直升机飞行人员非酒精性脂肪肝发病风险预测模型的建立与验证
Establishment and verification of risk prediction model of non-alcoholic fatty liver disease for helicopter flying personnel
徐宏伟 1刘俊松 2肖韵悦 1唐艳超 1钱棪梅1
作者信息
- 1. 空军杭州特勤疗养中心疗养三区健康管理科,杭州 310002
- 2. 空军杭州特勤疗养中心疗养三区,杭州 310002
- 折叠
摘要
目的 建立并验证直升机飞行人员非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)发病风险预测列线图模型.方法 选取于空军杭州特勤疗养中心疗养的直升机飞行人员为研究对象.采用整群随机法分为训练组(75%)和验证组(25%)进行内部验证.直升机飞行人员NAFLD的影响因素分析采用多因素逐步Logistic回归分析,采用R4.2.1软件和rms程序包构建列线图模型,采用H-L拟合优度检验和受试者工作特征(receiver operating characteristic,ROC)曲线评估预测模型的校准度和区分度,采用决策曲线分析(decision curve analysis,DCA)评估模型的临床实用性.结果 共纳入直升机飞行人员2 195例,其中训练组1 648例,验证组547例.年龄、BMI、高尿酸血症、高甘油三酯血症、高密度脂蛋白胆固醇异常、奶类及奶制品日摄入量和吸烟年数等7个变量作为直升机飞行人员NAFLD发病风险预测列线图模型的预测因子.训练组和验证组的H-L拟合优度检验χ2= 8.54、11.03,P=0.382、0.200,提示具有较好的预测准确度;两组的ROC曲线下面积分别为0.840和0.860,提示具有一定的区分度;两组的DCA曲线显示当发病风险概率在10%～30%范围内,净收益率高于 0,提示具有一定的临床实用性.年龄增加(OR=1.18,P=0.010)、超重及肥胖(OR=3.67,P<0.001)、高尿酸血症(OR=2.12,P<0.001)、高甘油三酯血症(OR=2.96,P<0.001)、高密度脂蛋白胆固醇异常(OR=1.83,P=0.010)、吸烟年数增加(OR=1.20,P=0.010)是直升机飞行人员NAFLD的危险因素,奶类及奶制品日摄入量(OR=0.76,P=0.020)的增加是保护因素.结论 基于上述因素建立的列线图模型可有效评估直升机飞行人员NAFLD发病风险,具有一定的临床实用性.
Abstract
Objective To establish and verify a nomogram model for predicting the risk of non-alcoholic fatty liver disease(NAFLD)in helicopter flying personnel.Methods The helicopter flying personnel who recuperated at Air Force Healthcare Center for Special Services Hangzhou were selected as the study subjects.They were divided into the training group(75%)and the verification group(25%)by using the cluster random sampling method for internal verification.Multivariate Logistic regression analysis was used to analyze the factors influencing NAFLD of helicopter flying personnel,and the nomogram model was constructed by R4.2.1 software and rms package.The H-L goodness-of-fit test and receiver operating characteristic(ROC)curve were used to assess the discrimination and calibration of the prediction model,and decision curve analysis(DCA)was used to evaluate the clinical practicality of the model.Results A total of 2 195 helicopter flying personnel were included,with 1 648 in the training group and 547 in the verification group.Seven variables,including age,BMI,hyperuricemia,hypertriglyceridemia,abnormal high-density lipoprotein,daily intakes of milk and/or its products and years of smoking were used as the predictors of the nomogram model for the risk prediction of NAFLD in helicopter flying personnel.The H-L goodness-of-fit tests of training group and verification group were χ2=8.54,11.03,P=0.382,0.200,respectively,indicating a good predictive accuracy.The area under the ROC curve of the 2 groups was 0.840 and 0.860,respectively,indicating a certain degree of discrimination.The incidence risk probability of DCA curve in 2 groups was about 10%-30%,and the net return rate was above 0,suggesting that it had a certain clinical applicability.Increased age(OR=1.18,P=0.010),overweight and obesity(OR=3.67,P<0.001),hyperuricemia(OR=2.12,P<0.001),hypertriglyceridemia(OR=2.96,P<0.001),abnormal high-density lipoprotein cholesterol(OR=1.83,P=0.010),and increased years of smoking(OR=1.20,P=0.010)were the risk factors for NAFLD in helicopter flying personnel,while increased daily intakes of milk and/or its products(OR=0.76,P=0.020)were identified as a protective factor.Conclusions The nomogram model based on the aforementioned factors can effectively evaluate the incidence risk of NAFLD in helicopter flying personnel,and has certain clinical practicality.
关键词
脂肪肝/模型,统计学/列线图/ROC曲线/DCA曲线/直升机飞行人员Key words
Fatty liver/Models,statistical/Nomograms/ROC curve/DCA curve/Helicopter flying personnel引用本文复制引用
出版年
2023
NETL
NSTL
万方数据