早期类风湿关节炎短期复发风险的列线图预测模型开发与评估-现代医学

早期类风湿关节炎短期复发风险的列线图预测模型开发与评估

单位：宁德师范学院附属宁德市医院骨一科, 福建宁德 352100

分类号：R593.22

出版年·卷·期（页码）：2022·50·第五期（608-612）

摘要：

目的：分析影响早期类风湿关节炎短期复发的因素，构建列线图预测模型并进行评估。方法：选取在我院接受治疗的早期类风湿关节炎患者289例，收集患者资料，以多因素Logistic回归分析影响早期类风湿关节炎患者短期复发的危险因素，以此为基础使用R软件构建列线图预测模型，并使用H-L拟合度检验及受试者工作特性曲线（ROC）曲线下面积评估模型准确性及区分度。结果：对纳入的患者进行为期1年的随访，结果显示共73例患者出现复发情况，占25.26%；单因素分析显示，抗环状瓜氨酸肽（CCP）、红细胞沉降率（ESR）、骨素（OPG）、核因子κB受体活化因子配体（RANKL）、基质金属蛋白酶9（MMP9）水平及滑膜炎总评分为影响早期类风湿关节炎患者短期复发的危险因素（P<0.05），与性别、年龄、身体质量指数、身高、病程、C反应蛋白（CRP）、类风湿因子（RF）水平、关节疼痛视觉模拟评分法（VAS）评分等因素无关（P>0.05）；根据单因素分析结果行多因素Logistic回归分析，结果显示，高水平的CCP、MMP9及滑膜炎总评分较高为影响早期类风湿性关节炎短期复发的独立危险因素（P<0.05）；基于多因素分析结果使用R软件构建早期类风湿关节炎患者短期复发的列线图预测模型，并以H-L拟合度检验及ROC曲线下面积进行验证，结果显示，H-L拟合度检验校准曲线与实际曲线具有较好的重合度，（χ²=3.123，P=0.214）；ROC曲线下面积为0.928（特异性为71.3，敏感性为97.3），提示该模型具有较高的区分度。结论：高水平的CCP、MMP9及滑膜炎总评分较高为影响早期类风湿关节炎短期复发的独立危险因素，所构建早期类风湿关节炎患者短期复发的列线图预测模型具有较好的区分度及准确度，可用于临床预测早期类风湿关节炎短期复发风险。

Objective:To analyze the short-term risk factors of early rheumatoid arthritis recurrence, to construct a nomogram prediction model and to evaluate its value. Methods:A total of 289 patients with early rheumatoid arthritis treated in our hospital were selected as study subjects and their clinical data were collected. Multivariate logistic regression was used to analyze the risk factors that affected the short-term recurrence of patients with early rheumatoid arthritis. Based on the results, R software was used to construct a nomogram prediction model, and the H-L fit test and the area under the receiver operator characteristic curves(ROC) were used to evaluate the accuracy and discrimination of the model. Results:All the subjects were followed up for one year, and the recurrence was found in 73 cases, accounting for 25.26%. Univariate analysis showed that cyclic citrullinated peptide(CCP), erythrocyte sedimentation rate(ESR), osteoprotegerin(OPG), receptor activator of nuclear factor κB ligand(RANKL), matrix metallopeptidase 9(MMP9) levels and total synovitis score were the risk factors affecting the short-term recurrence(P<0.05), but the gender, age, body mass index, height, course of disease, C-reactive protein(CRP), rheumatoid factor(RF) level and visual analogue scale(VAS) score were not related to the short-term recurrence(P>0.05). Multivariate logistic regression analysis was performed based on the results of univariate analysis, and the results showed that high-level of CCP, MMP9 and high total synovitis score were independent risk factors of short-term recurrence(P<0.05). Based on the results of multivariate analysis, the R software was used to construct a nomogram prediction model for the short-term recurrence of early rheumatoid arthritis, and the H-L fit test and the area under the ROC curve were used for verification. The results showed that the H-L fit test calibration curve was in coincidence with the actual curve(χ²=3.123, P=0.214). The area under the ROC curve was 0.928, and the specificity and the sensitivity were 71.3 and 97.3 respectively, indicating that the model had a high degree of discrimination. Conclusion:The high levels of CCP, MMP9 and high total synovitis score are independent risk factors affecting the short-term recurrence of early rheumatoid arthritis. The constructed nomogram prediction model for the short-term recurrence of early rheumatoid arthritis has good discrimination accuracy, and can be used to clinically predict the short-term risk of early rheumatoid arthritis recurrence.

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