮质激素、吸烟史、 1，3-β-D-葡聚糖检测、半乳甘露聚糖检测、中性粒细胞与淋巴细胞比值、动脉血氧分压。多因素 logistic回归分析结果显示:呼吸道慢性炎症、使用糖皮质激素、 1，3-β-D-葡聚糖检测、吸烟史、中性粒细胞与淋巴细胞比值、低蛋白血症(均 P<0.05)。基于这 6个影响因素构建列线图模型， ROC曲线构建预测模型的训练集和验证集的曲线下面积分别为 0.82［95%CI:(0.77，0.87)］和 0.82［95%CI:(0.75，0.90)］。训练集和验证集中的校准曲线显示，列线图预测的真菌感染概率与实际情况相符。而决策曲线分析( DCA)结果表明该列线图预测模型具有较好的临床实用性。结论老年病人肺部细菌感染合并肺部真菌感染的危险因素与呼吸道慢性炎症、使用糖皮质激素、低蛋白血症、吸烟史有关，鉴于这些危险因素，构建的列线图对老年病人肺部细菌感染合并真菌感染的风险进行评估和预测具有良好效能。 |
| 英文摘要: |
| Objective To investigate the risk factors of combined bacterial and fungal pulmonary infections in elderly patients, andestablish a model for the prediction of fungal pulmonary infection.Methods The clinical data of 415 elderly patients who were treatedfor bacterial pulmonary infections at the First Affiliated Hospital of Anhui Medical University from November 1, 2022 to February 20,2024 were collected for retrospective analysis. Patients with additional fungal pulmonary infections were included in the case group(n = 186), while those without fungal infections formed the control group (n = 229). The distribution and characteristics of pathogenicbacteria associated with fungal pulmonary infections in the case group were analyzed, the risk factors for fungal pulmonary infectionswere explored using logistic regression analysis, and the potential influencing factors were identified using LASSO regression analysis.A risk prediction model was constructed based on the regression coefficients of the risk factors. Finally, in the training set and the vali-dation set, the internal validation and prediction efficacy were evaluated by drawing the receiver's operating characteristic curve (ROCcurve), the calibration curve, the calibration curve, the calibration degree and the validity of the evaluation model.Results The pa-tients were randomly divided into a training set (70%) and a validation set (30%). LASSO regression analysis was used to identify poten-tial influencing factors, including chronic respiratory tract inflammation, glucocorticoid use, smoking history, 1,3-beta-Dglucan, Galac-tomannan assay, neutrophil-to-lymphocyte, and arterial blood oxygen partial pressure. Multivariate logistic regression analysis showedthat chronic respiratory inflammation, glucocorticoid use, 1,3-beta-Dglucan, smoking history, neutrophil-to-lymphocyte, and hypopro-teinemia (all P < 0.05). A nomogram model was constructed based on these six influencing factors, and the area under the curve (AUC) values for the ROC curves for the training and validation sets were 0.82 [95%CI: (0.77, 0.87)] and 0.82 [95%CI: (0.75, 0.90)], respec-tively. The calibration curves in the two sets showed that the probability of fungal infection predicted by the nomogram was consistentwith the actual situation. The decision curve analysis results indicated that the model had good clinical practicability. Conclusions The risk factors of pulmonary bacterial infection combined with pulmonary fungal infection in elderly patients are related to chronic re-spiratory inflammation, glucocorticoid use, hypoproteinemia, and smoking history. Given these risk factors, the constructed nomogramhas a good efficacy for assessing and predicting the risk of pulmonary bacterial infection combined with fungal infection in elderly pa-tients. |
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