摘要
目的探讨血清N末端B型利钠肽原(NT-ProBNP)、D-二聚体(D-D)、降钙素原(PCT)水平对慢性阻塞性肺疾病(COPD)急性加重期患者并发Ⅱ型急性呼吸衰竭的预测价值,并构建Nomogram模型。方法回顾性分析2023年3月~2023年12月于安徽省蒙城县第一人民医院接受治疗的380例COPD急性加重期患者作为训练集进行研究,根据其是否并发Ⅱ型急性呼吸衰竭分为呼吸衰竭组和非呼吸衰竭组,分析两组患者的一般资料和检验指标,对其进行危险因素分析并构建Nomogram模型。根据验证集与训练集3∶7的比例,选取2024年1月~2024年7月于本院接受治疗的163例COPD急性加重期患者对模型进行内部验证。结果训练集380例患者中并发Ⅱ型急性呼吸衰竭124例,发生率为32.63%。多因素logistic回归分析显示,年龄、1年内急性发作次数、第1秒用力呼气容积占预计值的百分比、慢性健康状况评分系统Ⅱ评分、慢性阻塞性肺疾病全球倡议分级、白细胞计数、C反应蛋白、NT-ProBNP、D-D、PCT水平是COPD急性加重期患者并发Ⅱ型急性呼吸衰竭的危险因素(P<0.05)。Hosmer-Lemeshow(H-L)验证显示,拟合优度较好,(χ^(2)=4.861,P=0.805),采用受试者工作特征(ROC)曲线的线下面积(AUC)为0.915(95%CI=0.885~0.945,P<0.05),灵敏度为0.879,特异度为0.844。模型校准图的校准曲线贴近标准曲线,提示该模型一致性较好。验证集H-L检验结果显示,拟合优度较好,(χ^(2)=4.360,P=0.823),预测模型的AUC为0.898(95%CI=0.865~0.931,P<0.05),灵敏度为0.855,特异度为0.801。结论本研究基于血清NT-ProBNP、D-D、PCT水平构建的COPD急性加重期患者并发Ⅱ型急性呼吸衰竭的Nomogram模型有较好预测价值,可为临床上早期识别高风险患者提供参考,减少Ⅱ型急性呼吸衰竭的发生。
Objective To investigate the predictive value of serum N-terminal pro-B-type natriuretic peptide(NT-ProBNP),D-dimer(D-D),and procalcitonin(PCT)levels for the occurrence of type II acute respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD),and to construct a nomogram prediction model.Methods A retrospective analysis was performed of 380 patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)who were treated in our hospital from March 2023 to December 2023 was conducted as the training set.These patients were used as the training set.They were divided into a respiratory failure group and a non-respiratory failure group according to whether they developed type Ⅱ acute respiratory failure.The general data and test indicators of the two groups of patients were analyzed,risk factor analysis was carried out,and a Nomogram model was constructed.The validation set,according to a 3∶7 ratio with the training set,selected 163 patients with acute exacerbation of COPD who were treated in our hospital from January 2024 to July 2024 for internal validation of the model.Results Among the 380 patients in the training set,124 cases developed type Ⅱ acute respiratory failure,with an incidence rate of 32.63%.Multivariate Logistic regression analysis showed that age,the number of acute exacerbations within 1 year,the percentage of forced expiratory volume in the first second as a percentage of the predicted value,the Chronic Health Evaluation Ⅱ(CHE Ⅱ)score,the Global Initiative for Chronic Obstructive Lung Disease(GOLD)grade,white blood cell count,C-reactive protein,NT-ProBNP,D-D,and PCT levels were risk factors for type Ⅱ acute respiratory failure in patients with acute exacerbation of COPD(P<0.05).The Hosmer-Lemeshow(H-L)test showed thatχ^(2)=4.861 and P=0.805.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was 0.915(95%CI=0.885~0.945,P<0.05),with a sensitivity of 0.879 and a specificity of 0.844.The calibration curve of the model calibration plot was close to the standard curve,indicating good consistency of the model.The results of the H-L test in the validation set showed that χ^(2)=4.360 and P=0.823.The AUC of the prediction model was 0.898(95%CI=0.865~0.931,P<0.05),with a sensitivity of 0.855 and a specificity of 0.801.Conclusion The Nomogram model based on serum NT-ProBNP,D-D and PCT levels has good predictive value for type Ⅱ acute respiratory failure in AECOPD patients,potentially aiding early clinical identification of high-risk individuals and reducing complications.
作者
王苗苗
孔方
何志君
Wang Miaomiao;Kong Fang;He Zhijun(Department of Laboratory Medicine,First People's Hospital of Mengcheng County,Bozhou 233500,China)
出处
《中华保健医学杂志》
2025年第3期405-410,共6页
Chinese Journal of Health Care and Medicine
基金
安徽省重点研究与开发计划项目(202106a05031396)。
