支气管扩张合并非结核分枝杆菌感染的危险因素及预测模型构建

Risk factors for bronchiectasis complicated with non-tuberculous Mycobacterium infection and establishment of prediction model

  • 摘要: 目的 探讨支气管扩张(简称支扩)患者合并非结核分枝杆菌(NTM)感染的危险因素,构建并验证列线图预测模型。方法 回顾性分析2021年5月-2024年10月郑州大学第一附属医院诊断为支扩并感染患者临床资料,根据是否合并NTM感染分组,通过LASSO回归及多因素logistic回归筛选独立预测因子并构建列线图模型。通过受试者工作特征(ROC)曲线评估模型的准确性。结果 329例支扩并感染患者中,99例(30.09%)合并NTM感染。通过Lasso回归及多因素logistic回归筛选出5个独立预测因子:年龄优势比(OR)=1.037,95%CI:1.008~1.066,P=0.012、累及右肺中叶(OR=2.136,95%CI:1.052~4.339,P=0.036)、空洞(5.812(1.821~18.552)OR=5.812,95%CI:1.821~18.552, P=0.003)、合并自身免疫性疾病(OR=18.444, 95%CI:1.705~199.468, P=0.016)和白细胞升高(OR=0.825,95%CI:0.727~0.936, P=0.003)。构建的列线图模型在训练集和验证集的曲线下面积(AUC)分别为0.743(95%CI:0.671~0.815和0.739(95%CI:0.636~0.843)。结论 年龄、累及右肺中叶、空洞形成、合并自身免疫性疾病以及白细胞水平是支扩合并NTM的独立预测因子,基于此构建的列线图预测模型具有较高的预测效能。

     

    Abstract: OBJECTIVE To explore the risk factors for bronchiectasis patients complicated with non-tuberculous Mycobacterium (NTM) infection and establish the nomogram prediction model and validate it. METHODS The patients who were diagnosed with bronchiectasis and infections in The First Affiliated Hospital of Zhengzhou University from May 2021 to Oct. 2024 were enrolled in the study, the clinical data of the enrolled patients were retrospectively analyzed, the patients were grouped according to the status of complication with NTM infection. The independent predictive factors were screened out through LASSO regression and multivariate logistic regression so as to establish the nomogram model. The accuracy, calibration blot and clinical practicability of the model were assessed through receiver operating characteristic (ROC) curve. RESULTS Of the 329 bronchiectasis patients complicated with infections, 99 (30.09%) were complicated with NTM infection. Totally 5 independent predictive factors, including age odds ratio (OR) =1.037,95%CI :1.008 to 1.066,P=0.012, involvement of middle lobe of the right lung (OR=2.136,95%CI:1.052 to 4.339,P=0.036), cavity (5.812(1.821 to 18.552)OR=5.812,95%CI:1.821 to 18.552, P=0.003), autoimmune disease (OR=18.444, 95%CI:1.705 to 199.468, P=0.016) and rise of white blood cell (OR=0.825,95%CI:0.727 to 0.936, P=0.003)), were screened out by Lasso regression and multivariate logistic regression. The area under the curve (AUC) of the nomogram model was 0.743(95%CI:0.671 to 0.815) in the training set, 0.739(95%CI:0.636 to 0.843) in the validation set. CONCLUSIONS The age, involvement of middle lobe of the right lung, cavity formation, autoimmune disease and WBC level are the independent predictive factors for the bronchiectasis complicated with NTM. The nomogram prediction model that is established based on the factors has high predictive efficiency.

     

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