| 柴桂芬,周明皓,汪 宏,钱惠宝,吴雪华.腹膜透析患者营养不良的影响因素及风险预测模型的构建及验证[J].,2022,(16):3182-3187 |
| 腹膜透析患者营养不良的影响因素及风险预测模型的构建及验证 |
| Construction and Validation of a Model for Predicting Factors and Risks Affecting Malnutrition in Maintenance Peritoneal Dialysis Patients |
| 投稿时间：2022-03-03 修订日期：2022-03-26 |
| DOI：10.13241/j.cnki.pmb.2022.16.037 |
| 中文关键词: 腹膜透析 营养不良 影响因素 预测模型 |
| 英文关键词: Peritoneal dialysis Malnutrition Influencing factors Predictive model |
| 基金项目:安徽省卫生计生委科研计划项目（2017QK0543） |
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| 中文摘要: |
| 摘要 目的：分析腹膜透析（PD）患者营养不良的影响因素，构建PD患者营养不良风险预测模型并验证该模型的预测效能。方法：选取2019年1月～2021年10月黄山市人民医院腹透中心随访的200例PD患者，根据是否存在营养不良将患者分为营养不良组72例和营养正常组128例。采用单因素及多因素分析Logistic回归分析PD患者营养不良的影响因素和构建预测模型。采用H-L和受试者工作特征（ROC）曲线检验预测模型拟合优度及预测效能，并进行统计推断。结果：单因素分析显示，营养不良组年龄≥60岁、透析龄≥3年、焦虑/抑郁比例和血肌酐、血尿素氮、超敏C反应蛋白（hs-CRP）水平高于营养正常组，体质量指数（BMI）≥18.50 kg/m2比例、血钙、白蛋白（ALB）、单室尿素清除指数（spKt/V）低于营养正常组（P＜0.05）。多因素Logistic回归分析显示，年龄≥60岁、透析龄≥3年、焦虑/抑郁、hs-CRP是PD患者营养不良的危险因素，BMI≥18.5 kg/m2、ALB、spKt/V是其保护因素（P＜0.05）。ROC曲线显示该模型预测PD患者营养不良风险的曲线下面积（AUC）（0.95CI）为0.905（95％CI：0.834～0.983），灵敏度、特异度、准确度分别为0.891、0.903、0.872。以25%的样本进行验证：该风险预测模型实际应用的灵敏度、特异度、准确度分别为0.889、0.875、0.880。统计推断显示：关联性好（P＜0.05），优势性相对一致（P＞0.05）。结论：年龄、BMI、透析龄、焦虑/抑郁、hs-CRP、ALB、spKt/V均是PD患者营养不良的影响因素，经验证本研究构建的风险预测模型预测效能良好。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the factors affecting malnutrition in patients on maintenance peritoneal dialysis (PD), construct a model for predicting the risk of malnutrition in PD patients and validate the predictive efficacy of the model. Methods: 200 PD patients followed up by the abdominal dialysis center of Huangshan People's Hospital from January 2019 to October 2021 were selected, and the group was divided into 72 cases in the malnutrition group and 128 cases in the normal nutrition group according to the presence or absence of malnutrition. Univariate and multivariate analysis and logistic regression were used to analyze the influencing factors of malnutrition in PD patients and build a prediction model. H-L and receiver operating characteristic (ROC) curves were used to test the goodness of fit and prediction efficiency of the prediction model, and statistical inference was carried out. Results: Univariate analysis showed that the age ≥ 60 years, dialysis age ≥3 years, anxiety / depression ratio, blood creatinine, blood urea nitrogen and high-sensitivity C-reactive protein (hs-CRP) levels in the malnutrition group were higher than those in the normal nutrition group, and the body mass index (BMI) ≥ 18.50 kg/m2, blood calcium, albumin (ALB) and single chamber urea clearance index (spKt/V) in the malnutrition group were lower than those in the normal nutrition group (P<0.05). Multivariate logistic regression analysis showed that age ≥ 60 years, dialysis age ≥3 years, anxiety / depression and hs-CRP were the risk factors of malnutrition in PD patients, and BMI ≥ 18.5 kg/m2, ALB and spKt/V were the protective factors (P<0.05). The ROC curve showed that the area under the curve (AUC) (0.95CI) of the model for predicting the risk of malnutrition in PD patients was 0.905 (95% CI: 0.834 ~ 0.983), and the sensitivity, specificity and accuracy were 0.891, 0.903 and 0.872 respectively. Verify with 25% of the samples: the sensitivity, specificity and accuracy of the risk prediction model are 0.889, 0.875 and 0.880 respectively. Statistical inference showed that the correlation was good (P<0.05), and the dominance was relatively consistent (P>0.05). Conclusion: Age, BMI, dialysis age, anxiety/depression, hs-CRP, ALB, and spKt/V are factors influencing malnutrition in patients with PD, and the risk prediction model constructed in this study has good predictive efficacy. |
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