老年肺结核患者衰弱风险预测模型的构建及验证

doi:10.19982/j.issn.1000-6621.20230329

摘要/Abstract

摘要：

目的：建立老年肺结核患者衰弱风险预测列线图模型并进行验证。方法：选择2022年6月1日至2022年10月28日深圳市第三人民医院肺病科收治的448例老年肺结核患者作为建模集,再选择2022年12月1日至2023年2月28日收治的129例老年肺结核患者作为验证集。采用一般资料调查问卷、FRAIL量表、Barthel指数评定量表、老年肺结核患者自我管理量表、结核病相关病耻感量表、患者健康问卷、领悟社会支持量表和查尔森并发症指数进行调查。根据FRAIL量表得分,将建模集患者分成衰弱组和无衰弱组,比较两组患者各项指标,并根据二分类logistic回归分析结果建立风险预测模型。采用R 4.0.2软件绘制老年肺结核患者衰弱风险评估列线图,采用1000次Bootstrap自抽样法和验证集数据分别进行列线图模型的内部验证和外部验证。结果：老年肺结核患者衰弱的发生率为50.78%(293/577),二分类logistic回归分析结果显示:年龄(OR=1.054,95%CI:1.020~1.089)、病程(OR=1.092,95%CI:1.013~1.177)、痰菌情况(OR=1.916,95%CI:1.136~3.229)、白细胞计数(OR=1.129,95%CI:1.031~1.235)、超敏-C反应蛋白(OR=1.007,95%CI:1.002~1.011)、日常生活能力(activities of daily living, ADL)(OR=0.970,95%CI:0.958~0.982)、抑郁(OR=1.110,95%CI:1.064~1.159)、自我管理能力(OR=0.944,95%CI:0.903~0.986)和并发症指数(OR=1.477,95%CI:1.180~1.849)是老年肺结核患者衰弱的独立影响因素。建模集和验证集ROC曲线下面积为 0.842(95%CI: 0.807~0.876)和0.859(95%CI:0.797~0.921)。结论：老年肺结核患者衰弱发生率较高,增强日常生活能力和自我管理能力,发生衰弱的风险降低;随着年龄、病程、炎症指标、并发症指数和抑郁得分增加及痰菌阳性,发生衰弱的风险增加。根据上述因素建立的列线图模型可用于老年肺结核患者衰弱的预测。

关键词: 老年人, 结核,肺, 衰弱, 预测, 模型,统计学

Abstract:

Objective: To establish and verify a nomogram model for predicting frailty risk in elderly patients with pulmonary tuberculosis. Methods: Of 448 elderly patients with pulmonary tuberculosis admitted to the Pulmonary Department of Shenzhen Third People’s Hospital from June 1, 2022 to October 28, 2022 were selected as the modeling set, and of 129 elderly patients with pulmonary tuberculosis admitted from December 1, 2022 to February 28, 2023 were selected as the validation set. General data questionnaire, FRAIL Scale, Barthel Index, Self-management scale for elderly patients with pulmonary tuberculosis, tuberculosis-related stigma Scale, patient health questionnaire-9, Perceived social support scale and Charlson Comorbidity Index were used to investigate. According to the FRAIL scale score, the patients in the modeling set were divided into frail group and non-frail group, and the indexes of patients in the two groups were compared,and the risk prediction model was established according to the results of binary logistic regression analysis. R software was used to draw the nomogram for the assessment of frailty risk in elderly patients with pulmonary tuberculosis. 1000 times Bootstrap self-sampling method and validation set data were used to conduct internal and external validation of the nomogram model. Results: The incidence of frailty in elderly patients with pulmonary tuberculosis was 50.78% (293/577). Binary logistic regression analysis showed that: age (OR=1.054, 95%CI:1.020-1.089), course of disease (OR=1.092, 95%CI:1.013-1.177), sputum status (OR=1.916, 95%CI:1.136-3.229), white blood cell count (OR=1.129,95%CI:1.031-1.235), hs-CRP (OR=1.007,95%CI:1.002-1.011), activities of daily living (ADL)(OR=0.970, 95%CI:0.958-0.982), depression (OR=1.110, 95%CI:1.064-1.159), self-management (OR=0.944, 95%CI:0.903-0.986) and Charlson Comorbidity Index (OR=1.477, 95%CI: 1.180-1.849) were independent factors of frailty in elderly patients with pulmonary tuberculosis. The AUC of the modeling set and validation set were 0.842 (95%CI: 0.807-0.876) and 0.859 (95%CI: 0.797-0.921). Conclusion: The incidence of frailty in elderly patients with pulmonary tuberculosis is higher, and the risk of frailty can be reduced by enhancing the ability of ADL and self-management. The risk of frailty increases with age, disease course, inflammatory markers, comorbidities, and depression scores, as well as sputum positive.The nomogram model based on the above factors can be used to predict the frailty of the elderly patients with pulmonary tuberculosis.

Key words: Elderly, Tuberculosis, pulmonary, Frailty, Forecasting, Models, statistical

中图分类号:

R521
G812.48

孔含含, 张娇红, 曾剑锋, 操静. 老年肺结核患者衰弱风险预测模型的构建及验证[J]. 中国防痨杂志, 2024, 46(1): 85-91. doi: 10.19982/j.issn.1000-6621.20230329

Kong Hanhan, Zhang Jiaohong, Zeng Jianfeng, Cao Jing. Construction and validation of frailty risk prediction model in elderly patients with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2024, 46(1): 85-91. doi: 10.19982/j.issn.1000-6621.20230329

图/表 6

表1

建模集两组患者社会人口学、生理、心理及社会资料比较

项目	无衰弱组(219例)	衰弱组(229例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	68(63,72)	72(66,79)	Z=-5.839	<0.001
BMI( $x ˉ$ ±s)	20.49±3.05	19.34±3.52	t=3.700	<0.001
ADL[分,M(Q₁,Q₃)]	100(90,100)	70(50,95)	Z=-9.440	<0.001
有无配偶[例(构成比,%)]			χ²=4.793	0.029
有	201(91.8)	195(85.2)
无	18(8.2)	34(14.8)
吸烟[例(构成比,%)]			χ²=4.217	0.040
是	78(35.6)	61(26.6)
否	141(64.4)	168(73.4)
痰菌情况			χ²=5079	0.024
阴性	80(36.5)	61(26.6)
阳性	139(63.5)	168(73.4)
病程[月,M(Q₁,Q₃)]	1(0.5,2)	1(0.5,3)	Z=-4.108	<0.001
用药[种,M(Q₁,Q₃)]	7(5,9)	8.5(6,11)	Z=-5.106	<0.001
血红蛋白[g/L,M(Q₁,Q₃)]	113(102,127)	106.5(91,120)	Z=-3.472	0.001
白细胞计数[×10⁹/L,M(Q₁,Q₃)]	6.23(4.99,7.63)	7.17(5.53,9.32)	Z=-4.040	<0.001
白蛋白[g/L,( $x ˉ$ ±s)]	36.78±4.78	34.17±5.30	t=5.487	<0.001
hs-CRP[mg/L,M(Q₁,Q₃)]	20.52(4.46,52.82)	43.06(11.08,77.61)	Z=-5.061	<0.001
并发症指数[M(Q₁,Q₃)]	2(1,3)	2(2,3)	Z=-3.617	<0.001
社会支持[分,M(Q₁,Q₃)]	59.5(45,69)	55(42,67)	Z=-2.260	0.024
抑郁[分,M(Q₁,Q₃)]	5(3,9.25)	12(7,16)	Z=-8.648	<0.001
病耻感[分,M(Q₁,Q₃)]	6(2,11)	9(5,14)	Z=-3.760	<0.001
自我管理(分, $x ˉ$ ±s)	27.48±6.04	23.95±5.74	t=6.333	<0.001

表1

表2

表3

建模集老年肺结核患者衰弱预测的多因素logistic回归分析

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
并发症指数	0.390	0.114	11.623	0.001	1.477(1.180~1.849)
年龄	0.052	0.017	9.671	0.002	1.054(1.020~1.089)
ADL	-0.031	0.006	23.587	0.000	0.970(0.958~0.982)
病程	0.088	0.038	5.237	0.022	1.092(1.013~1.177)
痰菌情况	0.650	0.266	5.955	0.015	1.916(1.136~3.229)
抑郁	0.105	0.022	22.871	0.000	1.110(1.064~1.159)
自我管理	-0.058	0.023	6.643	0.010	0.944(0.903~0.986)
hs-CRP	0.007	0.002	8.040	0.005	1.007(1.002~1.011)
白细胞计数	0.121	0.046	6.932	0.008	1.129(1.031~1.235)
常量	-3.251	1.625	4.003	0.045

表3

图1

图2

图3

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变量	赋值	变量	赋值
因变量		用药	原始数值
FRAIL量表评分	FRAIL量表评分≥3分=1;FRAIL量表评分<3分=0	用药	原始数值
		白细胞计数	原始数值
		血红蛋白	原始数值
自变量		血红蛋白	原始数值
自变量		白蛋白	原始数值
有无配偶	无配偶=1;有配偶=2	白蛋白	原始数值
有无配偶	无配偶=1;有配偶=2	hs-CRP	原始数值
是否吸烟	不抽烟=1;抽烟=2	hs-CRP	原始数值
是否吸烟	不抽烟=1;抽烟=2	社会支持	原始数值
痰菌情况	阴性=1;阳性=2	社会支持	原始数值
痰菌情况	阴性=1;阳性=2	抑郁	原始数值
年龄	原始数值	抑郁	原始数值
年龄	原始数值	病耻感	原始数值
BMI	原始数值	病耻感	原始数值
BMI	原始数值	自我管理	原始数值
ADL	原始数值	自我管理	原始数值
ADL	原始数值	查尔森并发症指数	原始数值
病程	原始数值	查尔森并发症指数	原始数值