摘要
中国是结核病高发地区,结核病防治形势非常严峻,而耐多药结核(multidrug-resistant tuberculosis,MDR-TB)是结核病防控的重点及难点。为探讨耐多药肺结核发病的危险因素,并构建风险预测模型,本文研究采用病例对照研究,通过现场流行病学调查,探讨耐多药肺结核发病的危险因素;用logistic回归法筛选危险因素,构建风险预测模型;采用受试者的作业特征(received operating characteristic,ROC)曲线下面积来评估其预测效能,拟合优度(hosmer-lemeshow,H-L)检验评价拟合优度。经多因素分析表明,与药敏结核患者相比,男性耐多药患病风险是女性的4.366倍,P=0.002,95%置信区间(confidence interval,CI)1.732~11.004;与高中及以上相比,学历初中及以下的患病风险是13.627倍(P=0.008,95%CI 2.006~92.560);性格内向是保护因素,比值比(odds ratio,OR)=0.181,P=0.033,95%CI 0.037~0.872);每日肉类摄入小于150 g是大于150 g患病风险的3.804倍(P=0.001,95%CI 1.670~8.667)。联合预测因子ROC曲线下面积为0.790(95%CI0.710~0.870)。H-Lχ^(2)检验结果为χ^(2)=14.956,P=0.060。由此可见,男性、初中及以下学历、性格外向、肉类摄入少与耐多药结核病发病相关,联合预测因子模型预测价值较高。
China is a high incidence area of tuberculosis,and the situation of tuberculosis prevention and control is very serious,and multidrug-resistant tuberculosis(MDR-TB)is the focus and difficulty of tuberculosis prevention and control.In order to explore the risk factors of MDR-TB and build a risk prediction model,a case-control study was used to explore the risk factors of MDR-TB through field epidemiological investigation.Risk factors were screened by logistic regression,and risk prediction model was constructed.The area under ROC curve was used to evaluate the prediction efficiency,and H-L test was used to evaluate the goodness of fit.Multivariate analysis show that compare with drug sensitive TB patients,the risk of MDR in male is 4.366 times higher than that in female(P=0.002,95%CI 1.732~11.004).Compare with those in high school and above,the risk of disease in middle school and below is 13.627 times(P=0.008,95%CI 2.006~92.560).Introversion is a protective factor(OR=0.181,P=0.033,95%CI 0.037~0.872).The daily meat intake less than 150 g is 3.804 times the risk of higher than 150 g(P=0.001,95%CI 1.670~8.667).The area under the ROC curve of the joint predictor is 0.790(95%CI 0.710~0.870).The result of H-L test isχ^(2)=14.956,P=0.060.It can be seen that male,under middle school,extrovert and low meat intake are related to the incidence of MDR-TB,and the joint predictor model has a high predictive value.
作者
胡靖雯
张向荣
胡春梅
刘永福
郑以山
HU Jing-wen;ZHANG Xiang-rong;HU Chun-mei;LIU Yong-fu;ZHENG Yi-shan(School of Public Health,Nanjing Medical University,Nanjing 211166,China;Nanjing Public Health Medical Center,Nanjing 211100,China)
出处
《科学技术与工程》
北大核心
2023年第10期4111-4116,共6页
Science Technology and Engineering
基金
江苏省卫生健康委2021年度医学科研项目(M2021088)。
关键词
肺结核
耐多药
危险因素
ROC曲线分析
联合预测模型
tuberculosis
multi drug-resistant TB
risk factors
ROC curve analysis
joint prediction model
