摘要
目的探讨2型糖尿病合并流感病毒性肺炎患者糖化血红蛋白变异指数、胰岛细胞功能及相关代谢标志物与临床转归的关系。方法纳入2023年1月至2024年4月在我院收治的240例2型糖尿病合并流感病毒性肺炎患者作为研究对象,按不同预后分为存活组167例(69.6%)和死亡组73例(30.4%)。将单因素分析中P<0.05变量纳入多因素Logistic回归分析,采用最大似然比前进法筛选出最终变量,获得影响2型糖尿病合并流感病毒性肺炎患者预后的独立预测因素,并基于独立预测因素构建2型糖尿病合并流感病毒性肺炎患者死亡风险的列线图预测模型,计算列线图模型的区分度评价指标C指数(C-index),并通过拟合优度(H-L)检验和受试者工作特征(ROC)曲线评价列线图模型的准确度和预测效能。结果单因素分析结果显示,存活组和死亡组年龄、动脉氧分压(PaO_(2))、D-二聚体、肺损伤评分、糖化血红蛋白变异指数、稳态模型评估胰岛素抵抗指数(HOMA-IR)、稳态模型评估β细胞功能指数(HOMA-β)、空腹胰岛素及住院时间比较差异有统计学意义(P<0.05)。多因素Logistic回归分析调整和校正混杂因素后,糖化血红蛋白变异指数、HOMA-β、空腹胰岛素为影响2型糖尿病合并流感病毒性肺炎患者预后的独立预测因素(P<0.05),将独立预测因素结合其影响权重构建2型糖尿病合并流感病毒性肺炎患者死亡风险的列线图预测模型。H-L检验结果显示,2型糖尿病合并流感病毒性肺炎患者死亡风险的预测值与实际观测值符合度良好(P>0.05)。ROC分析结果显示,列线图模型预测的AUC为0.894(95%CI 0.845~0.933)。结论基于糖化血红蛋白变异指数、HOMA-β、空腹胰岛素构建的列线图模型能准确预测2型糖尿病合并流感病毒性肺炎患者的死亡风险。
Objective To explore the relationship of glycosylated hemoglobin variation index,islet cell function and related metabolic markers with clinical outcomes in type 2 diabetes mellitus patients with influenza virus pneumonia.Methods All 240 type 2 diabetes mellitus patients with influenza virus pneumonia admitted to Civil Aviation General Hospital from January 2023 to April 2024 were included as the study subjects.167 patients(69.6%)were in the survival group and 73 patients(30.4%)were in the death group according to different prognosis.The statistically significant variables in the univariate analysis(P<0.05)were included in the multivariate Logistic regression analysis,and the final variables were screened by the maximum likelihood ratio progression method to obtain independent predictors of the prognosis of type 2 diabetes mellitus patients with influenza virus pneumonia.A nomogram prediction model was constructed to predict the death risk of type 2 diabetes mellitus patients with influenza virus pneumonia based on the independent predictors.The differentiation evaluation index(C index)of the nomogram model was calculated,and the accuracy and predictive performance of the nomogram model was evaluated by goodness of fit(H-L)test and the receiver operating characteristic(ROC)curve.Results The results of the univariate analysis showed that there were statistically significant differences in age,PaO_(2),D-dimer,lung injury score,glycosylated hemoglobin variation index,homeostasis model assessment of insulin resistance(HOMA-IR),homeostasis model assessmentβcell function(HOMA-β),fasting insulin and length of hospital stay of patients between the two groups(P<0.05).After adjusting and correcting for confounding factors by multivariate Logistic regression analysis,glycosylated hemoglobin variation index,HOMA-β,fasting insulin were independent predictors of prognosis in type 2 diabetes mellitus patients with influenza virus pneumonia(P<0.05).A nomogram prediction model was constructed to predict the death risk of type 2 diabetes mellitus patients with influenza virus pneumonia based on the independent factors combined with the influence weight.The results of H-L test showed that the predicted death risk of type 2 diabetes mellitus patients with influenza virus pneumonia was in good agreement with the actual observed value(P>0.05).The ROC analysis results showed that the AUC of the nomogram prediction model was 0.894(95%CI 0.845-0.933).Conclusions The nomogram model based on glycosylated hemoglobin variation index,HOMA-βand fasting insulin can accurately predict the death risk of type 2 diabetes mellitus patients with influenza virus pneumonia.
作者
豆亚静
彭春霞
周亚光
刘亚楠
李松
Dou Yajing;Peng Chunxia;Zhou Yaguang;Liu Yanan;Li Song(Emergency Department,Civil Aviation General Hospital,Beijing 100123,China)
出处
《中国急救医学》
2025年第6期516-521,共6页
Chinese Journal of Critical Care Medicine
关键词
2型糖尿病
流感病毒性肺炎
糖化血红蛋白变异指数
胰岛细胞功能
Type 2 diabetes mellitus
Influenza virus pneumonia
Glycosylated hemoglobin variation index
Islet cell function
