肾综合征出血热透析危险因素及早期预警价值分析
Analysis of risk factors and early predicting value of dialysis for hemorrhagic fever with renal syndrome
唐情容 1徐逸洲 1徐春华 1卢瑾 1李向军1
作者信息
- 1. 长沙市第一医院感染科,湖南长沙 410000
- 折叠
摘要
目的 从临床常用的指标中筛选出肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)透析危险因素并构建早期预警模型,从而指导临床.方法 回顾分析2013年12月至2023年4月在长沙市第一医院感染科住院的112例HFRS患者的病例资料,根据是否进行血液透析分为透析组(38例)与非透析组(74例),比较两组患者基本资料与常规实验室检查指标的差异,采用Logistic回归构建早期预测模型,使用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)预警各指标需透析的能力.结果 透析组平均住院时间为(24.00±8.95)d,非透析组患者平均住院时间为(16.00±6.10)d;两组性别及基础疾病无差异(均P＞0.05),透析组输血、休克、肺部感染及尿蛋白发生率均高于非透析组,差异有统计学意义(均P＜0.05);透析组年龄低于非透析组(P=0.015)、住院时间长于非透析组(P＜0.001),两组白蛋白(albumin,ALB)水平差异无统计学意义(P=0.393);白细胞(white blood cell,WBC)计数,降钙素原(procalcitonin,PCT)、肌酐(creatinine,CR)、肌酸激酶同工酶(creatine kinase isoenzymes MB,CK-MB)水平透析组高于非透析组;血小板(platelet,PLT)计数透析组低于非透析组,谷丙转氨酶(glutamic-pyruvic transaminase,ALT)、谷草转氨酶(glutamic oxaloacetic transaminase,AST)、C反应蛋白(c-reactive protein,CRP)及乳酸脱氢酶(lactate dehydrogenase,LDH)则在两组中差异均无统计学意义.年龄、WBC、PLT、PCT、CR、CKMB的AUC分别为0.650、0.712、0.801、0.671、0.700、0.712,预判的最佳阈值分别为48.50岁、11.92×109/L、22.50× 109/L、1.63 μ g/L、181.75μmol/L、25.15U/L;采用 Logistic 回归制作模型为 P=1(1+e-γ),γ=1.745-0.084×PLT+0.006×CR(P 为预测患者需要透析的概率值,γ为预测指数),得出PLT及CR联合检测AUC为0.888,敏感度81.10％,特异度为86.80％.结论 年龄、WBC、PLT、PCT、CR、CKMB可作为HFRS患者需行血液透析的早期预测指标,联合指标(PLT、CR)检测较单一指标检测更有助于发现HFRS患者是否需透析.
Abstract
Objective Screening the dialysis risk factors of hemorrhagic fever with renal syndrome(HFRS)from the commonly used clinical indicators and constructing an early warning model,so as to guide the clinic.Method The clinical data of 112 HFRS patients in the first hospital of Changsha from December 2013 to April 2023 were retrospectively analyzed,divided into dialysis group(38 cases)and non dialysis group(74 cases)based on whether hemodialysis is performed or not.To compare and analyze the differences between the basic data of patients in dialysis group and those in non-dialysis group and the indexes of routine laboratory examination.Logstic regression was used to build an early prediction model,and receiver operating characteristic curve(ROC)was used to warn the dialysis ability of each index.Result In 112 HFRS patients,38 in dialysis group(33.928％)with(24±8.95)days average hospitalization time and 74 in non-dialysis group(66.07％),and the average hospitalization time was(16±6.10)days.Sex and underlying diseases were no difference in two groups(P＞0.05).Blood transfusion,shock,pulmonary infection and proteinuria incidence rates in dialysis group was higher than non-dialysis group,and the differences have significant(P＜0.05).Age in dialysis group was less than non-dialysis group(P=0.015)and hospitalization time was longer than non-dialysis group(P＜0.001),and ALB in two groups were no differences(P=0.393).WBC、PCT、CR and CK-MB were higher in dialysis group and PLT was lower in dialysis group.ALT,AST,CRP and LDH were no differences in two groups.The AUC of Age,WBC,PLT,PCT,CR and CKMB is 0.650,0.712,0.801,0.671,0.700 and 0.712,respectively,and the optimal thresholds for prediction are 48.50 years old,11.92×109/L,22.50×109/L,1.63 μ g/L,181.75 μ mol/L and 25.15U/L,using Logstic regression model,P=1(1+e-γ),γ=1.745-0.084×PLT+0.006×CR(P is the probability value for predicting patient requiring dialysis,y is the prediction index),and it is concluded that the AUC of the combined detection of PLT and CR is 0.888,the sensitivity is 81.10％,and the specificity is 86.80％.Conclusions Age,WBC,PLT,PCT,CR,CKMB can be used as early predictors of whether hemorrhagic fever with renal syndrome needs hemodialysis,and combined indicators(PLT and CR)detection is more helpful to find out whether hemorrhagic fever with renal syndrome needs dialysis than single indicators detection.
关键词
肾综合征出血热/汉坦病毒/实验室指标/透析/早期预警Key words
Hemorrhagic fever with renal syndrome/Hantavirus/Laboratory index/Dialysis/Early predict引用本文复制引用
基金项目
长沙市卫健委基金(SXSW2021004)
出版年
2024
国家科技期刊平台
NSTL
万方数据