摘要
目的分析慢性阻塞性肺疾病(COPD)患者气胸发生的独立危险因素,构建并验证COPD患者气胸风险预测模型。方法采用便利抽样法,选取2018年1月至2021年12月温州市中西医结合医院呼吸内科治疗的COPD患者500例进行病例对照研究,以胸部CT或X线胸片为诊断标准,根据是否发生气胸分为气胸组和对照组,以患者是否发生气胸为因变量,纳入的预测危险因素为自变量,将纳入的危险因素数据进行单因素logistic回归分析和多因素logistic回归分析,筛选出COPD患者发生气胸的独立影响因素,构建气胸风险预测模型并进行评价。用决策曲线分析法评估模型的临床实用性。结果500例COPD患者共计104例患者发生气胸,发生率为20.80%。二分类logistic回归分析结果显示,COPD病程长、C反应蛋白、机械通气是COPD患者气胸发生的独立危险因素;1秒钟用力呼气容积占预计值的百分比(FEV_(1)%)、FEV_(1)/用力肺活量(FVC)比值、血清白蛋白(ALB)是COPD患者气胸发生的保护因素。构建气胸风险预测模型,最终得到公式:Logit(P)=12.427+2.241×COPD病程+0.899×吸烟+7.715×C反应蛋白+0.208×机械通气史-0.514×ALB-0.243×FEV_(1)%-0.286FEV_(1)/FVC。受试者工作特征曲线分析显示,曲线下面积(AUC)是0.815,C-Index是0.781(95%CI:0.856~0.891),表明构建的COPD患者气胸风险预测模型能较好地区分气胸患者与非气胸患者。结论C反应蛋白、ALB、FEV_(1)%、FEV_(1)/FVC、吸烟、机械通气史是COPD患者气胸发生风险影响因素。据此成功构建COPD患者气胸发生的风险预测模型,模型具有良好的预测效果,可为医护人员采取预防性治疗和护理措施提供参考依据。
Objective To analyze the independent risk factors for pneumothorax in older adult patients with chronic obstructive pulmonary disease(COPD),construct and validate a prediction model of pneumothorax risk in patients with COPD.Methods A total of 500 patients with COPD who received treatment at the Department of Emergency,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2021 were selected using the convenience sampling method and included in this study.Chest CT scan or chest X-ray film findings were used as diagnostic criteria.These patients were divided into a pneumothorax group and a control group according to whether they developed pneumothorax.Taking whether patients develop pneumothorax as a dependent variable and predictive risk factors as independent variables,univariate and multivariate logistic regression analyses of the included risk factors were performed to identify the independent influential factors for developing pneumothorax in patients with COPD.Subsequently,a prediction model for predicting the risk of pneumothorax was constructed and evaluated.A decision curve analysis was conducted to evaluate its clinical practicality.Results Among 500 patients with COPD,104 developed pneumothorax,with an incidence of 20.80%.Binary logistic regression analysis showed that long duration of COPD,C-reactive protein,and mechanical ventilation were independent risk factors for the development of pneumothorax in these patients.The percentage of forced expiratory volume in one second(FEV_(1)%),the FEV_(1)/forced vital capacity ratio(FEV_(1)/FVC),and serum albumin are protective factors for the development of pneumothorax in patients with COPD.A prediction model for the risk of developing pneumothorax was constructed.Finally,we obtained the formula:Logit(P)=12.427+2.241×COPD duration+0.899×smoking+7.715×CRP+0.208×mechanical ventilation history-0.514×albumin-0.243×FEV_(1)%-0.286 FEV_(1)/FVC.Receiver operating characteristic curve analysis results showed that the
作者
周文
邵灿
谭洁
Zhou Wen;Shao Can;Tan Jie(Department of Emergency,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine,Wenzhou 325000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2024年第2期208-212,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省温州市基础性医疗卫生科研项目(Y20210859)。
关键词
肺疾病
慢性阻塞性
气胸
预测
呼吸功能试验
C反应蛋白质
尿素
人体质量指数
Pulmonary disease,chronic obstructive
Pneumothorax
Forecasting
Respiratory function tests
C-Reactive protein
Urea
Body mass index
