摘要
目的探讨耐药肺结核患者发生抗结核药物不良反应的影响因素并构建风险预测模型。方法选取2021年1月至2024年1月本院结核病信息系统登记的108例耐药(耐多药及利福平耐药)肺结核患者,根据不良反应发生情况将其分为不良反应组(n=65)和无不良反应组(n=43)。采用单因素分析和多因素Logistic回归分析筛选与不良反应发生显著相关的因素,并基于这些因素构建Nomogram风险预测模型。通过受试者工作特征(ROC)曲线、校准曲线(H-L检验)及决策曲线分析(DCA)评估模型效能。结果肺结核病史、白蛋白水平、血尿酸水平是耐药肺结核患者发生抗结核药物不良反应的影响因素(P<0.05)。Nomogram风险预测模型的曲线下面积(AUC)为0.900,灵敏度和特异度分别为92.3%和74.4%;H-L检验结果显示,模型预测概率与实际观测结果无显著差异(P=0.625);DCA显示,当阈值概率为0.3~1.0时临床净获益高。结论肺结核病史、白蛋白、血尿酸水平是耐药肺结核患者抗结核药物不良反应发生的影响因素,依据上述影响因素构建的列线图模型能够较好预测耐药肺结核患者抗结核药物不良反应发生风险。
Objective To explore the influencing factors of adverse reactions of anti-tuberculosis drugs in patients with drug-resistant pulmonary tuberculosis and to construct a risk prediction model.Methods A total of 108 patients with drug-resistant(multidrug-resistant and rifampicin-resistant)pulmonary tuberculosis admitted in the tuberculosis information system of our hospital from January 2021 to January 2024 were selected.According to the occurrence of adverse reactions,the patients were divided into adverse reaction group(n=65)and non-adverse reaction group(n=43).Univariate analysis and multivariate Logistic regression analysis were used to screen the factors significantly related to the occurrence of adverse reactions,and a Nomogram risk prediction model was constructed based on these factors.The performance of the model was evaluated by receiver operating characteristic(ROC)curve,calibration curve(H-L test)and decision curve analysis(DCA).Results The history of pulmonary tuberculosis,albumin level and blood uric acid level were the influencing factors of adverse reactions of anti-tuberculosis drugs in patients with drug-resistant pulmonary tuberculosis(P<0.05).The area under the curve(AUC)of the Nomogram risk prediction model was 0.900,and the sensitivity and specificity were 92.3%and 74.4%,respectively;the H-L test results showed that there was no significant difference between the predicted probability of the model and the actual observation results(P=0.625);DCA showed that the net clinical benefit was high when the threshold probability was 0.3-1.0.Conclusion The history of pulmonary tuberculosis,albumin and blood uric acid levels are the influencing factors of adverse reactions of anti-tuberculosis drugs in patients with drug-resistant pulmonary tuberculosis.The nomogram model constructed based on the above influencing factors can better predict the risk of adverse reactions of anti-tuberculosis drugs in patients with drug-resistant pulmonary tuberculosis.
作者
李晓娟
卜裕
冯君兰
丘圆圆
阮玉英
曹赋
罗键
LI Xiaojuan;BU Yu;FENG Junlan;QIU Yuanyuan;RUAN Yuying;CAO Fu;LUO Jian(Red Cross Hospital of Yulin City,Yulin 537000,China)
出处
《临床医学研究与实践》
2026年第4期33-37,共5页
Clinical Research and Practice
基金
玉林市科学研究与技术开发计划项目(玉市科202235055)。
关键词
耐药肺结核
抗结核药物
不良反应
NOMOGRAM
drug-resistant pulmonary tuberculosis
anti-tuberculosis drug
adverse reaction
Nomogram
