基于血清LPS和1,3-β-D葡聚糖构建腹膜透析患者感染性腹膜炎发生风险预测模型OA
Construction of A Risk Prediction Model for Infectious Peritonitis in Peritoneal Dialysis Patients Based on Serum Lipopolysaccharide and 1,3-β-D Glucan
目的 构建基于血清脂多糖(LPS)、1,3-β-D葡聚糖(BG)的腹膜透析(PD)患者感染性腹膜炎发生的风险预测模型.方法 回顾性收集2023年6月至2024年5月淮安市第一人民医院收治的152例PD患者临床资料,根据患者1年内是否发生感染性腹膜炎分为腹膜炎组(42例)和非腹膜炎组(110例).比较两组患者一般资料及血清LPS、BG水平;并比较不同病原菌感染的感染性腹膜炎患者血清LPS、BG水平;采用多因素Logistic回归分析感染性腹膜炎发生的影响因素;构建列线图模型,并绘制校准曲线、受试者工作特征(ROC)曲线、决策曲线,分别验证模型校准度、预测价值及临床适用性.结果 腹膜炎组残余肾功能(RRF)、白蛋白(Alb)水平低于非腹膜炎组(P<0.05),血清铁蛋白(SF)、C反应蛋白(CRP)、LPS、BG水平高于非腹膜炎组(P<0.05);不同病原菌感染的感染性腹膜炎患者血清LPS、BG水平比较,差异无统计学意义(P>0.05).多因素Logistic回归分析显示,SF(OR=1.007,95%CI:1.001～1.013)、CRP(OR=1.110,95%CI:1.038～1.187)、LPS(OR=86.770,95%CI:1.280～5 880.902)、BG(OR=1.029,95%CI:1.008～1.051)水平升高是PD患者感染性腹膜炎发生的危险因素(P<0.05);RRF(OR=0.746,95%CI:0.570～0.975)、Alb(OR=0.885,95%CI:0.799～0.979)水平升高是PD患者发生感染性腹膜炎的保护因素(P<0.05),且调整混杂因素后,LPS、BG仍是PD患者感染性腹膜炎发生的独立危险因素,同时对上述变量进行多重共线性检验显示,各指标的方差膨胀因子值均<5,容差均>0.1,提示多重共线性可能性较低.基于血清LPS、BG构建的列线图模型显示,一致性指数=0.778(95%CI:0.706～0.850),列线图模型预测PD患者感染性腹膜炎发生的曲线下面积为0.814(95%CI:0.742～0.886);绘制决策曲线显示,最大净获益为0.223.结论 RRF、Alb、SF、CRP、LPS、BG是PD患者感染性腹膜炎发生的影响因素,据此构建的列线图模型对感染性腹膜炎有一定的预测价值.
Objective To construct a risk prediction model for infectious peritonitis in peritoneal dialysis(PD)patients based on serum lipopolysaccharide(LPS)and 1,3-β-D glucan(BG).Methods Clinical data of 152 PD patients admitted to Huaian First People's Hospital from June 2023 to May 2024 were retrospectively collected.According to the occurrence of infectious peritonitis within one year,patients were divided into a peritonitis group(42 cases)and a non-peritonitis group(110 cases).General data and serum levels of LPS and BG were compared between the two groups;serum LPS and BG levels were also compared among infectious peritonitis patients with different pathogenic infections.Multivariate logistic regression analysis was used to analyze influencing factors for infectious peritonitis.A nomogram model was constructed,and calibration curves,receiver operating characteristic curves,and decision curves were plotted to validate the model's calibration,predictive value,and clinical applicability,respectively.Results Residual renal function(RRF)and albumin(Alb)levels in the peritonitis group were lower than those in the non-peritonitis group(P<0.05),while serum ferritin(SF),C-reactive protein(CRP),LPS,and BG levels were higher than those in the non-peritonitis group(P<0.05).There was no statistically significant difference in serum LPS and BG levels among infectious peritonitis patients with different pathogenic infections(P>0.05).Multivariate logistic regression analysis showed that elevated levels of SF(OR=1.007,95%CI:1.001-1.013),CRP(OR=1.110,95%CI:1.038-1.187),LPS(OR=86.770,95%CI:1.280-5 880.902),and BG(OR=1.029,95%CI:1.008-1.051)were risk factors for infectious peritonitis in PD patients(P<0.05);high levels of RRF(OR=0.746,95%CI:0.570-0.975)and Alb(OR=0.885,95%CI:0.799-0.979)were protective factors against infectious peritonitis in PD patients(P<0.05).After adjusting for confounding factors,LPS and BG remained independent risk factors for infectious peritonitis in PD patients.Furthermore,multicollinearity testing on the aforementioned variables showed that the variance inflation factor for all indicators was<5 and tolerance was>0.1,suggesting a low possibility of multicollinearity.The nomogram model based on serum LPS and BG showed a concordance index of 0.778(95%CI:0.706-0.850).The area under the curve of the nomogram model for predicting infectious peritonitis in PD patients was 0.814(95%CI:0.742-0.886).The decision curve showed a maximum net benefit of 0.223.Conclusion RRF,Alb,SF,CRP,LPS,and BG are influencing factors for infectious peritonitis in PD patients.The nomogram model constructed based on these factors has certain predictive value for infectious peritonitis.
徐焱;陈敏;赵金文
淮安市第一人民医院肾内科,江苏 淮安 223300淮安市第一人民医院肾内科,江苏 淮安 223300淮安市第一人民医院肾内科,江苏 淮安 223300
腹膜透析感染性腹膜炎脂多糖1,3-β-D葡聚糖列线图
peritoneal dialysisinfectious peritonitislipopolysaccharide1,3-β-D glucannomogram
《转化医学杂志》 2026 (4)
547-553,7
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