结核性气道狭窄介入治疗后再狭窄风险预测模型的构建及验证

doi:10.19982/j.issn.1000-6621.20250441

摘要/Abstract

摘要：

目的: 分析结核性气道狭窄介入治疗后再狭窄的危险因素,构建风险预测模型,并验证其预测性能。方法: 回顾性收集2021年4月至2024年10月苏州市第五人民医院收治并接受介入治疗的结核性气道狭窄患者350例作为研究对象,采用留出法,以4∶1比例分层随机分为建模组和验证组,收集患者临床资料,采用LASSO回归分析筛选关键变量,进行多因素分析,基于独立危险因素构建列线图预测模型,并分别采用受试者工作特征(ROC)曲线、Hosmer-Lemeshow检验、决策曲线分析(DCA)对模型性能进行验证。结果: 纳入患者介入治疗后再狭窄发生率为41.71%(146/350)。LASSO回归共筛选出10个关键变量,对其进行多因素分析,结果显示,并发糖尿病(OR=3.126,95%CI:1.017~9.604)、镜下活动期(OR=2.646,95%CI:1.197~5.851)、狭窄长度>3cm(OR=5.437,95%CI:2.682~11.022)、系统免疫炎症指数升高(OR=1.008,95%CI:1.006~1.011)均为结核性气道狭窄治疗后再狭窄的危险因素;治疗前接受全身抗结核治疗(OR=0.326,95%CI:0.150~0.707)为保护因素。ROC曲线分析结果显示,建模组和验证组AUC分别为0.878(95%CI:0.832~0.924)和0.867(95%CI:0.771~0.962);建模组和验证组Hosmer-Lemeshow检验(χ²值分别为5.419和6.331,P值分别为0.712和0.610);DCA结果显示,在高风险阈值0.1~0.8范围内,采用列线图模型对患者进行预防性干预,相比于均干预和均不干预,可获得更高的标准化净效益。结论: 结核性气道狭窄患者行介入治疗后再狭窄与并发糖尿病、镜下活动期、狭窄长度>3cm、系统免疫炎症指数升高等因素有关,基于相关构建列线图预测模型,可实现再狭窄的风险评估及早期预测,可为患者介入治疗后的疾病管理方案提供参考依据。

关键词: 结核, 气管狭窄, 支气管镜, 预后, 列线图

Abstract:

Objective: To analyze the risk factors for restenosis after interventional treatment of tuberculous airway stenosis, construct a risk prediction model, and verify its predictive performance. Methods: A total of 350 patients with tuberculous airway stenosis who received interventional therapy in the Suzhou Fifth People’s Hospital from April 2021 to October 2024 were retrospectively collected as the research subjects. The patients were randomly divided into a modeling group and a validation group at a ratio of 4∶1 using the set-away method. Clinical data of patients was collected and LASSO regression was performed to identify key variables and do multivariable analysis, and a nomogram prediction model was constructed based on independent risk factors. Receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) were used to verify performance of the model. Results: The incidence of restenosis after interventional treatment in patients included in this study was 41.71% (146/350). Ten key variables were screened by LASSO regression for multivariable analysis. The results showed that diabetes (OR=3.126, 95%CI:1.017-9.604), microscopic active period (OR=2.646, 95%CI:1.197-5.851), stenosis length >3 cm (OR=5.437, 95%CI:2.682-11.022), and increased systemic immune inflammation index (OR=1.008, 95%CI:1.006-1.011) were all risk factors for restenosis after treatment of tuberculous airway stenosis, while receiving systemic antituberculosis treatment before treatment (OR=0.326, 95%CI:0.150-0.707) was protective factor. The ROC curve analysis showed that the AUCs of the modeling group and the validation group were 0.878 (95%CI:0.832-0.924) and 0.867 (95%CI:0.771-0.962), respectively; The Hosmer Lemeshow test results for the modeling group and validation group were 5.419 (P=0.712) and 6.331 (P=0.610), respectively; The DCA results showed that within the high-risk threshold range of 0.1-0.8, using a nomogram model for preventive intervention in patients could achieve higher standardized net benefit compared to average intervention and no intervention. Conclusion: The restenosis of patients with tuberculous airway stenosis after interventional treatment is related to diabetes, microscopic active period, stenosis length >3 cm, and increased systemic immune inflammation index factors. Based on the relevant factors, a nomogram prediction model can be constructed to conduct risk assessment and early prediction of restenosis, which can provide reference for disease management plans for patients after interventional treatment.

Key words: Tuberculosis, Tracheal stenosis, Bronchoscopy, Prognosis, Nomograms

中图分类号:

R562.1+2

徐勇, 周腾, 刘俊佳. 结核性气道狭窄介入治疗后再狭窄风险预测模型的构建及验证[J]. 中国防痨杂志, 2026, 48(6): 760-768. doi: 10.19982/j.issn.1000-6621.20250441

Xu Yong, Zhou Teng, Liu Junjia. Construction and validation of a risk prediction model for restenosis after interventional treatment of tuberculous airway stenosis[J]. Chinese Journal of Antituberculosis, 2026, 48(6): 760-768. doi: 10.19982/j.issn.1000-6621.20250441

图/表 7

表1

两组患者临床资料比较

特征	建模组(280例)	验证组(70例)	统计检验值	P值
再狭窄[例(构成比,%)]			χ²=0.106	0.745
否	162(57.86)	42(60.00)
是	118(42.14)	28(40.00)
性别[例(构成比,%)]			χ²=0.004	0.951
男性	73(26.07)	18(25.71)
女性	207(73.93)	52(74.29)
年龄(岁,$\overline{x}$±s)	49.84±14.58	49.30±15.35	t=0.272	0.786
BMI(kg/m²,$\overline{x}$±s)	21.53±2.90	21.37±2.73	t=0.410	0.682
病程(月,$\overline{x}$±s)	4.94±1.98	5.40±1.80	t=-1.784	0.075
并发症[例(构成比,%)]
高血压	31(11.07)	7(10.00)	χ²=0.066	0.797
糖尿病	33(11.79)	9(12.86)	χ²=0.061	0.805
胸腔积液	34(12.14)	8(11.43)	χ²=0.027	0.869
肺不张	59(21.07)	16(22.86)	χ²=0.106	0.745
治疗分类[例(构成比,%)]			χ²=0.198	0.656
初治	253(90.36)	62(88.57)
复治	27(9.64)	8(11.43)
治疗周期[例(构成比,%)]			χ²=0.027	0.870
单个	113(40.36)	29(41.43)
多个	167(59.64)	41(58.57)
镜下分期[例(构成比,%)]			χ²=0.033	0.855
非活动期	73(26.07)	19(27.14)
活动期	207(73.93)	51(72.86)
气道狭窄部位[例(构成比,%)]			χ²=0.016	0.992
左侧	129(46.07)	32(45.71)
右侧	126(45.00)	32(45.71)
双侧	25(8.93)	6(8.57)
狭窄程度[例(构成比,%)]			χ²=0.003	0.957
非重度	147(52.50)	37(52.86)
重度	133(47.50)	33(47.14)
狭窄长度[例(构成比,%)]			χ²=0.076	0.782
≤3cm	177(63.21)	43(61.43)
>3cm	103(36.79)	27(38.57)
治疗前全身抗结核治疗[例(构成比,%)]			χ²=0.169	0.681
否	199(71.07)	48(68.57)
是	81(28.93)	22(31.43)
联合治疗方案[例(率,%)]
球囊扩张术	42(15.00)	10(14.29)	χ²=0.023	0.881
激光治疗	37(13.21)	9(12.86)	χ²=0.006	0.937
冷冻治疗	25(8.93)	6(8.57)	χ²=0.009	0.925
器官分泌物抗酸染色[例(构成比,%)]			χ²=0.183	0.669
阴性	148(52.86)	35(50.00)
阳性	132(47.14)	35(50.00)
实验室指标
Scr(μmol/L,$\overline{x}$±s)	56.87±11.91	56.27±13.76	t=0.366	0.714
UA(μmol/L,$\overline{x}$±s)	309.53±130.22	305.82±132.87	t=0.212	0.832
ALB(g/L,$\overline{x}$±s)	42.47±4.87	42.52±4.75	t=-0.086	0.931
TC(mmol/L,$\overline{x}$±s)	4.03±1.00	3.96±0.90	t=0.544	0.587
TG(mmol/L,$\overline{x}$±s)	1.06±0.32	1.06±0.35	t=-0.107	0.915
HDL-C(mmol/L,$\overline{x}$±s)	1.14±0.36	1.17±0.35	t=-0.484	0.629
LDL-C(mmol/L,$\overline{x}$±s)	2.42±0.79	2.41±0.80	t=0.146	0.884
GLU(mmol/L,$\overline{x}$±s)	5.27±0.85	5.33±0.79	t=-0.536	0.593
SII(×10⁹/L,$\overline{x}$±s)	797.83±168.88	807.69±188.45	t=-0.427	0.670

表1

图1

表2

图2

图3

图4

图5

参考文献 18

[1]	Chen Q, Huang T, Zou L, et al. Differences in epidemiological and clinical features between adult and pediatric tracheobronchial tuberculosis patients in Southwest China. Front Public Health, 2023, 11: 1225267. doi:10.3389/fpubh.2023.1225267.
[2]	Su Z, Cheng Y, Wu Z, et al. Incidence and Predictors of Tracheobronchial Tuberculosis in Pulmonary Tuberculosis: A Multicentre, Large-Scale and Prospective Study in Southern China. Respiration, 2019, 97(2): 153-159. doi:10.1159/000492335.
[3]	Peng AZ, Yang A, Li SJ, et al. Incidence, laboratory diagnosis and predictors of tracheobronchial tuberculosis in patients with pulmonary tuberculosis in Chongqing, China. Exp Ther Med, 2020, 20(6): 174. doi:10.3892/etm.2020.9304.
[4]	陈善婷, 郭述良. 支气管结核性气道狭窄介入治疗研究进展. 职业与健康, 2016, 32(3): 419-422. doi:10.13329/j.cnki.zyyjk.2016.0187.
[5]	Li F, Tian S, Huang H, et al. Post-tuberculosis tracheobronchial stenosis: long-term follow-up after self-expandable metallic stents placement and development of a prediction score-the Restenosis Score. Eur J Med Res, 2022, 27(1): 133. doi:10.1186/s40001-022-00765-1.
[6]	中华医学会结核病学分会, 《中华结核和呼吸杂志》编辑委员会. 气管支气管结核诊断和治疗指南(试行). 中华结核和呼吸杂志, 2012, 35(8): 581-587. doi:10.3760/cma.j.issn.1001-0939.2012.08.007.
[7]	World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA, 2025, 333(1): 71-74. doi:10.1001/jama.2024.21972.
[8]	曾宗鼎, 苏柱泉, 孙婉, 等. 插管后气管狭窄介入治疗的疗效及其影响因素分析. 中国呼吸与危重监护杂志, 2017, 16(4): 367-370. doi:10.7507/1671-6205.201703034.
[9]	杨东明, 许东风, 任蔚, 等. 冷热联合消融技术治疗气道良性肿瘤效果及预后影响因素分析. 现代肿瘤医学, 2024, 32(2): 276-280. doi:10.3969/j.issn.1672-4992.2024.02.013.
[10]	Huang W, Xu C, Wei B, et al. Analysis of Risk Factors for Restenosis after Interventional Treatment of Tuberculous Airway Stenosis. Respiration, 2025, 104(5): 341-348. doi:10.1159/000542909.
[11]	罗莉, 周磊, 罗林紫, 等. 球囊扩张联合曲安奈德局部注射治疗结核性气管支气管狭窄的疗效及相关机制探讨. 临床肺科杂志, 2024, 29(9): 1297-1303. doi:10.3969/j.issn.1009-6663.2024.09.001.
[12]	Alwin Robert A, Al Dawish MA. Microvascular complications among patients with diabetes: An emerging health problem in Saudi Arabia. Diab Vasc Dis Res, 2019, 16(3): 227-235. doi:10.1177/1479164118820714.
[13]	Hu T, Li Y, Wang X, et al. Early and Regular Bronchoscopy Examination on Effect of Diagnosis and Prognosis for Patients With Tracheobronchial Tuberculosis. Front Med (Lausanne), 2022, 9: 825736. doi:10.3389/fmed.2022.825736.
[14]	Liew PX, Kubes P. The Neutrophil’s Role During Health and Disease. Physiol Rev, 2019, 99(2): 1223-1248. doi:10.1152/physrev.00012.2018.
[15]	Yin LX, Motz KM, Samad I, et al. Fibroblasts in Hypoxic Conditions Mimic Laryngotracheal Stenosis. Otolaryngol Head Neck Surg, 2017, 156(5): 886-892. doi:10.1177/0194599817697049.
[16]	Le TT, Karmouty-Quintana H, Melicoff E, et al. Blockade of IL-6 Trans signaling attenuates pulmonary fibrosis. J Immunol, 2014, 193(7): 3755-3768. doi:10.4049/jimmunol.1302470.
[17]	Motz KM, Yin LX, Samad I, et al. Quantification of Inflammatory Markers in Laryngotracheal Stenosis. Otolaryngol Head Neck Surg, 2017, 157(3): 466-472. doi:10.1177/0194599817706930.
[18]	Li CY, Xie RX, Zhang SW, et al. Metabolism, fibrosis, and apoptosis: The effect of lipids and their derivatives on keloid formation. Int Wound J, 2024, 21(2): e14733. doi:10.1111/iwj.14733.

自变量	β值	s${}_{\overline{x}}$值	Wald χ²值	P值	OR值	95%CI值
自变量	β值	s${}_{\overline{x}}$值	Wald χ²值	P值	OR值	下限	上限
并发高血压	0.782	0.528	2.188	0.139	2.185	0.776	6.153
并发糖尿病	1.140	0.573	3.960	0.047	3.126	1.017	9.604
镜下分期为活动期	0.973	0.405	5.781	0.016	2.646	1.197	5.851
狭窄长度>3cm	1.693	0.361	22.060	<0.001	5.437	2.682	11.022
治疗前行全身抗结核治疗	-1.122	0.396	8.042	0.005	0.326	0.150	0.707
进行球囊扩张术	-0.631	0.494	1.628	0.202	0.532	0.202	1.402
器官分泌物抗酸染色阳性	0.504	0.337	2.243	0.134	1.656	0.856	3.203
TG	0.466	0.547	0.726	0.394	1.594	0.546	4.658
HDL-C	-0.883	0.476	3.436	0.064	0.414	0.163	1.052
SII升高	0.008	0.001	40.581	<0.001	1.008	1.006	1.011
常量	-7.940	1.311	36.694	<0.001	0.000