文章摘要
李霄鹏,谢志敏,张润润,等.系统性红斑狼疮复发风险因素研究及预测模型的构建[J].浙江中医药大学学报,2024,48(4):420-428.
系统性红斑狼疮复发风险因素研究及预测模型的构建
Study on Risk Factors for Recurrence of SLE and the Construction of Predictive Model
DOI:10.16466/j.issn1005-5509.2024.04.006
中文关键词: 系统性红斑狼疮  复发  风险因素  预测模型  中西医结合  巢式病例对照研究
英文关键词: systemic lupus erythematosus  recurrence  risk factors  prediction model  combination of Chinese traditional and western medicine  nested case-control study
基金项目:国家自然科学基金面上项目(82074341);浙江省中医药现代化专项项目(2020ZX008);第二批国家中医临床研究基地建设项目(国中医药科技函﹝2018﹞131号)
作者单位
李霄鹏 浙江中医药大学附属第二医院 杭州 310005 
谢志敏 浙江中医药大学附属第二医院 杭州 310005 
张润润 浙江中医药大学第二临床医学院 
赵婷 浙江中医药大学第二临床医学院 
陆定其 浙江中医药大学第二临床医学院 
张旭峰 浙江中医药大学第二临床医学院 
杨科朋 浙江中医药大学附属第二医院 杭州 310005 
姚心怡 浙江中医药大学第二临床医学院 
朱鑫超 浙江中医药大学第二临床医学院 
包洁 浙江中医药大学基础医学院 
范永升 浙江中医药大学附属第二医院 杭州 310005 
王新昌 浙江中医药大学附属第二医院 杭州 310005 
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中文摘要:
      [目的] 通过多中心大样本资料,探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者病情稳定后复发的情况,探究影响SLE患者病情复发的因素,构建预测模型,为SLE的防治提供循证医学证据。[方法] 2020至2023年,从全国21家医院收集SLE患者1 209例,建立SLE列队研究人群。选择其中48例复发患者作为病例组,根据其年龄、性别分布情况,以1:2的比例从队列中选取96例未复发患者作为对照组。采用单因素及多因素Logistic 分析复发的相关因素,通过Logistic分析及列线图构建复发预测模型,并使用受试者工作特征(receiver operating characteristic,ROC)曲线、校准图及决策曲线分析(decision curve analysis,DCA)评估模型的准确性及适用性。[结果] 单因素分析显示,SLE病情活动指数(SLE disease activity index,SLEDAI)[优势比(odds ratio,OR)=2.40]、肾脏损伤(OR=2.39)、抗U1核糖核蛋白(U1 ribonucleoprotein,U1RNP)抗体(OR=2.90)、畏寒肢冷(OR=2.90)、腰膝酸软(OR=3.95)、治疗用药(OR=0.45)均为SLE复发的影响因素。多因素分析提示,SLEDAI评分≥10(P=0.002)、肾脏损伤(P=0.036)、抗U1RNP抗体阳性(P=0.047)、腰膝酸软(P=0.010)、畏寒肢冷(P=0.033)是影响SLE复发的危险因素。治疗用药使用中西医结合治疗(P=0.001)则是减少复发的有利因素。临床指标预测模型曲线下面积(area under curve,AUC)=0.699,中医因素模型AUC=0.679,中西医结合预测模型AUC=0.786。校准曲线及DCA证实三种模型均具有良好预测能力及适用性。其中中西医结合模型更具有优势。[结论] SLEDAI评分≥10、肾脏损伤、抗U1RNP抗体阳性、腰膝酸软、畏寒肢冷是SLE复发的主要危险因素,而中西医结合治疗是减少复发的有利因素。基于SLEDAI评分、肾脏损伤、抗U1RNP抗体、腰膝酸软、畏寒肢冷及治疗用药构建的预测模型具有良好的预测性及临床使用价值。
英文摘要:
      [Objective] To explore the recurrence of systemic lupus erythematosus(SLE) patients after stable condition through multicenter large sample data, explore the factors that affect the recurrence of SLE patients, construct predictive models and provide evidence-based medical evidence for the prevention and treatment of SLE. [Methods] From year 2020 to 2023,1 209 patients with SLE were collected from 30 hospitals across the country, and a cohort study population was established for the study of SLE. Forty-eight recurrent patients were selected as the case group, and 96 non-recurrent patients were selected as the control group in a ratio of 1:2 based on their ages and gender distribution. The survey content includesd general demographic characteristics, systemic lupus disease activity index(SLEDAI) score, traditional Chinese medicine syndrome score, Systemic Lupus International Collaborating Clinics/American College of Rheumatology(SLICC/ACR) damage index and Logistic analysis of single and multiple factors related to SLE recurrence Logistic analysis and column charts were used to construct a recurrence prediction model, and the accuracy and applicability of the model were evaluated using the receiver operating characteristic (ROC) curve calibration curve and decision curve analysis(DCA). [Results] Univariate analysis showed that SLEDAI score odds ratio(OR)=2.40, kidney injury(OR=2.39), anti U1 ribonucleoprotein(U1RNP) antibody(OR=2.90), chills and cold limbs(OR=2.90), waist and knee soreness(OR=3.95) and therapeutic medication(OR=0.45) were all influencing factors for SLE recurrence. Multivariate analysis suggested that SLEDAI score ≥10(P=0.002), kidney injury(P=0.036), positive anti U1RNP antibody (P=0.047), waist and knee soreness(P=0.010), and chills and cold limbs(P=0.033) were risk factors for SLE recurrence. The use of a combination of traditional Chinese and western medicine for treatment(P=0.001) was a favorable factor in reducing recurrence. The clinical indicator prediction model area under curve(AUC)=0.699, the traditional Chinese medicine factor model AUC=0.679, and the integrated Chinese and western medicine prediction model AUC=0.786. The calibration curve and DCA curve confirm that all three models had good predictive ability and applicability. The integrated model of traditional Chinese and western medicine had more advantages. [Conclusion] SLEDAI score ≥ 10, kidney injury, positive anti U1RNP antibody, weak waist and knees, and chills and cold limbs are the main risk factors for the recurrence of SLE. The combination of traditional Chinese and western medicine treatment is a favorable factor to reduce recurrence. The prediction model constructed based on SLEDAI score, kidney injury, anti U1RNP antibody, waist and knee soreness, chills and cold limbs and therapeutic drugs has good predictability and clinical value.
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