基于超声特征构建甲状腺髓样癌颈部淋巴结转移的预测模型

目的探讨基于超声特征构建的列线图在预测甲状腺髓样癌(MTC)颈部淋巴结(LN)转移中的应用价值。方法回顾性分析139例MTC患者的性别、年龄和超声影像资料。使用lasso回归和logistic回归分析筛选出颈部LN转移的危险因素,构建列线图预测模型。通过Bootstrap重采样进行内部验证。结果多灶、形态不规则、被膜受累以及超声提示LN转移被确定为危险因素。基于上述超声特征构建的预测LN转移风险列线图的C-index为0.894(95%CI:0.845～0.943),AUC为0.894。结论基于超声特征构建的列线图可作为一种简便、无创的量化工具预测MTC患者颈部LN转移的风险。     

预测维持性血液透析患者心血管事件发生风险列线图模型的建立

目的探讨维持性血液透析患者发生心血管事件的危险因素,并构建相应列线图模型。方法纳入2014年5月～2017年3月在温州市中西医结合医院行维持性血液透析治疗的229例终末期尿毒症患者,采用门诊或电话进行定期随访,每季度1次,随访终点为主要心血管疾病不良事件,根据COX多因素回归结果建立列线图模型。结果年龄≥60岁(HR=2.80;95%CI:1.56～5.01;P0.001)、心血管疾病史(HR=2.08;95%CI:1.07～4.07;P=0.032)、透析龄≥36月(HR=2.36;95%CI:1.25～4.44;P=0.008)以及QT间期离散度≥63 ms(HR=2.14;95%CI:1.20～3.82;P=0.010)是血液透析患者发生心血管事件的独立危险因素。该列线图模型初始C-index为0.719(95%CI:0.652～0.786),采用重复Bootstrap自抽样方法进行1000次内部验证后C-index为0.722(95%CI:0.656～0.788),且经Hosmer-Lemeshow检验该模型拥有良好的区分度和一致性(χ~2=8.124,P=0.632)。结论基于上述4个影响因素构建的列线图能较为准确预测维持性血液透析患者心血管事件发生风险。     

机械通气患者重症监护获得性肌无力的列线图模型建立

目的建立机械通气患者重症监护获得性肌无力(ICU-AW)风险列线图预测模型。方法选取2018年11月-2020年5月江苏大学附属医院入住ICU接受机械通气治疗患者353例为研究对象,其中发生ICU-AW的200例作为ICU-AW组,未发生ICU-AW的153例作为对照组,利用单因素和多因素Logistic回归筛选ICU-AW的独立危险因素。采用R软件包建立ICU-AW预测列线图,并对其预测效果进行评价。结果本次研究ICU-AW的发生率为43.34%。Logistic回归分析显示:年龄、APACHE II评分、血糖、是否使用神经阻滞药物、乳酸水平、机械通气时间是ICU-AW独立危险因素(P0.05)。纳入该6项独立危险因素建立列线图预测模型,经验证C-index为0.873(95%CI 0.837~0.910)。结论本研究基于患者临床资料和实验室检查结果构建的ICU-AW列线图模型具有良好的特异性和敏感性,值得临床推广应用。     

基于影像学和血清学特征构建的列线图模型可较好预测原发性肝细胞癌的微血管浸润

  目的   探讨术前基于影像学和血清学特征构建的列线图模型对肝癌微血管浸润(MVI)的预测价值。   方法   回顾性分析2015年1月~2020年12月于中山市人民医院接受切除或肝移植的548例肝细胞癌(HCC)患者的临床资料,最终纳入315例肝癌MVI患者,年龄53.2±11.5岁,肿瘤最大直径3.7~7.0 cm。收集患者临床及影像学资料并进行分析,采取单因素与多因素Logistic分析,筛查出能预测MVI的独立风险因素,构建预测HCC中MVI的列线图模型,利用ROC曲线、校准曲线和决策曲线对模型进行评估。   结果   MVI (+)患者的中位生存时间为13月(95%CI:8.1~17.9),1、3、5年无病生存率分别为50.6%、38.5%和30.9%(P < 0.05);MVI (-)患者的中位生存时间为47月(95%CI:32.7~61.3),1、3、5年无病生存率分别为77.9%、62.3%和38.8%(P < 0.05)。多因素Logistic回归分析显示,更大的肿瘤体积、突破肝外生长、缺乏或不完整假包膜、存在动脉期瘤周强化以及术前过高的球蛋白值是MVI (+)的独立危险因素(P < 0.05)。最终模型效能曲线下面积为0.895,95%CI为0.859-0.930,准确性为85.1%,敏感度为85.9%,特异性为84.1%。校准曲线显示预测概率与病理结果MVI (+)/MVI (-)概率有良好的一致性。决策曲线显示模型具有良好的临床应用价值。   结论   构建的列线图及预测模型能较好地术前预测MVI (+)的概率,可以根据MVI发生的风险调整HCC的治疗计划,以优化生存结果。      

直肠癌患者保肛术1年后发生重度低位前切除综合征列线图预测模型的构建

目的 探讨直肠癌患者保肛术1年后发生重度低位前切除综合征的危险因素,并构建预测模型。方法 回顾性收集安徽省某三级甲等医院接受直肠癌保肛术1年后的患者,采用一般资料调查表、低位前切除综合征评分进行调查。通过二分类Logistic回归模型分析相关危险因素,采用R语言绘制列线图,构建风险预测模型。结果 本研究共纳入319例患者,其中57例（17.9%）直肠癌患者在保肛术1年以后仍存在重度低位前切除综合征。Logistic回归分析结果显示,肿瘤距肛缘的距离、预防性造口、吻合口漏、术前放疗、术后放疗是直肠癌患者保肛术1年后重度低位前切除综合征发生的独立危险因素。基于回归分析结果构建列线图预测模型,C-index为0.849（95%CI:0.790~0.907）,ROC曲线下面积（AUC）为0.843（95%CI:0.784~0.901）,均显示该模型区分度较好,Brier得分和校正曲线均显示校准度较好,H-L检验（χ²=9.313,P=0.231）表明模型拟合度较好。结论 本研究构建的预测模型具有较好的预测效果,可直观、简便地甄别保肛术1年后仍存在重度低位前切除综合征的高危患者,为早期筛查和干预提供参考。     

颅脑手术患者全麻苏醒期发生低氧血症护理预警模型的建立与验证

目的构建个体化预测颅脑手术全麻苏醒期发生低氧血症的护理预警模型,并对模型的预测效能予以验证。方法分别选取2019年10月-2020年6月和2020年7月-2020年9月于我院行全麻下颅脑外科手术的患者作为训练集(n=119)和验证集(n=38),收集患者的临床资料,使用单因素和Logistic回归多因素分析训练集患者全麻苏醒期发生低氧血症的影响因素,并建立相关列线图模型。结果观察者的警觉性/镇静评估量表(OAA/S)评分BMI≥24、吸烟、高血压、气道不通畅、OAA/S评分≥3分和Riker躁动评分≥5分是颅脑手术全麻苏醒期发生低氧血症的危险因素(P<0.05)。依此建立预测颅脑手术全麻苏醒期发生低氧血症的护理预警模型,模型验证结果显示训练集和验证集的C-index分别为0.861和0.796,校正曲线均趋近于理想曲线,ROC曲线的AUC分别为0.875(95%CI 0.833~0.892)和0.826(95%CI 0.787~0.873),表明该模型具有良好的预测能力。结论颅脑手术全麻苏醒期发生低氧血症危险因素较多,基于风险因素构建的列线图护理模型能有效预警全麻苏醒期发生低氧血症的风险概率,对颅脑手术患者的临床护理具有一定的指导意义。     

颅脑手术患者全麻苏醒期发生低氧血症护理预警模型的建立与验证

目的构建个体化预测颅脑手术全麻苏醒期发生低氧血症的护理预警模型,并对模型的预测效能予以验证。方法分别选取2019年10月-2020年6月和2020年7月-2020年9月于我院行全麻下颅脑外科手术的患者作为训练集(n=119)和验证集(n=38),收集患者的临床资料,使用单因素和Logistic回归多因素分析训练集患者全麻苏醒期发生低氧血症的影响因素,并建立相关列线图模型。结果观察者的警觉性/镇静评估量表(OAA/S)评分BMI≥24、吸烟、高血压、气道不通畅、OAA/S评分≥3分和Riker躁动评分≥5分是颅脑手术全麻苏醒期发生低氧血症的危险因素(P<0.05)。依此建立预测颅脑手术全麻苏醒期发生低氧血症的护理预警模型,模型验证结果显示训练集和验证集的C-index分别为0.861和0.796,校正曲线均趋近于理想曲线,ROC曲线的AUC分别为0.875(95%CI 0.833~0.892)和0.826(95%CI 0.787~0.873),表明该模型具有良好的预测能力。结论颅脑手术全麻苏醒期发生低氧血症危险因素较多,基于风险因素构建的列线图护理模型能有效预警全麻苏醒期发生低氧血症的风险概率,对颅脑手术患者的临床护理具有一定的指导意义。     

呼吸科住院患者抗生素药物相关腹泻风险预测模型的构建及验证

目的 通过分析呼吸科住院患者抗生素药物相关腹泻的危险因素,建立并验证呼吸科住院患者抗生素药物相关腹泻风险的列线图模型。 方法 纳入2019年1月—9月于北京市某三级甲等医院呼吸科病房住院使用抗生素治疗的患者291例并收集临床资料。应用Logistic回归模型分析呼吸科住院患者抗生素药物相关腹泻的独立危险因素。应用R软件构建预测呼吸科住院患者抗生素药物相关腹泻风险的列线图模型,并进行验证。 结果 Logistic回归分析显示,大便潜血[OR=4.517,95%CI（1.440~14.163）]、体重指数[OR=0.834,95%CI（0.735~0.947）]、血红蛋白浓度[OR=0.970,95%CI（0.946~0.994）]、院前使用抗生素[OR=2.957,95%CI（1.076~8.130）]及使用抗生素种类[OR=2.148,95%CI（1.146~4.026）]是呼吸科住院患者抗生素药物相关腹泻的独立危险因素（P<0.05）。对列线图模型进行验证,ROC曲线显示该模型预测呼吸科住院患者抗生素药物相关腹泻的风险曲线下面积为0.779;校准曲线为斜率接近于1的直线,Hosmer-Lemeshow拟合优度检验（ χ²=1.413,P=0.994）均显示该模型能够较准确地预测呼吸科住院患者抗生素药物相关腹泻的风险。结论 该研究基于大便潜血、院前使用抗生素、体重指数、血红蛋白浓度、使用抗生素种类数这5项抗生素药物相关腹泻发生的独立危险因素,构建的列线图模型具有良好的区分度与准确度,可为临床个体化预测抗生素药物相关腹泻发生风险提供参考。     

个体化预测早期消化道肿瘤ESD术后迟发性出血风险的列线图模型的建立

目的探讨个体化预测早期消化道肿瘤患者内镜黏膜下剥离术(ESD)术后迟发性出血的风险因素,建立列线图模型,并提出护理对策。方法回顾性分析2017年12月—2019年12月因早期消化道肿瘤于泰州市人民医院行ESD治疗的236例患者资料,分别使用单因素和二分类Logistic回归分析术后发生迟发性出血的独立危险因素并建立列线图预测模型。结果长期使用抗血栓药物(OR=4.990)、活检次数≥3次(OR=7.834)、伴溃疡和瘢痕(OR=6.079)、病变直径≥3 cm(OR=5.316)、浸润至黏膜下层(OR=5.667)、术中明显出血(OR=5.745)及术者经验(OR=7.660)是早期消化道肿瘤患者ESD术后迟发性出血的独立危险因素(P<0.05)。基于以上7项独立危险因素建立相关列线图预测模型,并对该模型进行验证,H-L偏差度检验结果为χ²=3.753,P=0.663,C-index为0.907(95%置信区间0.877~0.937),说明列线图预测模型具有良好的精准度和区分度。结论长期使用抗血栓药物、活检次数≥3次、伴溃疡和瘢痕、病变直径≥3 cm、浸润至黏膜下层、术中明显出血及手术者不熟练是早期消化道肿瘤患者ESD术后迟发性出血的独立危险因素,建立的列线图模型具有准确的预测能力和区分度,有利于护理人员筛查高风险患者并制订相关护理对策。     

胃癌病人化疗所致恶心呕吐危险因素分析及列线图预测模型构建

目的:了解胃癌病人化疗所致恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)的危险因素,建立并验证列线图预测模型。方法:选取2019年4月—2020年12月福建省肿瘤医院的189例胃癌化疗病人作为研究对象。采用单因素分析和多因素Logistic回归筛选CINV的独立危险因素,建立列线图风险预测模型并验证模型的预测效能。结果:共有37.6%病人出现CINV。单因素分析表明年龄、性别、饮酒史、晕动症史、化疗次数与CINV有关(P<0.05)。多因素Logistic回归分析表明年龄、性别、饮酒史、晕动症史、化疗次数是CINV的独立危险因素(P<0.05)。构建列线图的ROC曲线下面积为0.759(95%CI[0.688,0.830]),C指数为0.776(95%CI[0.704,0.849]),Calibration校准曲线显示模拟曲线和实际曲线一致性良好。结论:年龄、性别、饮酒史、晕动症史、化疗次数是胃癌化疗病人CINV的独立预测因子,构建的列线图预测模型具有良好的预测价值,为临床医护人员制定个体化的管理方案提供重要的参考。     

非瓣膜性心房颤动患者左心房血栓或自发性显影影响因素分析

目的 探讨非瓣膜性心房颤动(房颤)患者左心房血栓或自发性显影的影响因素。方法 连续入选非瓣 膜性房颤患者130例,进行CHA2DS2-VASc评分,并记录性别、年龄、伴发疾病、化验指标、超声心动图结果等基线资 料。根据食管超声结果分为左心房血栓或自发性显影阳性组和阴性组,比较两组各项指标的差异。Logistic多因素 分析确定左心房血栓或自发性显影的独立危险因素。通过受试者工作特征性曲线(ROC)判断CHA2DS2-VASc评 分、左心房内径(LAD)、左心耳排空速率及左心耳充盈速率对左心房血栓或自发性显影的预测价值。结果 LAD、左 心室舒张末内径(LVEDD)、左心室射血分数(LVEF)、持续性房颤、既往脑卒中或短暂性脑缺血发作(TIA)史、体质量 指数(BMI)、CHA2DS2-VASc评分、左心耳排空速率、左心耳充盈速率在两组间差异有统计学意义(P <0.05)。多因 素回归显示,LAD>40.0mm(P <0.01)、左心耳排空速率<54.15cm/s(P <0.01)、BMI≥25(P <0.01)与非瓣膜 性房颤患者左心房血栓或自发性显影独立相关。LAD 的ROC 曲线下面积为0.845(95%CI=0.776~0.913,P < 0.01);左心耳排空速率的ROC曲线下面积分别为0.851(95%CI =0.781~0.921,P <0.01)。结论 左心房内径> 40.0mm、左心耳排空速率<54.15cm/s是非瓣膜性房颤患者左心房血栓或自发性显影的独立危险因素。     

Distribution of thromboembolism in valvular versus non-valvular atrial fibrillation

The most feared consequence of atrial fibrillation (AF) is thromboembolism, either to the brain causing stroke or to the non-cerebral circulation. Valvular atrial fibrillation (VAF) and non-valvular atrial fibrillation (NVAF) differ not only by morphological substrate of arrhythmia but also by the rate of thromboembolic complications, predisposing factors and destination of embolism. In the setting of VAF, there is a higher risk of thromboembolism and a higher prevalence of thrombus location within the body of the left atrium compared to NVAF. VAF is also associated with a proportionally higher propensity for non-cerebral thromboemboli than in NVAF. The distribution of non-cerebral thromboemboli appears to be similar in VAF and NVAF; however, more research needs to be done in this area, particularly with regard to VAF.     

Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women

OBJECTIVE: To evaluate the contribution of left atrial (LA) volume in predicting atrial fibrillation (AF). PATIENTS AND METHODS: In this retrospective cohort study, a random sample of 2200 adults was identified from all Olmsted County, Minnesota, residents who had undergone transthoracic echocardiographic assessment between 1990 and 1998 and were 65 years of age or older at the time of examination, were in sinus rhythm, and had no history of AF or other atrial arrhythmias, stroke, pacemaker, congenital heart disease, or valve surgery. The LA volume was measured off-line by using a biplane area-length method. Clinical characteristics and the outcome event of incident AF were determined by retrospective review of medical records. Echocardiographic data were retrieved from the laboratory database. From this cohort, 1655 patients in whom LA size data were available were followed from baseline echocardiogram until development of AF or death. The clinical and echocardiographic associations of AF, especially with respect to the role of LA volume in predicting AF, were determined. RESULTS: A total of 666 men and 989 women, mean +/- SD age of 75.2 +/- 7.3 years (range, 65-105 years), were followed for a mean +/- SD of 3.97 +/- 2.75 years (range, < 1.00-10.78 years); 189 (11.4%) developed AF. Cox model 5-year cumulative risks of AF by quartiles of LA volume were 3%, 12%, 15%, and 26%, respectively. With Cox proportional hazards multivariate models, logarithmic LA volume was an independent predictor of AF, incremental to clinical risk factors. After adjusting for age, sex, valvular heart disease, and hypertension, a 30% larger LA volume was associated with a 43% greater risk of AF, incremental to history of congestive heart failure (hazard ratio [HR], 1.887; 95% confidence interval [CI], 1.230-2.895; P = .004), myocardial infarction (HR, 1.751; 95% CI, 1.189-2.577; P = .004), and diabetes (HR, 1.734; 95% CI, 1.066-2.819; P = .03). Left atrial volume remained incremental to combined clinical risk factors and M-mode LA dimension for prediction of AF (P < .001). CONCLUSION: This study showed that a larger LA volume was associated with a higher risk of AF in older patients. The predictive value of LA volume was incremental to that of clinical risk profile and conventional M-mode LA dimension.     

The prognostic significance of atrial arrhythmias recorded early after cardioversion for atrial fibrillation

In a substantial number of patients, AF recurs after successful electrical cardioversion. The purpose of this study was to investigate if the atrial arrhythmias recorded immediately after cardioversion are associated with the risk of recurrence of the arrhythmia and to compare the prognostic significance of this parameter with that of other established risk factors. In a series of 71 patients, the risk factors for recurrence of AF during the first year after successful electrical cardioversion were analyzed. A new parameter that was investigated was the frequency of atrial premature beats and the presence of runs of supraventricular tachycardia in the Holter recording started immediately after the cardioversion. Age, left atrial size, left ventricular systolic function, duration of the arrhythmia before cardioversion, underlying cardiac disease, or medication taken were not found to be predictive of recurrence of the arrhythmia. However, the natural logarithm of the number of atrial premature complexes per hour of the Holter recording in the 37 patients in whom AF recurred was higher compared to that of the 34 patients who maintained sinus rhythm (P < 0.0005). The same was true if only the first 6 hours of the recording were analyzed (P < 0.0005). There was a trend for more frequent arrhythmia recurrence if runs of supraventricular tachycardia were present. The finding of > 10 atrial premature complexes per hour in the recording had a relative risk of 2.57 (1.51-4.37), a positive predictive accuracy of 76.5%, and a negative predictive accuracy of 70.3% for subsequent arrhythmia recurrence. We can conclude that frequent (> 10/hour) atrial premature complexes in the Holter recording after electrical cardioversion for AF is a significant risk factor for recurrence of the arrhythmia.     

Detecting nonvalvular atrial fibrillation and anticoagulant therapy in cardioembolic ischemic stroke

Nonvalvular Atrial fibrillation (NVAF) is the most common cardiac arrhythmia associated with an increase in risk of stroke and systemic thromboembolism. Strokes related to AF are associated with higher mortality, greater disability, longer hospital stays, and lower chance of being discharged home. The present review will focus on the current status of detecting NVAF and stroke prevention when there is AF. The CHA2DS2-VASc risk stratification scheme is discussed for the identification of patients who are at risk for thromboembolic stroke related to NVAF. Patient with a CHA2DS2-VASc score of 2 or greater are candidates for warfarin or a novel oral anticoagulant, irrespective of whether the strategy is for rate or rhythm control. Finally, guidelines and landmark clinical trials in NVAF patients with primary or secondary stroke prevention are discussed.     

A novel predictive model for late recurrence after catheter ablation for atrial fibrillation using left appendage volume measured by cardiac computed tomography

Larger left atrial appendage (LAA) volume is associated with a higher risk of late recurrence (LR) in patients undergoing radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, it is unclear whether LAA volume predicts LR, independent of established risk factors. We sought to evaluate the value of LAA volume in predicting LR after RFCA for AF and to develop a score prediction model including LAA volume for these patients. We retrospectively studied 992 patients who underwent RFCA for AF and cardiac computed tomography before RFCA at a single center. At 3 years after RFCA, 362 patients (36.5?%) experienced recurrence. The multivariate Cox regression model showed that age?≥?75 years (10 points), non-paroxysmal AF (9 points), diabetes mellitus (4 points), left atrial volume index (1 point per 10 ml/m² rounded to the nearest integer), and the second (4.7 to < 7 ml/m²; 4 points) and third (≥?7 ml/m²; 5 points) tertiles of the LAA volume index were independent risk factors LR. The above-mentioned risk factors were included in the integrated score model, and the C-index of the proposed score model was 0.715 (95?% confidence interval [CI] 0.679–0.752). LAA volume is an independent predictor of LR and the predictive model including LAA volume showed good discrimination power. These findings provide evidence for the inclusion of LAA volume in the risk stratification for AF recurrence in patients undergoing RFCA for AF.

     

Left atrial volume computed by 3D rotational angiography best predicts atrial fibrillation recurrence after circumferential pulmonary vein isolation

Left atrium (LA) size is a well-studied predictor of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Yet, there is still little agreement on the best imaging technique to size the LA, and on the most appropriate sizing parameter. Volumetric assessment of LA with three-dimensional rotational angiography (3DRA LA volume index) might be a valid alternative to the commonly used transthoracic echocardiography (TTE LA volume index). The aim of our study was to investigate whether LA volume by 3DRA at the time of PVI is able to predict the risk of atrial fibrillation recurrence. We analysed 352 consecutive patients with symptomatic paroxysmal or persistent atrial fibrillation referred for PVI to our Institution. In all patients, LA volume index (LAVI) was assessed by TTE and by 3DRA. Sinus rhythm was restored after PVI in 348 patients (99%). Average TTE-LAVI and 3DRA-LAVI were 37?±?12 and 83?±?18 ml/m2, respectively. At a median follow-up of 19 (12, 24) months, 27% of patients had AF recurrence after the first PVI. At the univariate analysis, persistent AF (p?<?0.01), use of anti-arrhythmic drugs (AAD) (p?<?0.05) and 3DRA-LAVI (p?<?0.01) were significantly associated with AF recurrence. In contrast, none of the echocardiographic parameters considered, including TTE-LAVI, was associated with AF recurrence (p?=?0.29). At the multivariate analysis, 3DRA-LAVI was the only independent predictor for AF recurrence (HR 1.01 [1.00–1.03], p?=?0.017). Left atrial volume measured with 3DRA is superior to TTE assessment and to AF history in predicting atrial fibrillation recurrence after PVI.     

急性胰腺炎患者合并感染性胰腺坏死的影响因素及其列线图模型构建

目的观察急性胰腺炎(AP)患者合并感染性胰腺坏死(IPN)的影响因素,并构建列线图模型。方法制定纳入及排除标准,回顾性分析长江船运总医院2015年1月至2021年1月收治的516例AP患者的临床资料,用于建模及内部验证;按照同样标准,从Dryad数据知识库中筛选独立的AP患者1062例,回顾性分析患者资料,用于外部验证。记录患者基线资料,记录内部验证组患者住院期间IPN发生情况,将患者分为合并IPN组与未合并IPN组,采用Logistic回归分析检验AP患者合并IPN的影响因素,应用R语言建立预测AP患者合并IPN的列线图模型,采用Bootstrap法进行模型验证,计算一致性指数(C-index),检验模型准确性;并探讨列线图模型对AP患者发生IPN的预测效能。结果内部验证组516例AP患者,103例发生IPN,413例未发生IPN。初步比较合并IPN组与未合并IPN组基线资料后,经Logistic回归分析结果显示,急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)高、降钙素原(PCT)及脂肪酶(LPS)水平高、合并胰腺外感染、合并低氧血症及合并多器官功能衰竭是AP患者发生IPN的危险因素(OR>1,P<0.05);应用抗生素是AP患者发生IPN的保护因素(OR<1,P<0.05)。建立预测AP患者发生IPN的列线图模型,使用Bootstrap内部验证法对预测AP患者发生IPN的列线图模型进行验证,校准曲线和Y=X直线相近,模型校准度良好,C-index值为0.814,说明模型具有良好的区分度。对列线图模型进行内部验证,绘制ROC曲线发现,列线图模型预测AP患者IPN发生风险的AUC>0.80,有一定预测价值;对列线图模型进行外部验证,绘制ROC曲线发现,列线图模型预测AP患者IPN发生风险的AUC>0.90,有高预测价值。结论AP患者发生IPN受APACHEⅡ评分、PCT、LPS、合并胰腺外感染、合并低氧血症、合并多器官功能衰竭、机械通气及应用抗生素影响,基于多种因素建立列线图模型,可为临床合理预测AP患者IPN发生风险提供有效手段。