恙虫病个体化治疗的临床预测模型
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摘要
目的探讨恙虫病不同临床转归的临床特征,及重症恙虫病发生的预测因素。方法回顾性分析恙虫病383例,对比不同临床转归的差异并对各因素进行多因素Lasso回归分析。利用各个危险因素构建ROC曲线和诺模图,并对模型进行评估。结果重症恙虫病组谷草转氨酶(AST)、白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、肌酐(CRE)、白细胞计数(WBC)、中性粒细胞比值(NEUT)、单核细胞比值(MONO)和非重症恙虫病组比较差异均有统计学意义(P均<0.05)。Lasso回归分析显示,从发病到多西环素开始使用的时间间隔、谷丙转氨酶(ALT)、ALB、球蛋白(GLO)、TBIL、CRE、血小板(PLT)、淋巴细胞比值(LYMPH)、MONO等为重症恙虫病组发生的预测因素。在这些因素构建的ROC预测曲线中,CRE和PLT的AUC分布为0.800和0.724。这些因素综合构建的ROC曲线AUC值最高,为0.931。并且,由它们构建的诺模图可量化预测发生恙虫病加重情况的可能性。结论 ALT、ALB、TBIL、DBIL、CRE、WBC、NEUT、MONO有预警恙虫病病情加重发生的价值,且本研究所构建的诺模图可量化评估恙虫病的病情。
Objective To explore the clinical characteristics of different clinical outcomes of tsutsugamushi disease and its predictive factors. Methods 383 patients with tsutsugamushi disease were analyzed retrospectively. The difference of different clinical outcomes between the two groups was analyzed,and Lasso regression analysis was carried out on relevant indexes. ROC curves were constructed using various risk factors,and nomograph was constructed using these factors.Finally,the model was evaluated and verified. Results The laboratory indexes of tsutsugamushi disease patients in the two groups,such as aspartate transaminase(AST),albumin(ALB),total bilirubin(TBIL),direct bilirubin(DBIL),creatinine(CRE),white blood cell count(WBC)and neutrophil ratio(NEUT),had obvious differences,and the differences were statistically significant(P<0.05). Lasso regression analysis showed that DAY(Time interval from onset of tsutsugamushi disease to onset of doxycycline use),alanine transaminase(ALT),ALB,globulin(GLO),TBIL,CRE,PLT,LYMPH and MONO were predictors of tsutsugamushi disease. In the ROC prediction curve constructed by these factors,the AUC distributions of CRE,PLT were 0.8 and 0.724,respectively. The AUC value of ROC curve constructed by these factors was the highest,which was 0.931. Moreover,the nomogram constructed by them could quantitatively predict the possibility of tsutsugamushi disease exacerbation. Conclusion ALT,ALB,TBIL,DBIL,CRE,WBC,NEUT,MONO had the value of early warning of tsutsugamushi disease exacerbation. And the nomogram constructed could quantitatively evaluate the condition of tsutsugamushi disease.
Objective To explore the clinical characteristics of different clinical outcomes of tsutsugamushi disease and its predictive factors. Methods 383 patients with tsutsugamushi disease were analyzed retrospectively. The difference of different clinical outcomes between the two groups was analyzed,and Lasso regression analysis was carried out on relevant indexes. ROC curves were constructed using various risk factors,and nomograph was constructed using these factors.Finally,the model was evaluated and verified. Results The laboratory indexes of tsutsugamushi disease patients in the two groups,such as aspartate transaminase(AST),albumin(ALB),total bilirubin(TBIL),direct bilirubin(DBIL),creatinine(CRE),white blood cell count(WBC)and neutrophil ratio(NEUT),had obvious differences,and the differences were statistically significant(P<0.05). Lasso regression analysis showed that DAY(Time interval from onset of tsutsugamushi disease to onset of doxycycline use),alanine transaminase(ALT),ALB,globulin(GLO),TBIL,CRE,PLT,LYMPH and MONO were predictors of tsutsugamushi disease. In the ROC prediction curve constructed by these factors,the AUC distributions of CRE,PLT were 0.8 and 0.724,respectively. The AUC value of ROC curve constructed by these factors was the highest,which was 0.931. Moreover,the nomogram constructed by them could quantitatively predict the possibility of tsutsugamushi disease exacerbation. Conclusion ALT,ALB,TBIL,DBIL,CRE,WBC,NEUT,MONO had the value of early warning of tsutsugamushi disease exacerbation. And the nomogram constructed could quantitatively evaluate the condition of tsutsugamushi disease.
引文
[1]Wu YC,Qian Q,Magalhaes RJ,et al.Rapid increase inscrub typhus incidence in mainland China,2006-2014[J].Am J Trop Med Hyg,2016,94(3):532-536.
[2]吴翠萍,曹显刚,赵利.恙虫病的特殊临床类型[J].传染病信息,2010,23(1):58-61.
[3]吴欣华,王万仲.AIDS合并恙虫病误诊1例[J].传染病信息,2011,24(3):181-182.
[4]李兰娟,任红.传染病学[M].第8版.北京:人民卫生出版社,2013.
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[6]Park SW,Lee CS,Chi KL,et al.Severity predictors in escharpositive scrub typhus and role of serum osteopontin[J].Am JTrop Med Hyg,2011,85(5):924-930.
[7]Venkategowda PM,Rao SM,Mutkule DP,et al.Scrub typhus:clinical spectrum and outcome[J].Indian J Crit Care Med,2015,19(4):208-213.
[8]Chrispal A,Boorugu H,Gopinath KG,et al.Scrub typhus:an unrecognized threat in South India-clinical profile and predictors of mortality[J].Trop Doct,2010,40(3):129-133.
[9]Griffith M,Peter JV,Karthik G,et al.Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission[J].Indian J Crit Care Med,2014,18(8):497-502.
[10]孙明,汪东亮,赵春云,等.宿迁地区32例恙虫病临床特征分析[J].中国血吸虫病防治杂志,2013,25(6):639-641.
[11]廖云珍,叶晓光,罗润齐.恙虫病误诊原因分析[J].广东医学,2010,31(4):488-490.
[12]杨松,张耀亭,邱跃灵.58例恙虫病并发肺部感染的流行病学及临床分析[J].临床肺科杂志,2016,21(8):1439-1442.
[13]Subbalaxmi MV,Madisetty MK,Prasad AK,et al.Outbreak of scrub typhus in Andhra Pradesh-experience at a tertiary care hospital[J].J Assoc Physicians India,2014,62(6):490-496.
[14]张彦,张学武,胡国启,等.以嗜酸粒细胞减少为主要特征的117例恙虫病报告[J].中华传染病杂志,2014,32(6):330-333.
[15]Sriwongpan P,Krittigamas P,Kantipong P,et al.Clinical indicators for severe prognosis of scrub typhus[J].Risk Manag Healthc Policy,2013,6:43-49.
[16]薛聃,魏琼英,林琼.恙虫病患者血清降钙素原水平的变化及其临床意义[J].中华传染病杂志,2015,33(3):166-167.
[17]Peter JV,Karthik G,Ramakrishna K,et al.Elevated procalcitonin is associated with increased mortality in patients with scrub typhus infection needing intensive care admission[J].Indian J Crit Care Med,2013,17(3):174-177.2019-03-05
[2]吴翠萍,曹显刚,赵利.恙虫病的特殊临床类型[J].传染病信息,2010,23(1):58-61.
[3]吴欣华,王万仲.AIDS合并恙虫病误诊1例[J].传染病信息,2011,24(3):181-182.
[4]李兰娟,任红.传染病学[M].第8版.北京:人民卫生出版社,2013.
[5]卢鹤云.小儿恙虫病104例临床分析[J].中国医疗前沿,2011,6(11):39-40.
[6]Park SW,Lee CS,Chi KL,et al.Severity predictors in escharpositive scrub typhus and role of serum osteopontin[J].Am JTrop Med Hyg,2011,85(5):924-930.
[7]Venkategowda PM,Rao SM,Mutkule DP,et al.Scrub typhus:clinical spectrum and outcome[J].Indian J Crit Care Med,2015,19(4):208-213.
[8]Chrispal A,Boorugu H,Gopinath KG,et al.Scrub typhus:an unrecognized threat in South India-clinical profile and predictors of mortality[J].Trop Doct,2010,40(3):129-133.
[9]Griffith M,Peter JV,Karthik G,et al.Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission[J].Indian J Crit Care Med,2014,18(8):497-502.
[10]孙明,汪东亮,赵春云,等.宿迁地区32例恙虫病临床特征分析[J].中国血吸虫病防治杂志,2013,25(6):639-641.
[11]廖云珍,叶晓光,罗润齐.恙虫病误诊原因分析[J].广东医学,2010,31(4):488-490.
[12]杨松,张耀亭,邱跃灵.58例恙虫病并发肺部感染的流行病学及临床分析[J].临床肺科杂志,2016,21(8):1439-1442.
[13]Subbalaxmi MV,Madisetty MK,Prasad AK,et al.Outbreak of scrub typhus in Andhra Pradesh-experience at a tertiary care hospital[J].J Assoc Physicians India,2014,62(6):490-496.
[14]张彦,张学武,胡国启,等.以嗜酸粒细胞减少为主要特征的117例恙虫病报告[J].中华传染病杂志,2014,32(6):330-333.
[15]Sriwongpan P,Krittigamas P,Kantipong P,et al.Clinical indicators for severe prognosis of scrub typhus[J].Risk Manag Healthc Policy,2013,6:43-49.
[16]薛聃,魏琼英,林琼.恙虫病患者血清降钙素原水平的变化及其临床意义[J].中华传染病杂志,2015,33(3):166-167.
[17]Peter JV,Karthik G,Ramakrishna K,et al.Elevated procalcitonin is associated with increased mortality in patients with scrub typhus infection needing intensive care admission[J].Indian J Crit Care Med,2013,17(3):174-177.2019-03-05