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[预测结核病住院患者抗结核药物性肝损伤风险的列线图模型]

[Nomogram model for predicting risk of anti-tuberculosis drug-induced liver injury among inpatients with tuberculosis].

作者信息

Zhao P, Chen J, Yang Y Q, Peng Yanqing

机构信息

School of Public Health, Guizhou Medical University, Guiyang 550025, China.

Public Health Treatment Center of Guiyang City, Guiyang 550003, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2022 Feb 12;45(2):171-176. doi: 10.3760/cma.j.cn112147-20210705-00467.

Abstract

To explore the influencing factors of anti-tuberculosis drug-induced liver injury (ATB-DILI) in hospitalized tuberculosis patients, and to establish a risk prediction model of Nomogram. A retrospective study was conducted on 5 681 tuberculosis patients admitted to Guiyang public health treatment center from January 2017 to June 2021, including 3 342 males and 2 339 females. The inpatients with ATB-DILI were selected as the case group (214 cases) and the non-ATB-DILI patients as the control group (5 427 cases). The baseline characteristics, tuberculosis condition, behavior and disease-related data of the patients were retrospectively analyzed, and the influencing factors were screened by chi-square test and multivariate logistic regression, based on which the Nomogram model was constructed and verified. The decision curve was used to evaluate the clinical application value of the model. In this study, 3.8%(214/5 681) patients developed ATB-DILI. Multivariate logistic regression analysis showed that extrapulmonary tuberculosis (=1.876, <0.001), malnutrition (=4.411, <0.001), complicated with underlying liver disease (=4.961, <0.001) and intermittent use of hepatoprotective drugs (=2.137=0.007) were independent risk factors for ATB-DILI, while whole-course use of hepatoprotective drugs (=0.292, <0.001) was protective factor. The Nomogram model was constructed based on the above five related factors. The area under the receiver operating characteristic (ROC) curve was 0.749 (95%:0.713-0.786), the sensitivity was 0.640, and the specificity was 0.752, respectively. The Bootstrap method was used for internal repeated sampling for 1 000 times, the average absolute error was 0.003, the correction curve and the ideal curve were basically fitted, and the predicted values were in good agreement with the actual values. Hosmer-lemeshow test showed that the model had a good degree of fit (χ=3.068, =0.381). The decision curve showed that the Nomogram model had certain clinical practicability in the high risk threshold range (0.10-0.68). The Nomogram model for risk predicting ATB-DILI among inpatients with tuberculosis in this study has good predictability, consistency and clinical practicability, and can provide a basis for clinical prevention and control of ATB-DILI and individualized treatment in the process of anti-tuberculosis treatment.

摘要

为探讨住院结核病患者抗结核药物性肝损伤(ATB-DILI)的影响因素,并建立列线图风险预测模型。对2017年1月至2021年6月在贵阳市公共卫生治疗中心住院的5681例结核病患者进行回顾性研究,其中男性3342例,女性2339例。将发生ATB-DILI的住院患者作为病例组(214例),未发生ATB-DILI的患者作为对照组(5427例)。回顾性分析患者的基线特征、结核病病情、行为及疾病相关数据,通过卡方检验和多因素logistic回归筛选影响因素,并据此构建和验证列线图模型。采用决策曲线评估模型的临床应用价值。本研究中,3.8%(214/5681)的患者发生了ATB-DILI。多因素logistic回归分析显示,肺外结核(β=1.876,P<0.001)、营养不良(β=4.411,P<0.001)、合并基础肝病(β=4.961,P<0.001)及间断使用保肝药物(β=2.137,P=0.007)是ATB-DILI的独立危险因素,而全程使用保肝药物(β=0.292,P<0.001)是保护因素。基于上述5个相关因素构建列线图模型。受试者工作特征(ROC)曲线下面积为0.

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