医学新知2024,Vol.34Issue(7) :756-767.DOI:10.12173/j.issn.1004-5511.202401109

HIV/AIDS患者肠内营养治疗喂养不耐受发生风险预测模型的构建与验证

Construction and validation of a predictive model for the risk of feeding intolerance to enteral nutrition therapy in HIV/AIDS patients

龚贝贝 黄海妹 韦彩云 玉明柳 何华伟
医学新知2024,Vol.34Issue(7) :756-767.DOI:10.12173/j.issn.1004-5511.202401109

HIV/AIDS患者肠内营养治疗喂养不耐受发生风险预测模型的构建与验证

Construction and validation of a predictive model for the risk of feeding intolerance to enteral nutrition therapy in HIV/AIDS patients

龚贝贝 1黄海妹 1韦彩云 1玉明柳 2何华伟3
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作者信息

  • 1. 南宁市第四人民医院/广西艾滋病临床治疗中心(南宁)护理部(南宁 530012)
  • 2. 南宁市第四人民医院/广西艾滋病临床治疗中心(南宁)重症医学科(南宁 530012)
  • 3. 南宁市第四人民医院/广西艾滋病临床治疗中心(南宁)结核病科(南宁 530012)
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摘要

目的 调查HIV/AIDS患者肠内营养治疗喂养不耐受的影响因素,建立列线图预测模型并进行验证.方法 回顾性分析2015年1月1日至2021年9月30日南宁市第四人民医院收治的HIV/AIDS住院患者临床资料,通过二分类Logistic回归模型,探索HIV/AIDS患者肠内营养治疗喂养不耐受的危险因素,构建列线图预测模型并验证评价.结果 共纳入174例HIV/AIDS患者,其中76例HIV/AIDS患者发生早期肠内营养喂养不耐受(43.68%).多因素分析显示,平均动脉压≤ 80 mmHg[OR=2.822,95%CI(1.267,6.287)]、急性生理学与慢性健康状况评分Ⅱ>15分[OR=5.625,95%CI(1.435,22.048)]、机械通气应用[OR=5.459,95%CI(2.046,14.564)]、高效抗反转录病毒治疗[OR=2.428,95%CI(1.118,5.275)]、肌松剂应用[OR=3.833,95%CI(1.758,8.357)]、CD4+T 细胞计数≤ 200 个·µL-1[OR=3.785,95%CI(1.126,12.724)]、抗生素使用数量>2种[OR=2.365,95%CI(1.039,5.384)]是HIV/AIDS患者肠内营养治疗发生喂养不耐受的影响因素.列线图预测模型AUC值为0.849[95%CI(0.794,0.905)],最大约登指数为0.555时,最佳临界值为0.331,灵敏度为88.16%,特异度为67.35%;校准曲线、决策曲线评价模型具有较好的一致性及获益性.结论 本研究构建的HIV/AIDS患者肠内营养治疗喂养不耐受风险预测模型可为医护人员快速识别HIV/AIDS患者喂养不耐受发生风险、及时采取预防性护理措施提供参考依据.

Abstract

Objective To investigate the influencing factors of enteral nutrition therapy intolerance in HIV/AIDS patients,establish and validate a Nomogram model.Methods A retrospective analysis was conducted on the clinical data of hospitalized HIV/AIDS patients admitted to the Fourth people's Hospital of Nanning,from January 1,2015 to September 30,2021.Through the binary Logistic regression model,the risk factors for feeding intolerance in HIV/AIDS patients were explored,a Nomogram model was constructed and validated.Results A total of 174 HIV/AIDS patients were included,among which 76 patients experienced early enteral nutrition feeding intolerance(43.68%).Multivariate analysis showed that mean arterial pressure ≤ 80 mmHg[OR=2.822,95%CI(1.267,6.287)],Acute Physiology and Chronic Health Status Score Ⅱ>15 points[OR=5.625,95%CI(1.435,22.048)],mechanical ventilation application[OR=5.459,95%CI(2.046,14.564)],highly active anti-retroviral therapy[OR=2.428,95%CI(1.118,5.275)],muscle relaxant use[OR=3.833,95%CI(1.758,8.357)],CD4+T cell count ≤200·μL-1[OR=3.785,95%CI(1.126,12.724)],the number of antibiotics used>2[OR=2.365,95%CI(1.039,5.384)]were influential factors of feeding intolerance in enteral nutrition therapy in HIV/AIDS patients.A nomogram prediction model was constructed,the model AUC value was 0.849[95%CI(0.794,0.905)],with the maximum Youden index of 0.555.The optimal threshold was 0.331.The sensitivity was 88.16%,and the specificity was 67.35%.The calibration curve and decision curve indicated good consistency and benefit of the model.Conclusion The prediction model for the risk of enteral nutrition therapy intolerance in HIV/AIDS patients constructed in this study can provide a reference for medical staff to quickly identify the risk of feeding intolerance in HIV/AIDS patients and take preventive nursing measures in time.

关键词

HIV/艾滋病/肠内营养/喂养耐受/列线图/预测模型

Key words

HIV/AIDS/Enteral nutrition/Feeding tolerance/Nomogram model/Prediction model

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基金项目

南宁市科学研究与技术开发计划课题(20193008-4)

南宁市科学研究与技术开发计划课题(20213025-1)

出版年

2024
医学新知
武汉大学中南医院,中国农工民主党湖北省委医药卫生工作委员会

医学新知

CSTPCD
影响因子:0.243
ISSN:1004-5511
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