倾向性评分匹配法分析慢性阻塞性肺疾病合并肺结核的危险因素及预测模型构建

doi:10.19983/j.issn.2096-8493.2024121

摘要/Abstract

摘要：

目的: 探讨基于倾向性评分分析慢性阻塞性肺疾病(COPD)合并肺结核的危险因素及预测模型。方法: 选取2020年7月至2023年7月保定市人民医院收治的150例COPD合并肺结核患者作为观察组,并选择保定市人民医院同期收治的100例单纯COPD患者作为对照组。搜集可能影响COPD合并肺结核的相关因素,采用倾向性评分匹配法对患者性别、年龄、居住地进行匹配,匹配比例为1∶2。应用单因素和多因素logistic回归分析,筛选出影响COPD患者合并肺结核的独立危险因素,并根据危险因素的回归系数得到危险权重构建预测模型,通过绘制受试者工作特征(ROC)曲线,以曲线下面积评估预测模型的价值。结果: 多因素logistic回归分析结果显示,吸烟史(OR=2.038,95%CI:1.119~3.713)、未接种卡介苗(OR=1.714,95%CI:1.283~2.291)、结核病病史(OR=2.795,95%CI:1.723~4.536)、吸入糖皮质激素(OR=2.083,95%CI:1.367~3.175)、粉尘接触史(OR=2.109,95%CI:1.333~3.336)、营养不良(OR=2.815,95%CI:1.755~4.515)均是COPD合并肺结核的独立危险因素。ROC曲线结果显示,预测模型对预测COPD合并肺结核的曲线下面积为0.811(95%CI:0.762~0.894),此时敏感度和特异度分别为80.67%和73.59%。结论: 基于倾向性评分匹配法分析的结果,吸烟史、未接种卡介苗、结核病病史、吸入糖皮质激素、粉尘接触史、营养不良均是COPD合并肺结核的独立危险因素,根据以上危险因素构建的预测模型对预测COPD合并肺结核具有较好的预测价值。

关键词: 肺疾病, 阻塞性, 结核, 肺, 危险因素, 预测, 模型, 结构

Abstract:

Objective: To investigate risk factors and develop a prediction model for chronic obstructive pulmonary disease (COPD) combined with pulmonary tuberculosis (PTB) using propensity score analysis. Methods: A total of 150 patients with COPD and PTB admitted to the Baoding People’s Hospital from July 2020 to July 2023 were selected as observation group, and 100 patients with only COPD admitted to the hospital during the same period were selected as control group. Relevant factors that might affect COPD combined with PTB were collected, and propensity score matching method was used to match gender, age, and place of residence of the patients, with a matching ratio of 1∶2. Univariable and multivariable logistic regression analysis was used to screen out independent risk factors affecting COPD combing PTB, and risk weights were obtained according to regression coefficients of risk factors to construct a prediction model, and then a ROC curve was drawn, and the value of the prediction model was evaluated by area under the curve (AUC). Results: Multivariable logistic regression analysis revealed that a history of smoking (OR=2.038, 95%CI: 1.119-3.713), lack of BCG vaccination (OR=1.714, 95%CI: 1.283-2.291), tuberculosis history (OR=2.795, 95%CI: 1.723-4.536), use of inhaled glucocorticoids (OR=2.083, 95%CI: 1.367-3.175), dust exposure (OR=2.109, 95%CI: 1.333-3.336), and poor nutritional status (OR=2.815, 95%CI: 1.755-4.515) were independent risk factors for COPD combined with PTB. AUC of ROC curve for the prediction model was 0.811 (95%CI: 0.762-0.894), with a sensitivity and specificity of 80.67% and 73.59%, respectively. Conclusion: Propensity score matching analysis indicates that a history of smoking, lack of BCG vaccination, tuberculosis history, use of inhaled glucocorticoids, dust exposure, and poor nutritional status are independent risk factors for COPD combined with PTB. The prediction model constructed based on these risk factors demonstrates a good prediction value for COPD combined with PTB.

Key words: Lung diseases, obstructive, Tuberculosis, pulmonary, Risk factors, Forecasting, Models, structural

中图分类号:

R521

刘芳, 马金彤, 刘永梅, 罗培培, 冯洋, 刘振龙, 王玉红. 倾向性评分匹配法分析慢性阻塞性肺疾病合并肺结核的危险因素及预测模型构建[J]. 结核与肺部疾病杂志, 2024, 5(6): 511-516. doi: 10.19983/j.issn.2096-8493.2024121

Liu Fang, Ma Jintong, Liu Yongmei, Luo Peipei, Feng Yang, Liu Zhenlong, Wang Yuhong. Analysis of risk factors of chronic obstructive pulmonary disease complicated with pulmonary tuberculosis with tendency score matching method and construction of a prediction model[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(6): 511-516. doi: 10.19983/j.issn.2096-8493.2024121

图/表 3

表1

慢性阻塞性肺疾病合并肺结核影响因素的单因素分析

因素	观察组(150例)	对照组(100例)	统计检验值	P值
性别[例,构成比(%)]			χ²=2.400	0.121
男性	81(54.00)	44(44.00)
女性	69(46.00)	56(56.00)
年龄组[例,构成比(%)]			χ²=0.600	0.439
≥60岁	78(52.00)	47(47.00)
<60岁	72(48.00)	53(53.00)
体质量指数[例,构成比(%)]			χ²=1.667	0.197
≥24	70(46.67)	55(55.00)
<24	80(53.33)	45(45.00)
吸烟史[例,构成比(%)]			χ²=5.400	0.020
是	84(56.00)	41(41.00)
否	66(44.00)	59(59.00)
饮酒史[例,构成比(%)]			χ²=9.600	0.002
是	87(58.00)	38(38.00)
否	63(42.00)	62(62.00)
居住地[例,构成比(%)]			χ²=1.667	0.197
农村	80(53.33)	45(45.00)
城市	70(46.67)	55(55.00)
文化程度[例,构成比(%)]			χ²=1.067	0.302
初中及以下	71(47.33)	54(54.00)
高中及以上	79(52.67)	46(46.00)
婚姻状况[例,构成比(%)]			χ²=0.267	0.606
已婚	73(48.67)	52(52.00)
未婚	77(51.33)	48(48.00)
卡介苗接种史[例,构成比(%)]			χ²=17.067	0.000
是	59(39.33)	66(66.00)
否	91(60.67)	34(34.00)
结核病病史[例,构成比(%)]			χ²=6.667	0.010
是	85(56.67)	40(40.00)
否	65(43.33)	60(60.00)
吸入糖皮质激素[例,构成比(%)]			χ²=15.000	0.020
是	90(60.00)	35(35.00)
否	60(40.00)	65(65.00)
粉尘接触史[例,构成比(%)]			χ²=8.067	0.005
是	86(57.33)	39(39.00)
否	64(42.67)	61(61.00)
营养状况[例,构成比(%)]			χ²=5.400	0.020
营养不良	84(56.00)	41(41.00)
营养正常	66(44.00)	59(59.00)
结核分枝杆菌暴露史[例,构成比(%)]			χ²=5.154	0.023
是	68(45.33)	31(31.00)
否	82(54.67)	69(69.00)
FEV₁/FVC(%,$\bar{x}\pm s$)	58.19±18.95	53.85±16.97	t=1.849	0.066
CAT评分(分,$\bar{x}\pm s$)	16.15±5.74	14.92±4.21	t=1.952	0.052
mMRC评分(分,$\bar{x}\pm s$)	2.13±0.69	1.98±0.56	t=1.888	0.060
被传染史[例,构成比(%)]			χ²=4.620	0.032
是	52(34.67)	22(22.00)
否	98(65.33)	78(78.00)

表1

表2

慢性阻塞性肺疾病合并肺结核影响因素的多因素logistic回归分析

因素	赋值	β值	$s x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
吸烟史	1=是,0=否	0.712	0.306	5.414	0.020	2.038	1.119~3.713
饮酒史	1=是,0=否	0.425	0.239	3.162	0.075	1.530	0.957~2.444
卡介苗接种史	1=否,0=是	0.539	0.148	13.263	0.000	1.714	1.283~2.291
结核病病史	1=是,0=否	1.024	0.247	17.322	0.000	2.795	1.723~4.536
吸入糖皮质激素	1=是,0=否	0.732	0.215	11.655	0.001	2.083	1.367~3.175
粉尘接触史	1=是,0=否	0.746	0.234	10.164	0.001	2.109	1.333~3.336
营养状况	1=营养不良, 0=营养正常	1.035	0.241	18.444	0.000	2.815	1.755~4.515
结核分枝杆菌暴露史	1=是,0=否	0.823	0.425	3.750	0.053	2.277	0.990~5.238
被传染史	1=是,0=否	0.749	0.389	3.707	0.054	2.115	0.987~4.533
常数项	-	―0.540	0.222	5.917	0.015	-	-

表2

图1

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