高脂血症性急性胰腺炎继发感染性胰腺坏死列线图预测模型构建及评估

相龙; 王春宇; 雷冉; 杜星驰; 张以诺; 张海涛; 姜洪池; 孙备; 谭宏涛

doi:10.19538/j.cjps.issn1005-2208.2026.04.21

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中国实用外科杂志 ›› 2026, Vol. 46 ›› Issue (4) : 510-515. DOI: 10.19538/j.cjps.issn1005-2208.2026.04.21

论著

高脂血症性急性胰腺炎继发感染性胰腺坏死列线图预测模型构建及评估

作者信息 +

Construction and evaluation a nomogram model for predicting secondary infected pancreatic necrosis of hypertriglyceridemic acute pancreatitis

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文章历史 +

摘要

目的探讨高脂血症性急性胰腺炎（HTG-AP）进展为感染性胰腺坏死（IPN）的危险因素，并建立早期可视化的多指标预测模型。方法回顾性分析2019年9月至2024年12月哈尔滨医科大学附属第一医院普外科收治的119例HTG-AP病人的临床资料，依据是否确诊 IPN 分为 IPN 组（38例）与非IPN 组（81例）。通过单因素分析及多因素Logistic回归筛选HTG-AP继发IPN的独立危险因素并以此构建列线图预测模型，用受试者工作曲线（ROC）、校准曲线与临床决策曲线评价模型的效能。结果 IPN组与非IPN组在白蛋白、血清总钙、血尿素氮（BUN）、降钙素原（PCT）、凝血酶原活动度（PTA）、高密度脂蛋白胆固醇（HDL-C）、D-二聚体、入院72 h内发生持续性器官功能障碍（POF）、平均动脉压、胸腔积液方面的差异有统计学意义（P<0.05）。多因素Logistic回归分析结果表明，入院72 h内发生POF（OR=4.110，95%CI 1.128-14.971，P=0.032）、PCT升高（OR=1.120，95%CI 1.005-1.248，P=0.041）、PTA降低（OR=0.946，95%CI 0.897-0.997，P=0.039）、D-二聚体升高（OR=1.148 ，95%CI 1.046-1.260，P=0.004）是HTG-AP继发IPN的独立危险因素。所建立的预测模型的ROC曲线下面积为0.895（95%CI 0.834-0.957），提示该模型具有较高的预测价值。结论基于PCT、PTA、D-二聚体与入院72 h内发生POF建立的列线图模型可在早期预测HTG-AP病人进展为IPN的风险，辅助早期识别高危病人。

Abstract

Objective To investigate the prognostic factors infecting pancreatic necrosis (IPN) secondary to hypertriglyceridemic acute pancreatitis (HTG-AP) and to establish the multiple visualized model of IPN in HTG-AP patients. Methods The clinical data of 119 HTG-AP patients who received treatment at the Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, between September 2019 and December 2024, was retrospectively analyzed. These patients were categorized into IPN group (38 cases) and non-IPN group (81 cases) based on whether IPN occurred. Univariate analysis was initially conducted to identify potential prognostic factors, followed by multivariate logistic regression analysis to determine independent predictors of IPN in HTG-AP. Nomogram model for IPN in HTG-AP patients were established based on independent prognostic factors. Receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used to test the effectiveness of the nomogram model. Results The differences in albumin, calcium, blood urea nitrogen (BUN), procalcitonin (PCT), prothrombin time activity (PTA), high density lipoprotein cholesterol (HDL-C), D-dimer, persistent organ failure (POF) within 72 hours, mean arterial pressure and pleural effusion between the IPN group and non-IPN group were statistically significant (P<0.05). Multivariate logistic regression analysis showed that diagnosed POF within 72 hours of admission (OR=4.110, 95%CI 1.128-14.971, P=0.032), elevation of PCT(OR=1.120, 95%CI 1.005-1.248, P=0.041), declining of PTA (OR=0.946, 95%CI 0.897-0.997, P=0.039) and elevation of D-Dimer (OR=1.148, 95%CI 1.046-1.260, P=0.004), were independent risk factors of IPN in HTG-AP patients. The AUC of this nomogram model was 0.895 (95%CI 0.834-0.957) which demonstrated good calibration and discrimination. Conclusion The nomogram incorporating PCT, PTA, D-Dimer, and POF within 72 hours can early and reliably predict IPN in HTG-AP patients, which could assist surgeons in early identification of high-risk patients.

导出引用

相龙, 王春宇, 雷冉, 等. 高脂血症性急性胰腺炎继发感染性胰腺坏死列线图预测模型构建及评估[J]. 中国实用外科杂志. 2026, 46(4): 510-515 https://doi.org/10.19538/j.cjps.issn1005-2208.2026.04.21

XIANG Long, WANG Chun-yu, LEI Ran, et al. Construction and evaluation a nomogram model for predicting secondary infected pancreatic necrosis of hypertriglyceridemic acute pancreatitis[J]. Chinese Journal of Practical Surgery. 2026, 46(4): 510-515 https://doi.org/10.19538/j.cjps.issn1005-2208.2026.04.21

中图分类号： R6

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